Garry Choy MD, Presenter: Nothing to Disclose

Pari Pandharipande MD, Abstract Co-Author: Nothing to Disclose

Marcela G. Del Carmen MD, Abstract Co-Author: Nothing to Disclose

G. Scott Gazelle MD, PhD, Abstract Co-Author: Consultant, Elbit Medical Imaging Ltd (InSightec - Image Guided Treatment Ltd)

Anthony Russell MD, Abstract Co-Author: Nothing to Disclose

Susanna In-Sun Lee MD, PhD, Abstract Co-Author: Nothing to Disclose

To assess survival benefit conferred by three imaging-based staging strategies for clinically operable cervical cancer relative to manual pelvic examination alone.

We developed a decision-analytic model to predict survival in women with clinically operable cervical cancer (FIGO Stage Ib) who undergo pre-operative imaging with: MRI, PET CT, both MRI & PET CT, or manual examination alone. The model incorporates: prevalence of parametrial extension and lymph node involvement, imaging sensitivity/specificity, treatment (surgery and chemoradiation (with and without extended fields)) and treatment fatalities. Staging strategies affect outcomes via treatment choice. Survival estimates for each strategy were compared. Sensitivity analysis evaluated impact of varied test performance characteristics and therapeutic effectiveness upon survival.

Survival estimates were similar for all strategies. PET CT yielded the highest 5-year survival (91.872%), followed by surgery (91.867%), combined MRI-PET CT (91.801%), and MRI (91.697%). For a 48yo woman (median age in U.S. of cervical cancer diagnosis), projected life expectancy was 24.942, 24.938, 24.879, and 24.786 yrs, respectively. Results of reduced life expectancy with MRI-based strategies were driven by clinical consequences of low MRI sensitivity for detection of pelvic lymph node involvement. Specifically, when parametrial extension was detected at MRI, patients underwent chemoradiation alone; failure to identify lymph node involvement and treat with extended radiation fields decreased long-term survival. At PET CT, patients with undetected lymph node involvement underwent surgery, affording the opportunity to detect lymph node involvement and thereby reduce mortality. Results were also sensitive to other parameters of imaging test performance and therapeutic effectiveness.

PET CT for staging clinically operable cervical cancer confers a minimal long-term survival benefit, whereas MRI-based strategies may not due to adverse clinical consequences of false-negative results.

Pre-operative staging with PET CT for clinically operable cervical cancer confers a minimal long-term survival benefit, whereas MRI strategies may not.

Choy, G, Pandharipande, P, Del Carmen, M, Gazelle, G, Russell, A, Lee, S, Pelvic MRI and PET CT for Staging Clinically Operable Cervical Cancer: A Decision Analysis to Assess Survival Implications.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008351.html