title: The negative predictive value of clinical examination with or without anesthesia versus magnetic resonance imaging for parametrial infiltration in cervical cancer stages IB1 to IIA.
abstract: OBJECTIVE
  This study aimed to compare the negative predictive value (NPV) of clinical examination with or without anesthesia and magnetic resonance imaging (MRI) in identifying patients with cervical carcinoma without parametrial infiltration.
  
  
  METHODS
  This retrospective cohort study was conducted at the Academic Medical Center in Amsterdam. The medical files of 203 patients diagnosed with cervical cancer stages IB1-IIA, who underwent surgical treatment between January 1, 2003, and January 31, 2011, were reviewed. We compared clinical International Federation of Gynecology and Obstetrics staging and MRI during the staging procedure. The results were compared with the parametrial status by surgical-pathological investigation, which was considered to be the reference standard.
  
  
  RESULTS
  Based on the surgical-pathological findings, 16.7% of the patients treated surgically had parametrial infiltration. For parametrial infiltration, examination under anesthesia (EUA) had an NPV of 65.3% and MRI of 76.9%, respectively. We found no significant difference between these NPVs.
  
  
  CONCLUSIONS
  Examination under anesthesia and MRI are equal in identifying cervical cancer patients without parametrial infiltration with a tendency for MRI to perform better than EUA. When outpatient clinical staging is considered inconclusive, pretreatment staging may be limited to MRI. In these cases, EUA seems to have no additional value.
authors.affiliation: Department of Gynecology and Obstetrics, Academic Medical Center, University of Amsterdam, the Netherlands.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Bleker
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: Anje M
authors.initials: AM
authors.lastname: Spijkerboer
authors.forename: Jacobus
authors.initials: J
authors.lastname: van der Velden
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Gemma G
authors.initials: GG
authors.lastname: Kenter
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000758:Anesthesia / Q000379:methods; D002277:Carcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005260:Female; D058869:Gynecological Examination / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017773:Pelvic Floor / Q000473:pathology*; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult