title: Preoperative imaging in patients undergoing trachelectomy for cervical cancer: validation of a combined T2- and diffusion-weighted endovaginal MRI technique at 3.0 T.
abstract: OBJECTIVE
  The aim of this study is to validate high-resolution endovaginal T2- and diffusion-weighted MRI measurements (tumour size, volume and length of uninvolved cervical canal) against histology in patients undergoing trachelectomy.
  
  
  METHODS
  55 consecutive patients 25-44 years with cervical cancer being considered for trachelectomy were prospectively assessed with endovaginal T2-W and diffusion-weighted MRI. Two independent observers blinded to histology recorded maximum tumour dimension, volume and distance from the superior aspect of the tumour to the internal os. Following trachelectomy, pathologist-outlined tumour sections were photographed with a set scale and similar measurements were recorded.
  
  
  RESULTS
  Fifteen of 45 patients subsequently treated with fertility-sparing surgery had residual tumour (median histological volume: 0.28 cm(3), IQR=0.14-1.06 cm(3)). Sensitivity, specificity, positive and negative predictive values for detecting tumour: Observer 1: 86.7%, 80.0%, 68.4%, and 92.3%, respectively; Observer 2: 86.7%, 90.0%, 81.0%, and 93.1%, respectively. Size and volume correlated between observers (r=0.96, 0.84, respectively, p<0.0001). Size correlated between each observer and histology (observer 1 r=0.91, p<0.0001; observer 2 r=0.93, p<0.0001), volume did not (observer 1: r=0.08, p=0.6; observer 2: r=0.21, p=0.16); however, differences between observer measurements and histology were not significant (size p=0.09, volume p=0.15). Differences between MRI and histology estimates of endocervical canal length were not significant (p=0.1 both observers).
  
  
  CONCLUSIONS
  In subcentimetre cervical cancers, endovaginal MRI correlates with pathology and is invaluable in assessing patients for fertility-sparing surgery.
authors.affiliation: CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Downey
authors.affiliation: Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK.
authors.forename: John H
authors.initials: JH
authors.lastname: Shepherd
authors.affiliation: Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK.
authors.forename: Ayoma D
authors.initials: AD
authors.lastname: Attygalle
authors.affiliation: Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Hazell
authors.affiliation: CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
authors.forename: Veronica A
authors.initials: VA
authors.lastname: Morgan
authors.affiliation: CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Giles
authors.affiliation: Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK.
authors.forename: Thomas E J
authors.initials: TE
authors.lastname: Ind
authors.affiliation: CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, UK. Electronic address: nandita.deSouza@icr.ac.uk.
authors.forename: Nandita M
authors.initials: NM
authors.lastname: Desouza
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods; D011300:Preoperative Care; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery
keywords: Cervical cancer; Endovaginal; Fertility-sparing; MRI; Trachelectomy; Volume