title: Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer.
abstract: OBJECTIVE
  The aim of this study was to evaluate the predictive value of pretherapeutic magnetic resonance imaging (MRI)-based measurements of tumor diameter and volume with regard to recurrent disease.
  
  
  METHODS
  MRI on 0.5- or 1.5-T scanners was performed in 126 consecutive women with invasive carcinoma of the uterine cervix. Initial tumor diameter and volume were determined on T(2)-weighted images; volume was calculated by the standard technique of multiplying the sum of the areas by the slice thickness. Patients were treated by radical surgery, radiotherapy, or a combined approach based on clinical International Federation of Gynecology and Obstetrics (FIGO) stage and individual patient criteria. Clinical data (patient age and FIGO stage), MRI-derived tumor dimensions (diameter and volume), and histological findings (tumor invasion depth and lymph-node involvement) were associated and linked to patient outcome.
  
  
  RESULTS
  MRI-based tumor diameter correlated strongly with histological tumor invasion depth and lymph-node status (P < 0.01 and P = 0.01) while tumor volume on MRI was significantly associated only with tumor invasion depth into adjacent tissues (P < 0.01). Univariate analysis demonstrated graphically that MRI-derived tumor diameter and volume and clinical FIGO stage are associated with progression-free survival. Correlation analysis showed a strong association between MRI-derived tumor diameter and volume on MRI (r = 68%, P < 0.01) and also demonstrated a correlation between tumor diameter on MRI and FIGO stage Ib (Ib1 versus Ib2) cervical tumors (r = 46.7%, P < 0.01).
  
  
  CONCLUSIONS
  Tumor diameter and volume, determined by pretreatment MRI examinations, predict progression-free survival for patients with invasive cervical carcinoma. This study demonstrates the value of MRI as an adjunct to clinical evaluation of invasive cervical cancer, providing more complete assessment of morphological risk factors important in patient prognosis and treatment planning.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
authors.forename: H C
authors.initials: HC
authors.lastname: Wagenaar
authors.forename: J B
authors.initials: JB
authors.lastname: Trimbos
authors.forename: S
authors.initials: S
authors.lastname: Postema
authors.forename: A
authors.initials: A
authors.lastname: Anastasopoulou
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Geest
authors.forename: J H
authors.initials: JH
authors.lastname: Reiber
authors.forename: G G
authors.initials: GG
authors.lastname: Kenter
authors.forename: A A
authors.initials: AA
authors.lastname: Peters
authors.forename: P M
authors.initials: PM
authors.lastname: Pattynama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*