Preoperative imaging in patients undergoing trachelectomy for cervical cancer: validation of a combined T2- and diffusion-weighted endovaginal MRI technique at 3.0 T.
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Date
2014-05-01ICR Author
Author
Downey, K
Shepherd, JH
Attygalle, AD
Hazell, S
Morgan, VA
Giles, SL
Ind, TEJ
Desouza, NM
Type
Journal Article
Metadata
Show full item recordAbstract
AIM: The aim of this study is to validate high-resolution endovaginal T2- and diffusion-weighted MRI measurements (tumour size, volume and length of uninvolved cervical canal) against histology in patients undergoing trachelectomy. PATIENTS/INTERVENTIONS: 55 consecutive patients 25-44 years with cervical cancer being considered for trachelectomy were prospectively assessed with endovaginal T2-W and diffusion-weighted MRI. Two independent observers blinded to histology recorded maximum tumour dimension, volume and distance from the superior aspect of the tumour to the internal os. Following trachelectomy, pathologist-outlined tumour sections were photographed with a set scale and similar measurements were recorded. RESULTS: Fifteen of 45 patients subsequently treated with fertility-sparing surgery had residual tumour (median histological volume: 0.28 cm(3), IQR=0.14-1.06 cm(3)). Sensitivity, specificity, positive and negative predictive values for detecting tumour: Observer 1: 86.7%, 80.0%, 68.4%, and 92.3%, respectively; Observer 2: 86.7%, 90.0%, 81.0%, and 93.1%, respectively. Size and volume correlated between observers (r=0.96, 0.84, respectively, p<0.0001). Size correlated between each observer and histology (observer 1 r=0.91, p<0.0001; observer 2 r=0.93, p<0.0001), volume did not (observer 1: r=0.08, p=0.6; observer 2: r=0.21, p=0.16); however, differences between observer measurements and histology were not significant (size p=0.09, volume p=0.15). Differences between MRI and histology estimates of endocervical canal length were not significant (p=0.1 both observers). CONCLUSION: In subcentimetre cervical cancers, endovaginal MRI correlates with pathology and is invaluable in assessing patients for fertility-sparing surgery.
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Subject
Cervix Uteri
Humans
Carcinoma
Magnetic Resonance Imaging
Diffusion Magnetic Resonance Imaging
Preoperative Care
Hysterectomy
Tumor Burden
Sensitivity and Specificity
Cohort Studies
Adult
Uterine Cervical Neoplasms
Female
Organ Sparing Treatments
Fertility Preservation
Research team
Magnetic Resonance
Language
eng
Date accepted
2014-02-20
License start date
2014-05
Citation
Gynecologic oncology, 2014, 133 (2), pp. 326 - 332
Publisher
ACADEMIC PRESS INC ELSEVIER SCIENCE