title: Pre-operative MR evaluation of features that indicate the need of adjuvant therapies in early stage cervical cancer patients. A single-centre experience.
abstract: OBJECTIVE
  This study compared the MR measurement of minimum uninvolved cervical stroma and maximum stromal invasion, and the detection of positive lymph nodes with the pathological results. In addition, tumour type and grade were correlated with nodal status and apparent diffusion coefficient (ADC) values.
  
  
  METHODS
  Patients who underwent surgery and MR at our centre for early stage cervical cancer (FIGO IA1-IIB) were included. Data recorded included: age, date of MR, clinical FIGO (International Federation of Gynacology and Obstetrics) stage, histological type and grade, adjuvant therapy, pre-surgical conisation. MR evaluation included: measurement of the minimum uninvolved stroma, maximum thickness of stromal involvement, presence and site of positive pelvic lymph nodes, calculation of ADC values. Statistical analysis was performed to compare MR and pathological results. The agreement between MR and pathology in measuring depth of stromal invasion was analysed by Bland-Altman plot, calculating the limits of agreement (LoA).
  
  
  RESULTS
  113/217 patients underwent adjuvant therapies. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MR in evaluation of minimum thickness of uninvolved cervical stroma were 88%, 75%, 70%, 90% and 80%; the same values in evaluation of pelvic positive lymph nodes were 64%, 85%, 65%, 84% and 78%. The mean difference between MR and pathological results in measuring maximum depth of stromal invasion was -0.65mm (95% LoA: -9.37mm; 8.07mm). Depth of stromal invasion was strongly related to positive nodal status (p<0.001). ADC values (available in 51/217 patients) were not associated with the features assessed.
  
  
  CONCLUSIONS
  Pre-surgical MR is accurate (80%) in evaluating the minimum thickness of uninvolved cervical stroma; MR measurements of maximum depth of stromal invasion differed ±9mm from the pathological results in 95% of cases. Furthermore, a strong association was found between the depth of stromal invasion and the presence of positive lymph nodes, suggesting that inclusion of these measurements in the MR report might guide the choice of the best treatment option for early cervical cancer patients.
authors.affiliation: Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy. Electronic address: stefania.rizzo@ieo.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.affiliation: Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Calareso
authors.affiliation: Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Maccagnoni
authors.affiliation: Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy.
authors.forename: Salvatore Alessio
authors.initials: SA
authors.lastname: Angileri
authors.affiliation: Division of Gynecology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Raimondi
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Pasquali
authors.affiliation: Division of Radiotherapy, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lazzari
authors.affiliation: Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy; Department of Health Sciences, University of Milan, via A.di Rudinì 8, 20142 Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
mesh_terms: D017024:Chemotherapy, Adjuvant; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*
keywords: Adjuvant therapy; MR imaging; Staging; Stromal invasion; Uterine cervical cancer