title: Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery.
abstract: BACKGROUND
  Imaging findings of residual cervical tumor after chemoradiotherapy can closely resemble those of post-irradiation inflammation.
  
  
  OBJECTIVE
  To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC).
  
  
  METHODS
  Retrospective analysis of prospectively collected data from 41 patients with histopathologically proven LACC (International Federation of Gynecology and Obstetrics stage ≥IB2) who underwent MRI before and after chemoradiotherapy. At each examination, a qualitative and semi-quantitative analysis of primary tumor, including tumor volume and signal intensity were assessed on T2-weighted (T2W) images. All patients had surgery after post-chemoradiotherapy MRI. MRI and histopathologic results were compared.
  
  
  RESULTS
  All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively.
  
  
  CONCLUSIONS
  The differentiation of residual tumor from post-irradiation inflammation with early post- chemoradiotherapy MRI (within 28-60 days) is difficult with a high risk of false positive results. Combination of qualitative and semi-quantitative analysis does not improve the accuracy. Conversely, post-chemoradiotherapy MRI has a high negative predictive value with a low risk of false negative results. The role of conventional MRI combined with functional techniques should be evaluated.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy bgui@rm.unicatt.it.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Gui
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Anna Lia
authors.initials: AL
authors.lastname: Valentini
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Miccò
authors.affiliation: Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Giuseppe Roberto
authors.initials: GR
authors.lastname: D'Agostino
authors.affiliation: Department of Radiation Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Tagliaferri
authors.affiliation: Department of Pathology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Zannoni
authors.affiliation: Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Department of Radiology, University of Verona, Policlinico G.B. Rossi, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Manfredi
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*
keywords: Cervical cancer; chemoradiotherapy; inflammation; magnetic resonance imaging (MRI); post-treatment evaluation; tumor