title: Clinical examination versus magnetic resonance imaging in the pretreatment staging of cervical carcinoma: systematic review and meta-analysis.
abstract: OBJECTIVE
  To review the literature on the diagnostic performance of clinical examination and magnetic resonance imaging (MRI) in detecting parametrial invasion and advanced stage disease (FIGO stage ≥ IIB) in patients with cervical carcinoma.
  
  
  METHODS
  Reports of studies were searched using the MEDLINE, EMBASE and Cochrane databases. Two observers reported on data relevant for analysis and methodological quality using the QUADAS scoring system. Publication bias was analysed using Deeks funnel plots. Covariates were added to the model to study the influence on the summary results of the technical and methodological aspects of the clinical examination and MRI.
  
  
  RESULTS
  In total, 3,254 patients were included. Partial verification bias was often encountered. Pooled sensitivity was 40 % (95 % CI 25-58) for the evaluation of parametrial invasion with clinical examination and 84 % (95 % CI 76-90) with MRI, 53 % (95 % CI 41-66) for the evaluation of advanced disease with clinical examination, and 79 % (95 % CI 64-89) with MRI. Pooled specificities were comparable between clinical examination and MRI. Different technical aspects of MRI influenced the summary results.
  
  
  CONCLUSIONS
  MRI is significantly better than clinical examination in ruling out parametrial invasion and advanced disease in patients with cervical carcinoma.
  
  
  CONCLUSIONS
  • MRI has a higher sensitivity than clinical examination for staging cervical carcinoma. • Clinical examination and MRI have comparably high specificity for staging cervical carcinoma. • Quality of clinical examination studies was lower than that of MRI studies. • The use of newer MRI techniques positively influences the summary results. • Anaesthesia during clinical examination positively influences the summary results.
authors: Department of Radiology, Erasmus University Medical Centre, P.O. Box 2040, 's-Gravendijkwal 230, 3000 CA, Rotterdam, The Netherlands. m.thomeer@erasmusmc.nl
authors: Maarten G
authors: MG
authors: Thomeer
authors: Cees
authors: C
authors: Gerestein
authors: Sandra
authors: S
authors: Spronk
authors: Helena C
authors: HC
authors: van Doorn
authors: Els
authors: E
authors: van der Ham
authors: Myriam G
authors: MG
authors: Hunink
mesh_terms: D000758:Anesthesia / Q000379:methods; D005260:Female; D058869:Gynecological Examination / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D009367:Neoplasm Staging / Q000379:methods*; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology*