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VOLUME 8 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

Magnetic Resonance Imaging of Pelvis: A One-stop Shop Modality for the Staging of Carcinoma of Cervix

Ajit D Karambelkar, Rishabh D Bora

Keywords : Carcinoma, Cervix, Magnetic resonance imaging, Staging

Citation Information : Karambelkar AD, Bora RD. Magnetic Resonance Imaging of Pelvis: A One-stop Shop Modality for the Staging of Carcinoma of Cervix. J South Asian Feder Menopause Soc 2020; 8 (1):7-23.

DOI: 10.5005/jp-journals-10032-1193

License: CC BY-NC 4.0

Published Online: 18-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: Magnetic resonance imaging (MRI) of pelvis as a one-stop shop modality for locoregional staging of carcinoma of the cervix. Compare the MRI staging with the clinical staging of the carcinoma of the cervix. Materials and methods: We conducted pelvic MRI examinations on histological proved 83 cases of cervical carcinoma on MRI 1.5 T scanner. Results: Magnetic resonance imaging demonstrated cervical mass in 79 out of 83 (95%) patients. No mass lesion was demonstrated in 4 out of 83 patients, who were clinically diagnosed as stage I. X2 test demonstrated X2 value of 43.6 and p value < 0.01 indicating a significant difference between staging by staging by MRI and that by clinical staging. Z score test also showed a significant difference in staging by MRI and that by clinical staging for stages IB, IIB, IIIB, and IVA with a p value < 0.05. The Z score (RD) was maximum for stage IIIB and minimum 0.034 for stage IIIA, suggesting that the greatest difference was observed in stage IIIB. We could not find any significant difference for stage IIIA, IA and stage IIA. Conclusion: Magnetic resonance imaging is superior to clinical staging of the carcinoma of the uterine cervix in stage IB, IIB and IVA. Magnetic resonance imaging has an excellent ability to demonstrate the locoregional extent of the tumor. Hence, it should be used as a one-stop shop modality for the staging of cervical carcinoma.


