title: Comparison of elastography based on transvaginal ultrasound and MRI in assessing parametrial invasion of cervical cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical value of transvaginal elastography (TVES) combined with high-resolution transvaginal ultrasound (TVS) in the detection of parametrial invasion in cervical cancer and to compare the diagnostic performance with magnetic resonance imaging (MRI).
  
  
  METHODS
  52 women with histologically confirmed cervical cancer over a 2-year period were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and TVES combined with TVS according to a standardized protocol before treatment. When assessing parametrial involvement with TVS, MRI, and combination of TVES and TVS, the findings were recorded and compared with histopathological results after surgery in early-stage disease (stage⩽IIa). Sensitivity, specificity accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method independently; subsequently, a matched-sample analysis was performed by using McNemar's test or chi-square test.
  
  
  RESULTS
  Of 52 patients, 39 were early-stage disease (stage⩽IIa), and 13 were advanced-stage disease (stage⩾IIb) according to conventional FIGO staging. For the detection of parametrial infiltration, both the diagnostic sensitivity of MRI and the combination of TVS and TVES were statistically higher than alone TVS in early-stage of cervical cancer (P = 0.03 < 0.05). Both MRI and the combination of TVS and TVES had a sensitivity of 72.73%; specificity rates of 82.14% for MRI and 78.57% for the combination of TVES and TVS; and the diagnostic accuracy rates of 79.49% for MRI and 76.92% for the combination of TVES and TVS. A matched sample analysis revealed no statistically significant difference between the diagnostic performance of MRI and the combination of TVES and TVS in the assessment of parametrial invasion (all P values > 0.05).
  
  
  CONCLUSIONS
  TVES combined with TVS performed by a dedicated gynecologic radiologist should be considered a promising and economic method for pre-operative work-up for cervical cancer.
authors.affiliation: Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Jian-Liang
authors.initials: JL
authors.lastname: Wang
authors.affiliation: Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Shao
authors.affiliation: Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Zhu
authors.affiliation: Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Hou-Sheng
authors.initials: HS
authors.lastname: Zhang
authors.affiliation: Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
authors.forename: Hong-Yan
authors.initials: HY
authors.lastname: Wang
authors.affiliation: Department of Radiology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China.
authors.forename: Jun-Kang
authors.initials: JK
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D014463:Ultrasonography / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D014621:Vagina
keywords: Cervical cancer; MRI; diagnostic performance; parametrial invasion; transvaginal elastography