title: Changing trend in the patterns of pretreatment diagnostic assessment for patients with cervical cancer in Japan.
abstract: OBJECTIVE
  Cancer staging systems should be responsive to the development of diagnostic tools. The International Federation of Gynecology and Obstetrics (FIGO) cervical cancer guidelines were modified in 2009 regarding the pretreatment assessment. We report the recent Japanese patterns of pretreatment workup for cervical cancer.
  
  
  METHODS
  The Japanese Patterns of Care Study (PCS) working group analyzed the pretreatment diagnostic assessment data of 609 patients with cervical cancer treated with definitive radiotherapy in the two survey periods (1999-2001, 324; 2003-2005, 285) in Japan. Sixty-one of 640 institutions were selected for this survey using a stratified two-staged cluster sampling method.
  
  
  RESULTS
  The use of optional examinations in the latest FIGO guidelines such as intravenous urography, cystoscopy, and proctoscopy was gradually decreasing. Surgical staging was rarely performed in either survey period. Computed tomography (CT) and magnetic resonance imaging (MRI) were widely used, and MRI has become increasingly prevalent even between the two survey periods. Primary lesion size and pelvic lymph node status was evaluated by CT/MRI for most patients in both surveys.
  
  
  CONCLUSIONS
  The use of CT/MRI that is encouraged in the latest FIGO staging guidelines already replaced intravenous urography, cystoscopy, and proctoscopy in Japan. Japanese patients received the potential benefit of CT/MRI because prognostic factors such as primary lesion size and pelvic lymph node status were evaluated by these modalities. The use of cystoscopy and proctoscopy should be continuously monitored in the future PCS survey because only CT/MRI could lead to the stage migration for patients on suspicion of bladder/rectum involvement on CT/MRI.
authors.affiliation: Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan. ntomita@aichi-cc.jp
authors.forename: Natsuo
authors.initials: N
authors.lastname: Tomita
authors.forename: Takafumi
authors.initials: T
authors.lastname: Toita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Atsunori
authors.initials: A
authors.lastname: Shinoda
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
authors.forename: Hodaka
authors.initials: H
authors.lastname: Numasaki
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
authors.forename: Michihide
authors.initials: M
authors.lastname: Mitsumori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy; D003944:Diagnostic Techniques, Obstetrical and Gynecological / Q000592:standards / Q000639:trends*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007564:Japan; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D011351:Proctoscopy; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology