title: No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients.
abstract: OBJECTIVE
  Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging.
  
  
  METHODS
  All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 - September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography.
  
  
  RESULTS
  Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman - with advanced pre-radiograph stage (IVA) disease - showed findings consistent with pulmonary metastases. Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%.
  
  
  CONCLUSIONS
  Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years.
authors.affiliation: Department of Gynaecological Oncology, Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Hoogendam
authors.affiliation: Department of Gynaecological Oncology, Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Zweemer
authors.affiliation: Department of Radiology, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Verkooijen
authors.affiliation: Department of Radiology, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Department of Radiology, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maurice A A J
authors.initials: MA
authors.lastname: van den Bosch
authors.affiliation: Department of Gynaecological Oncology, Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
authors.affiliation: Department of Radiology, Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Wouter B
authors.initials: WB
authors.lastname: Veldhuis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D009426:Netherlands; D049268:Positron-Emission Tomography; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*