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: 6.87). 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.

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Available from: Bradley S. Snyder, Apr 01, 2014
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    • "For locally advanced disease, pelvic magnetic resonance imaging (MRI) and positron emission tomography-(PET) computed tomography (CT) should be obtained at diagnosis when possible. T2-weighted pelvic MRI is superior to clinical exam or CT, for determining the initial disease extent, with overall staging accuracy estimated between 75%–96%.13–15 Compared with CT, MRI has superior soft tissue resolution. "
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    International Journal of Women's Health 05/2014; 6(1):555-564. DOI:10.2147/IJWH.S46247
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    • "clinical systems. As it provides images with a 41-mm in-plane resolution and a 3-to 4-mm slice thickness, tumour dimensions from previous studies where it has achieved sensitivity/specificity for detecting tumour of B80% (Hricak et al, 2007) have been 41 cm (Sahdev et al, 2007). The spatial resolution of MR images may be improved by the use of receiver coils close to the region of interest because they provide significant increases in signal-to-noise ratio (SNR; deSouza et al, 1996; deSouza et al, 2000; deSouza et al, 2006). "
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    British Journal of Cancer 07/2013; 109:615 - 622. DOI:10.1038/bjc.2013.375 · 4.84 Impact Factor
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    • "CT is the current standard imaging modality for radiotherapy planning but has inferior soft tissue contrast to MRI. The gross tumour volume on CT has been shown to be substantially larger than that measured on MRI [75]. It is crucial, therefore, that CT is correlated with MRI when defining the gross tumour volume. "
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    Insights into Imaging 11/2010; 1(5-6):309-328. DOI:10.1007/s13244-010-0042-7
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