title: Influencing surgical management in patients with carcinoma of the cervix using a T2- and ZOOM-diffusion-weighted endovaginal MRI technique.
abstract: BACKGROUND
  Endovaginal MRI (evMRI) at 3.0-T with T2-weighted (T2-W) and ZOnal Oblique Multislice (ZOOM)-diffusion-weighted imaging (DWI) potentially improves the detection of stage Ia/Ib1 cervical cancer. We aimed to determine its sensitivity/specificity, document tumour-to-stromal contrast and establish the effect of imaging on surgical management.
  
  
  METHODS
  Following ethical approval and written informed consent, 57 consecutive patients with suspected stage Ia/Ib1 cervical cancer underwent evMRI at 3.0-T using T2-W and ZOOM-DWI. Sensitivity/specificity were calculated against histopathology for two independent observers. Tumour-to-stromal contrast was determined on T2-W, and diffusion-weighted (b=800 s mm(-2)) images and apparent diffusion coefficients (ADCs) were recorded. In patients due for radical vaginal trachelectomy (RVT), change of surgical management based on imaging findings was documented.
  
  
  RESULTS
  Sensitivity/specificity for detecting tumour was the following: reporting read 88.0/81.8%, anonymised read 92.0/81.8% (observer 1); 84.0/72.7% (observer2; median tumour volume=1.7 cm(3)). Intraobserver agreement was excellent (kappa=0.89) and the interobserver agreement was good (kappa=0.65). Tumour-to-stromal contrast was greater on ZOOM-DWI compared with T2-W images (3.35±2.36 vs 1.39±0.95; P<0.0004). Tumour and stromal ADCs were significantly different (P<0.00001). In 31 patients due for RVT, evMRI altered surgical management in 12 (38.7%) cases (10 cone-biopsy, 2 chemoradiotherapy).
  
  
  CONCLUSIONS
  T2-W+ZOOM-DWI evMRI has high sensitivity/specificity for detecting stage Ia/Ib1 cervical tumours; in patients due for RVT, the surgical management was altered in ∼39%.
authors.affiliation: Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK.
authors.forename: K
authors.initials: K
authors.lastname: Downey
authors.forename: M
authors.initials: M
authors.lastname: Jafar
authors.forename: A D
authors.initials: AD
authors.lastname: Attygalle
authors.forename: S
authors.initials: S
authors.lastname: Hazell
authors.forename: V A
authors.initials: VA
authors.lastname: Morgan
authors.forename: S L
authors.initials: SL
authors.lastname: Giles
authors.forename: M A
authors.initials: MA
authors.lastname: Schmidt
authors.forename: T E J
authors.initials: TE
authors.lastname: Ind
authors.forename: J H
authors.initials: JH
authors.lastname: Shepherd
authors.forename: N M
authors.initials: NM
authors.lastname: deSouza
mesh_terms: D000328:Adult; D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*