Early Invasive Cervical Cancer: CT and MR Imaging in Preoperative Evaluation—ACRIN/GOG Comparative Study of Diagnostic Performance and Interobserver Variability1

Johns Hopkins University, Baltimore, Maryland, United States
Radiology (Impact Factor: 6.21). 12/2007; 245(2):491-8. DOI: 10.1148/radiol.2452061983
Source: PubMed

ABSTRACT To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard.
This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage > or = IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P < or = .05 considered to indicate a significant difference). Descriptive statistics for staging and kappa statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard.
For CT and MR imaging, respectively, multirater kappa values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (> or =IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P < .001) and detection of parametrial invasion (P = .047).
Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.

Download full-text


Available from: Bradley S. Snyder, Apr 01, 2014
1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Die Klassifikation der Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) hält weiterhin am klinischen Staging des Zervixkarzinoms fest. Zur Vermeidung von Unter- und Übertherapie sollten folgende Parameter vor Erstellung eines Behandlungskonzepts bekannt sein: der Befall pelviner Lymphknoten, der Befall paraaortaler Lymphknoten, die intraabdominelle Aussaat sowie die histologische Bestätigung von Infiltration in die Nachbarorgane. In der Primärbehandlung des Zervixkarzinoms stehen die radikale Operation für frühe Stadien und die kombinierte Radiochemotherapie für lokal fortgeschrittene Stadien zur Verfügung. Ergebnisse von mehreren prospektiv-randomisierten Studien definierten Ende der 90er Jahre des vorigen Jahrhunderts den Standard der Radiochemotherapie und lösten die alleinige Bestrahlung sowohl in der Primärtherapie als auch in der adjuvanten Therapie ab. Es existieren bisher keine Daten, dass die neoadjuvante Radiochemotherapie das Gesamtüberleben der Patientinnen im Vergleich zur Operation bzw. primären Radiochemotherapie verbessern kann. Eine standardmäßige sekundäre Hysterektomie nach lege artis durchgeführter Radiochemotherapie ist nicht indiziert und gefährdet potenziell die Patientin. Mögliche radiogene Nebenwirkungen manifestieren sich in Akutreaktionen, Spätnebenwirkungen und einem erhöhten Risiko für Sekundärmalignome. Abstract The classification of the Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) still adheres to the clinical staging of cervical cancer. To avoid undertreatment and overtreatment the following parameters for establishing a treatment concept should be known: infiltration of pelvic and para-aortic lymph nodes, intra-abdominal metastases and histological confirmation of infiltration in adjacent organs. The primary treatment of cervical cancer consists of radical surgery and combined radiochemotherapy. Results from several prospective randomized studies towards the end of the 1990s defined the standard of radiochemotherapy which replaced radiation alone in primary therapy as well as in adjuvant therapy. No data currently exist that neoadjuvant radiochemotherapy can improve total survival of patients in comparison to surgery or primary radiochemotherapy. A standardized secondary hysterectomy following radiochemotherapy according to the current state of the art is not indicated and potentially endangers the patient. Possible radiogenic side effects are manifested as acute reactions, delayed side effects and an increased risk for secondary malignancies.
    Der Onkologe 01/2012; 18(1):47-55. DOI:10.1007/s00761-011-2179-5 · 0.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high-dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD2) with planned HRCTV doses of 75 to 85 Gy. From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P<.01) and clinical response at 3 months (P<.01). Among the adenocarcinoma subset, receiving HRCTV D90 EQD2 ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. This study constitutes one of the largest reported series of MRI-guided brachytherapy in North America, demonstrating excellent local control with acceptable morbidity. Dose escalation may be warranted when feasible for adenocarcinomas to offset the risk of local failure. Copyright © 2015 Elsevier Inc. All rights reserved.
    International journal of radiation oncology, biology, physics 03/2015; 91(3):540-7. DOI:10.1016/j.ijrobp.2014.10.053 · 4.18 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Magnetic resonance imaging (MRI) represents the reference imaging modality for image guided adaptive brachytherapy (IGABT) of cervix cancer. Accurate interpretation of pre-treatment MRI is required for proper understanding of the tumor extent and topography at IGABT. Planning and optimal timing of the application begins already before treatment, and may need to be adapted during external beam irradiation (EBRT) according to additional clinical and/or radiological findings. The level of MRI utilization in IGABT depends on the infrastructural capabilities of individual centers, ranging from no use at all to repetitive imaging during EBRT and each IGABT fraction. In this article, we summarize the role of different imaging modalities and practical aspects of MRI interpretation in cervix cancer IGABT, concentrating on the systematic evaluation of post-insertion images. MRI with the applicator in place from the radiation oncologist's perspective should begin with immediate identification of eventual complications of the application procedure and assessment of the implant adequacy, followed by appropriate corrective measures in case of adverse findings. Finally, the tumor extent, topography, and treatment response should be evaluated in the context of initial clinical and radiological findings to allow for an appropriate selection and delineation of the target volumes.
    Journal of Contemporary Brachytherapy 06/2014; 6(2):215-22. DOI:10.5114/jcb.2014.43459