Riccardo Manfredi MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Aim of the study is to asses the ability of MR imaging in assessing depth of cervical stromal invasion, vaginal infiltration, and presence of enlarged lymph nodes in patients with localized cervical carcinoma (stage Ia-IIa), compared to surgico-pathologic findings. Methods and Materials: 43 patients (mean age 47.6 years) were included in this prospective study. 19/43 (44%) patients had type 3 radical hysterectomy according to Piver, 14/43 (33%) patients had type 2, 7/43 (16%) patients had type 4 and 3/43 (7%) patients had type 1. Pelvic lymphadenectomy was performed in 43/43 (100%) patients; 12/43 patients underwent also para-aortic lymphadenectomy. At histology 34/43 (79%) tumors were squamous cell carcinomas, 5/43 (12%) tumors were adenocarcinomas and 4/43 (9%) tumors were adenosquamous carcinoma. At surgicopathologic examination 36/43 (84%) had stage Ib cervical cancer, 4/43 (9%) had Ia and 3/43 (7%) had IIa. Axial T1-WI, and axial, sagittal and coronal T2-WI were obtained. Qualitative image analysis included: infiltration of the cervical stroma (depth of neoplastic infiltration was classified as <50% or >50%), infiltration of the vaginal fornices, presence of enlarged pelvic and paraortic lymph nodes. Quantitative image analysis included: size of the tumor, 3D tumor volume and size of enlarged lymph nodes according to the 2 cut-off values: 0.5 and 1 cm along the minimal axial diameter. Sensitivity, specificity, and diagnostic accuracy were calculated for infiltration of the vaginal fornices and lymph node assessment. Results: The entity of the infiltration of the cervical stroma, detected on MR images, was concordant to the histo-pathologic results in 31/43 (72%), was underestimated in 10/43 (23%) patients and overestimated in 2/43 (5%) patients. In the assessment of vaginal infiltration, MR imaging reported an overall sensitivity, specificity, diagnostic accuracy and positive/negative predicting values of 66%, 92%, 90%, 40%, and 97% respectively. In the assessment of lymph nodes status, MR imaging reported an overall sensitivity, specificity, diagnostic accuracy and positive/negative predicting values of 37%, 100%, 88%, 100%, and 87% respectively for cut-off value of 1 cm and 37%, 83%, 74%, 33%, and 85% for cut-off value of 0.5 cm. The mean maximal tumor diameter was 2.6 cm. The mean tumor volume was 1.34 cc (range 0.2-19.50 cc). Conclusion: MR imaging is accurate in assessing stromal and vaginal infiltration; very difficult is detecting metastatic lymph nodes.       Questions about this event email: rmanfredi@rm.unicatt.it

Manfredi MD, R, Loco-Regional Staging of Localized Cervical Cancer (Stage IA-IIA): Role of MR Imaging in Treatment Planning.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3106537.html