title: Can radicality of surgery be safely modulated on the basis of MRI and PET/CT imaging in locally advanced cervical cancer patients administered preoperative treatment?
abstract: BACKGROUND
  The goal of this study was to prospectively analyze the diagnostic performances of magnetic resonance imaging (MRI) and positron emission tomography (PET)/computed tomography (CT) in predicting pathologically assessed residual disease in a large, single-institution series of locally advanced cervical cancer (LACC) patients triaged to neoadjuvant treatments followed by radical surgery.
  
  
  METHODS
  Between April 2007 and March 2010, 96 patients with histologically documented cervical cancer (any histology) and FIGO stage IB2-IVA were enrolled. MRI and PET/CT were recommended to be performed within 4-6 weeks from the end of treatment, and histology was the reference standard. Sensitivity, specificity, and accuracy were compared using the McNemar test.
  
  
  RESULTS
  For residual disease in the cervix, sensitivity was higher for MRI than for PET/CT (86.1% vs 63.1%; P = .002), while specificity was significantly higher for PET/CT compared with MRI (P = .002). There was no difference in accuracy values between the 2 imaging modalities. For MRI analysis of lymph node groups, sensitivity, specificity, and accuracy were 35.7%, 95.9%, and 88.0%, respectively. Conversely, sensitivity, specificity, and accuracy for PET/CT were 28.6%, 97.8%, and 88.7%, respectively. Absence of follicular structures replaced by prevalent sclerosis and/or sinus histiocytosis was the most frequently documented morphological pattern in false-positive cases.
  
  
  CONCLUSIONS
  Neither MRI nor PET/CT accurately detected residual disease in LACC patients triaged to radical surgery after neoadjuvant treatment, disallowing the option of avoiding or modulating completion surgery.
authors: Gynecologic Oncology Unit, Department of Oncology, Catholic University, Campobasso, Italy. gabriella.ferrandina@libero.it
authors: Gabriella
authors: G
authors: Ferrandina
authors: Marco
authors: M
authors: Petrillo
authors: Gennaro
authors: G
authors: Restaino
authors: Vittoria
authors: V
authors: Rufini
authors: Gabriella
authors: G
authors: Macchia
authors: Arnaldo
authors: A
authors: Carbone
authors: Gian Franco
authors: GF
authors: Zannoni
authors: Alessandro
authors: A
authors: Lucidi
authors: Giorgia
authors: G
authors: D'Angelo
authors: Giovanni
authors: G
authors: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery / Q000628:therapy