Article

Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability.

Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Radiology (Impact Factor: 6.34). 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.

0 Bookmarks
 · 
74 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Optimal applicator insertion is a precondition for the success of cervix cancer brachytherapy (BT). We aimed to assess feasibility and efficacy of MRI-assisted pre-planning, based on applicator insertion in para-cervical anaesthesia (PCA).
    Radiology and Oncology 09/2014; 48(3):293-300. · 1.60 Impact Factor
  • [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.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Consequently, advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This review provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer.
    International Journal of Women's Health 01/2014; 6:555-564.

Full-text

View
9 Downloads
Available from
May 16, 2014