title: Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound - a European multicenter trial.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard.
  
  
  METHODS
  Prospective multi-center trial enrolling 209 consecutive women with early-stage cervical cancer (FIGO IA2-IIA) scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology: remaining tumor, size, tumor stromal invasion<2/3 (superficial) or ≥2/3 (deep), and parametrial invasion.
  
  
  RESULTS
  Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (<2cm) and detecting parametrial invasion (kappa values 0.78 and 0.75, respectively). The agreement between MRI and histology was good for classifying tumors as <2cm, or >4cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy.
  
  
  CONCLUSIONS
  US and MRI are highly accurate for the preoperative assessment of women with early-stage cervical cancer, although US may be more accurate in detecting residual tumors and assessing parametrial invasion.
authors.affiliation: Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden. elisabeth.epstein@karolinska.se
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Epstein
authors.forename: Antonia
authors.initials: A
authors.lastname: Testa
authors.forename: Adrius
authors.initials: A
authors.lastname: Gaurilcikas
authors.forename: Alessia
authors.initials: A
authors.lastname: Di Legge
authors.forename: Liveke
authors.initials: L
authors.lastname: Ameye
authors.forename: Vaida
authors.initials: V
authors.lastname: Atstupenaite
authors.forename: Anna Lia
authors.initials: AL
authors.lastname: Valentini
authors.forename: Benedetta
authors.initials: B
authors.lastname: Gui
authors.forename: Nils-Olof
authors.initials: NO
authors.lastname: Wallengren
authors.forename: Sonja
authors.initials: S
authors.lastname: Pudaric
authors.forename: Arvydas
authors.initials: A
authors.lastname: Cizauskas
authors.forename: Anna
authors.initials: A
authors.lastname: Måsbäck
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Zannoni
authors.forename: Päivi
authors.initials: P
authors.lastname: Kannisto
authors.forename: Michal
authors.initials: M
authors.lastname: Zikan
authors.forename: Ivana
authors.initials: I
authors.lastname: Pinkavova
authors.forename: Andrea
authors.initials: A
authors.lastname: Burgetova
authors.forename: Pavel
authors.initials: P
authors.lastname: Dundr
authors.forename: Kristyna
authors.initials: K
authors.lastname: Nemejcova
authors.forename: David
authors.initials: D
authors.lastname: Cibula
authors.forename: Daniela
authors.initials: D
authors.lastname: Fischerova
mesh_terms: D005060:Europe; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery