The role of magnetic resonance imaging in the preoperative staging of invasive cervical cancer

Abstract

Aim: To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in the preoperative evaluation of patients with invasive cervical cancer, in terms of parametrial involvement, lymph node metastases and tumor size. Methods: The retrospective study included 48 patients with histologically verified invasive cervical cancer, treated surgically with radical hysterectomy and pelvic lymphadenectomy in the period January 2012 - December 2013. All patients had preoperative MRIs. The reference standard for comparison was the histopathological findings from the operative specimens. Results: Six patients in our study (12.5%) had parametrial involvement verified on histopathological analysis. MRI identified probable parametrial involvement in 8 (16.7%) patients. The sensitivity, specificity, positive predictive value and negative predictive value (PPV and NPV) of MRI in detecting parametrial involvement were 83.3%, 92.7%, 62.5% and 97.5%, respectively. Histopathological analysis of the operative specimens identified 11 (22.9%) patients with lymph node metastases. The MRI scans detected probable lymph node metastases in 15 (31.3%). The sensitivity, specificity, PPV and NPV of MRI in detecting lymph node metastases were 63.6%, 78.4%, 46.7% and 87.9%, respectively. MRI was better at estimating the tumor size (rs=0.67, p<0.001) when compared to clinical examination (rs=0.34, p<0.001). Conclusion: Preoperative MRI showed low PPV in detecting lymph node metastases and parametrial involvement. MRI was superior, compared to the clinical examination, in the estimation of tumor size. Further research is required to determine the cost-effectiveness of using MRI instead of conventional clinical staging tests.