title: Indications for endoscopy according to the revised FIGO staging for cervical cancer after MRI and CT scanning.
abstract: OBJECTIVE
  A recent revision of the FIGO staging system does not recommend the mandatory use of cystoscopy and sigmoidoscopy. The objective of this study was to assess the clinical utility of CT or MRI scans for ruling out bladder or rectal invasion and determine the indication for endoscopy in patients with cervical cancer.
  
  
  METHODS
  We retrospectively reviewed 769 patients with cervical cancer, who underwent imaging and endoscopic work-up between January 1997 and December 2010. Using endoscopy as the standard reference for comparison, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the imaging modality for bladder or rectal invasion.
  
  
  RESULTS
  The CT scan showed 68.2% and 85.7% for sensitivity and 96.4% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. CT scan provided a low PPV (51.7%, 54.5%) and a high NPV (98.2%, 99.8%). MRI scan showed 88.0% and 75.0% for sensitivity and 93.1% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. MRI scan provided a low PPV (35.6%, 42.9%) and a high NPV (99.4%, 99.7%). The accuracies of CT and MRI scans in identifying bladder invasion were 94.9% and 92.8%, respectively. The accuracies of CT and MRI in identifying rectal invasion were 98.7% and 98.6%, respectively.
  
  
  CONCLUSIONS
  The results of this study demonstrate that additional invasive endoscopy is not necessary for patients who present with no invasion on imaging work-up, and therefore, endoscopy should be considered a tool for confirming cases that are positive for invasion based on imaging work-up.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Bae Kwon
authors.initials: BK
authors.lastname: Jeong
authors.forename: Seung Jae
authors.initials: SJ
authors.lastname: Huh
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.forename: Dongryul
authors.initials: D
authors.lastname: Oh
authors.forename: Taegyu
authors.initials: T
authors.lastname: Kim
authors.forename: Hye Bin
authors.initials: HB
authors.lastname: Lee