The role of magnetic resonance imaging in determining the proximal extension of early stage cervical cancer to the internal os.
OBJECTIVE
To study the interobserver variability of MRI for visualization of the internal os and measuring the distance between tumor and the internal os in patients with early cervical carcinoma and to compare the distance between tumor and the internal os measured on MRI with invasion of the internal os determined by histopathology.


METHODS
All T2-weighed MRI examinations between January 2003 and December 2007 of patients who underwent hysterectomy, of ≤40 years, with clinical stage IB1 cervix carcinoma and tumor size ≤2cm were retrieved. 27 patients fulfilled these criteria. Two radiologists retrospectively reviewed the images for visualization of the internal os and the distance between tumor and the internal os; agreement and intraclass correlation coefficients (ICCs) were calculated to determine interobserver variability. The distance between tumor and the internal os measured on MRI was compared with invasion of the internal os determined by histopathology.


RESULTS
In 26 patients, visualization of the internal was rated as good or moderate by both radiologists (agreement 96%). In 15 patients, both radiologists observed a tumor and the ICC for the distance between tumor and the internal os was 0.752 (95%CI: 0.406-0.909). Assuming 5mm distance between tumor and the internal os on MRI as criterion for invasion of the internal os, 1 true-positive, 2 false-positives and none false-negatives were observed. Assuming 1cm as criterion increases the number of false-positives, respectively 3 and 5 by radiologist 1 and radiologist 2.


CONCLUSIONS
MRI has high interobserver values for visualization of the internal os and no false-negatives for involvement of the internal os.
Bipat
Shandra
S
Department of Radiology, G1-231, Academic Medical Centre, University of Amsterdam, Meibergdreef 1105 AZ, The Netherlands. s.bipat@amc.uva.nl
van den Berg
Ryan A
RA
van der Velden
Jacobus
J
Stoker
Jaap
J
Spijkerboer
Anje M
AM
D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D015588:Observer Variation; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery