Donald G. Mitchell MD, Presenter: Nothing to Disclose

Bradley Snyder MS, Abstract Co-Author: Nothing to Disclose

Gillian Thomas MD, Abstract Co-Author: Nothing to Disclose

Caroline Reinhold MD, Abstract Co-Author: Medical Director, Synarc, Inc

Fergus Vincent Coakley MD, Abstract Co-Author: Nothing to Disclose

Lawrence Howard Schwartz MD, Abstract Co-Author: Research Consultant, General Electric Company Research Consultant, Schering AG (Berlex Inc)

Marco A. Amendola MD, Abstract Co-Author: Nothing to Disclose

Paula Jean Woodward MD, Abstract Co-Author: Nothing to Disclose

Harpreet Kaur Pannu MD, Abstract Co-Author: Nothing to Disclose

Hedvig Hricak MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To explore the likelihood of finding occult lymph node metastases at lymphadenectomy in women with early invasive cervical carcinoma, based on findings of physical examination, MRI, CT, and radical hysterectomy specimens.

A 25-center ACRIN/GOG collaborative study (NCI grant #s U01 CA079778 & U01 CA080098) enrolled 208 patients with biopsy-proven invasive cervical cancer who had clinical staging, MRI and CT prior to attempted surgical cure by radical hysterectomy. Each imaging study was interpreted prospectively by onsite radiologists, blinded to all other data, measuring tumor diameter and rating likelihood of cervical uterine body involvement. Hysterectomy specimens were examined to determine tumor diameters and uterine involvement. Lymphatic metastases within hysterectomy and lymphadenectomy tissue were categorized as none, low pelvic (not involving common iliac or above), or retroperitoneal (common iliac and/or para-aortic). A logistic regression model was used to calculate odds ratios of physical examination, MRI, CT or hysterectomy specimen for predicting lymphadenopathy based on uterine involvement (confidence 5 of 5 for imaging) and tumor diameters.

Surgical material was adequate in 161 women, 55 of whom (34%) had occult lymphatic metastases (21 retroperitoneal, 34 low pelvis). Odds ratios for nodal metastases at diameter threshold 4 cm were significant for MRI (3.6; 95% CI: 1.2, 10.2) and clinical examination (3.1; 95% CI: 1.0, 9.0), but not for CT or hysterectomy specimen at any threshold. Odds ratios for retroperitoneal nodal metastases based on uterine involvement were significant for MRI (11.0; 95% CI: 3.5, 34.6), CT (6.0; 95% CI: 1.2, 29.1), and hysterectomy specimen (8.7; 95% CI: 2.1, 36.0), but not for clinical examination (3.6; 95% CI: 0.3, 41.0).

Tumor size and uterine involvement affected the odds of retroperitoneal lymphadenopathy more if MRI, rather than clinical examination, CT, or hysterectomy specimen, were used for these determinations.

Tumor size and uterine involvement affected the odds of retroperitoneal lymphadenopathy more if MRI, rather than clinical examination, CT, or hysterectomy specimen, were used for these determinations.

Mitchell, D, Snyder, B, Thomas, G, Reinhold, C, Coakley, F, Schwartz, L, Amendola, M, Woodward, P, Pannu, H, Hricak, H, et al, , Early Invasive Cervical Cancer: MRI and CT Predictors of Occult Lymphatic Metastases in the ACRIN 6651/GOG 183 Intergroup Study.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4429420.html