title: Craniocaudal tumour extension in uterine cervical cancer on MRI compared to histopathology.
abstract: OBJECTIVE
  To assess the reliability of magnetic resonance imaging (MRI) for evaluation of craniocaudal tumour extension by comparing the craniocaudal tumour extension on the pre-operative MRI and post-operative hysterectomy specimen in patients with early stage uterine cervical cancer.
  
  
  METHODS
  After approval of the institutional review board was acquired, pre-operative MRI and hysterectomy specimen of 21 women with early stage cervical cancer were re-evaluated. The craniocaudal extension on MRI was measured separately by two experienced radiologists and compared with corresponding measurements from the hysterectomy specimen, which were re-evaluated by an experienced pathologist.
  
  
  RESULTS
  Median craniocaudal extension of uterine cervical cancer on MRI was slightly smaller compared to histopathology (2.1 cm vs. 2.5 cm). The median underestimation was 0.4 cm (range -0.6 cm to 2.2 cm, mean 0.4 cm, standard deviation (SD) ±0.7 cm); Pearson's correlation was 0.83 (p < 0.001). In two patients (9%) MRI underestimated tumour craniocaudal extension by more than 1.8 cm.
  
  
  CONCLUSIONS
  MRI represents the histopathological craniocaudal tumour extension in the majority of patients with early stage uterine cervical cancer, but with a systematic small underestimation of the real craniocaudal tumour extension.
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: de Boer
authors.affiliation: Department of Pathology, AMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Maaike C G
authors.initials: MC
authors.lastname: Bleeker
authors.affiliation: Department of Radiology, AMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Anje M
authors.initials: AM
authors.lastname: Spijkerboer
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Agustinus J A J
authors.initials: AJ
authors.lastname: van de Schoot
authors.affiliation: Department of Radiology, AMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.affiliation: Department of Gynaecologic Oncology, AMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Marrije R
authors.initials: MR
authors.lastname: Buist
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Coen R N
authors.initials: CR
authors.lastname: Rasch
authors.affiliation: Department of Radiology, AMC, UvA, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Department of Radiation Oncology, Academic Medical Centre (AMC), University of Amsterdam (UvA), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Lukas J A
authors.initials: LJ
authors.lastname: Stalpers
keywords: Accuracy; CI, confidence interval; CRF, case record form; CTV, clinical target volume; Craniocaudal; EBRT, external beam radiation therapy; ESTRO, European society of therapeutic radiology and oncology; Extension; FIGO, international federation of gynaecology and obstetrics; ICC, intraclass correlation coefficient; JCOG, Japan clinical oncology group; LLETZ, large loop excision of the transformation zone; MRI; MRI, magnetic resonance imaging; NCIC, national cancer institute of Canada; PTV, planning target volume; RT, radiation therapy; SD, standard deviation; Uterine cervical cancer; VMAT, volumetric modulated arc therapy