title: Preoperative prediction of lymph node metastasis and deep stromal invasion in women with invasive cervical cancer: prospective multicenter study using 2D and 3D ultrasound.
abstract: OBJECTIVE
  To determine how various objective two-dimensional (2D) and three-dimensional (3D) ultrasound parameters allow prediction of deep stromal tumor invasion and lymph node involvement, in comparison to subjective ultrasound assessment, in women scheduled for surgery for cervical cancer.
  
  
  METHODS
  This was a prospective multicenter trial including 104 women with cervical cancer at FIGO Stages IA2-IIB, verified histologically. Patients scheduled for surgery underwent a preoperative ultrasound examination. The value of various 2D (size, color score) and 3D (volume, vascular indices) ultrasound parameters was compared to that of subjective assessment in the prediction of deep stromal tumor invasion and lymph node involvement. Histology obtained from radical hysterectomy or trachelectomy and pelvic lymphadenectomy was considered as the gold standard for assessment.
  
  
  RESULTS
  All women underwent pelvic lymphadenectomy, with 99 (95%) undergoing subsequent radical surgery; five underwent only pelvic lymphadenectomy because of the presence of a positive sentinel lymph node. Women with deep stromal invasion or lymph node involvement had significantly larger tumors (diameter and volume) but there was no correlation with vascular indices measured on 3D ultrasound. Subjective evaluation was superior (AUC, 0.93; sensitivity, 90.5%; specificity, 97.2%) in the prediction of deep stromal invasion when compared to any objective measurement technique, with maximal tumor diameter at 20.5-mm cut-off (AUC, 0.83; sensitivity, 90.5%; specificity, 61.1%) and 3D tumor volume at 9.1-mm(3) cut-off (AUC, 0.85; sensitivity, 79.4%; specificity, 83.3%) providing the best performance among the objective parameters. Both subjective assessment and objective measurements were poorly predictive of lymph node involvement.
  
  
  CONCLUSIONS
  In women with cervical cancer, subjective ultrasound evaluation allowed better prediction of deep stromal invasion than did objective measurements; however, neither subjective evaluation nor objective parameters were adequate to predict lymph node involvement. 3D vascular indices were ineffective in the prediction of advanced stages of the disease.
authors.affiliation: Department of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Pálsdóttir
authors.forename: D
authors.initials: D
authors.lastname: Fischerova
authors.forename: D
authors.initials: D
authors.lastname: Franchi
authors.forename: A
authors.initials: A
authors.lastname: Testa
authors.forename: A
authors.initials: A
authors.lastname: Di Legge
authors.forename: E
authors.initials: E
authors.lastname: Epstein
mesh_terms: D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D036821:Endometrial Stromal Tumors / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery
keywords: cervical cancer; deep stromal invasion; diagnostic accuracy; lymph node; power Doppler; three-dimensional ultrasound; transvaginal ultrasound