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  1. Global cancer statistics. CA Cancer J Clin 1999;49(1):33–64. DOI: 10.3322/canjclin.49.1.33.
  2. 2010.
  3. 2005 estimates. United Nations’ population division world population prospects the 2004 revision, New York. Br J Cancer 2005;98(1):15–21. DOI: 10.1038/sj.bjc.6604146.
  4. , HPV and Cervical Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer, HPV Information Centre. IARC GLOBOCON. 2002.
  5. , ed. SEER Cancer Statistics Review, 1975–2003, National Cancer Institute. Bethesda, MD, SEER Cancer Statistics Review 2006.
  6. , WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre) cervical cancer–the disease and its burden in India. HPV and Cervical Cancer in the World 2007 Report 2010.
  7. Carcinoma of the cervix: role of MR imaging. Ann Acad Med Singapore 2003;32(4):550–556.
  8. Magnetic resonance imaging of the cervix. Cancer Imaging 2007;7(1):69–76. DOI: 10.1102/1470-7330.2007.0011.
  9. Cervical cancer. J Magn Reson Imaging 1998;8(2):391–397. DOI: 10.1002/jmri.1880080219.
  10. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 1995;86(1):43–50. DOI: 10.1016/0029-7844(95)00109-5.
  11. The staging of cervical cancer: Inevitable discrepancies between clinical staging and pathologic findinges. Am J Obstet Gynecol 1971;110(7):973–978. DOI: 10.1016/0002-9378(71)90551-5.
  12. V factor (tumor volume) and T factor (FIGO classification) in the assessment of cervix cancer prognosis: the risk of lymph node spread. Gynecol Oncol 1985;22(1):15–22. DOI: 10.1016/0090-8258(85)90002-2.
  13. Carcinoma of the uterine cervix. Clinical radiation oncology. Philadelphia, Pa: Saunders; 1998;1998:799–841.
  14. Uterus and cervix Semelka RC, Ascher SM, et al., ed. MRI of the abdomen and pelvis: a text atlas, vol. 1997, New York, NY: Wiley-Liss; 1997. pp. 585–660.
  15. The uterus and vagina Higgins CB, Hricak H, Helms CA, ed. Magnetic resonance imaging of the body. 3rd ed., New York, NY: Lippincott-Raven; 1997. pp. 761–814.
  16. Invasive cervical carcinoma role of MR imaging in pretreatment work up-cost minimization and diagnostic efficacy analysis radiology magnetic resonance imaging of the abnormal female pelvis. 1996;198(2):403–409. DOI: 10.1148/radiology.198.2.8596840.
  17. Magnetic resonance imaging of the abnormal female pelvis. AJR Am J Roentgenol 1984;143(6):1259–1266. DOI: 10.2214/ajr.143.6.1259.
  18. Assessment of primary gynecologic malignancies: comparison of 0.15-T resistive MRI with CT. AJR Am J Roentgenol 1984;143(6):1249–1257. DOI: 10.2214/ajr.143.6.1249.
  19. MGARP. Role of X-ray CT and magnetic resonance imaging in the diagnosis of gynecological malignant tumor. Ann Radiol (Paris) 1990;33(4-5):241–247.
  20. Diagnostic imaging in invasive cervical carcinoma: MRI, CT, and ultrasonography. Zentralbl Gynakol 2001;123(4):222–228. DOI: 10.1055/s-2001-14784.
  21. Preoperative imaging of primary intra-abdominal gynaecological malignancies. Diagnostic accuracy of CT-scan and MRI. A greek cohort study. Eur J Gynaecol Oncol 2002;23(2):139–144.
  22. Magnetic resonance imaging, computed tomography and endosonography in the local staging of carcinoma of the cervix. Br J Radiol 1990;63(753):673–679. DOI: 10.1259/0007-1285-63-753-673.
  23. Magnetic resonance imaging--its application to cervical carcinoma. Br J Obstet Gynaecol 1986;93(12):1276–1285. DOI: 10.1111/j.1471-0528.1986.tb07866.x.
  24. Uterine cervix cancers: staging by magnetic resonance imaging. Ann Radiol (Paris) 1990;33(4-5):241–247.
  25. Magnetic resonance imaging in recurrent carcinoma of the cervix. Br J Radiol 1989;62(738):544–550. DOI: 10.1259/0007-1285-62-738-544.
  26. MR staging of clinical stage I and IIa cervical carcinoma: a reappraisal of efficacy and pitfalls. Eur J Radiol 2001;38(3):225–231. DOI: 10.1016/s0720-048x(00)00278-3.
  27. The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma. Eur Radiol 2003;13(10):2338–2345. DOI: 10.1007/s00330-003-1928-2.
  28. Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR Am J Roentgenol 1997;168(6):1579–1585. DOI: 10.2214/ajr.168.6.9168730.
  29. MR imaging of cervical carcinoma: comparison among T2-weighted, dynamic, and postcontrast T1-weighted images with histopathological correlation. Abdom Imaging 1997;22(1):103–107. DOI: 10.1007/s002619900151.
  30. Endometrial extension of carcinoma of the uterine cervix: a prognostic factor that may modify staging. Cancer 1981;48(1):170–180. DOI: 10.1002/1097-0142(19810701)48:13.0.co;2-0.
  31. MR evaluation of cervical cancer in hysterectomy specimens: correlation of quantitative T2 measurement and histology. J Magn Reson Imaging 1994;4(6):779–786. DOI: 10.1002/jmri.1880040607.
  32. Evaluation of magnetic resonance imaging in the diagnosis of extension in uterine cervical cancer cases with special attention to imaging planes. Nihon Sanka Fujinka Gakkai Zasshi 1990;42(12):1627–1633.
  33. Staging of cervix cancer using MRT. Rofo 1990;152(1):67–70. DOI: 10.1055/s-2008-1046819.
  34. Small pelvic lymph node metastases: evaluation with MR imaging. Clin Radiol 1997;52(6):437–440. DOI: 10.1016/s0009-9260(97)80004-9.
  35. Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. AJR Am J Roentgenol 1997;168(2):393–397. DOI: 10.2214/ajr.168.2.9016214.
  36. Evaluation of the role of MRI at 1.5 T in the staging of the initial extension of cancer of the uterine cervix. J Belge Radiol 1991;74(2):85–90.
  37. Radiological evaluation of lymph node metastases in patients with cervical cancer. a meta-analysis. JAMA 1997;278(13):1096–1101. DOI: 10.1001/jama.1997.03550130070040.
  38. MRI for pretreatment lymph node staging in uterine cervical cancer. AJR Am J Roentgenol 2006;187(5):W538–W543. DOI: 10.2214/AJR.05.0263.
  39. Carcinoma of the uterine cervix. High-resolution turbo spin-echo MR imaging with contrast-enhanced dynamic scanning and T2-weighting. Acta Radiol 1998;39(3):322–326. DOI: 10.1080/02841859809172203.
  40. Clinical significance of magnetic resonance imaging (MRI) in evaluation of the extension of uterine cervical cancer. Nihon Sanka Fujinka Gakkai Zasshi 1993;45(10):1115–1122.
  41. Differential diagnostic performance of magnetic resonance imaging in the detection of lymph node metastases according to the tumor size in early-stage cervical cancer patients. Int J Gynecol Cancer 2010;20(5):841–846. DOI: 10.1111/IGC.0b013e3181db5140.
  42. FDG-PET in carcinoma of the uterine cervix with endometrial extension. Cancer 2006;106(1):196–200. DOI: 10.1002/cncr.21573.
  43. Uterine cervical carcinoma: comparison of CT and MR findings. Radiology 1990;175(1):45–51. DOI: 10.1148/radiology.175.1.2315503.
  44. Invasive carcinoma of the cervix uteri (stage IB-IIB): evaluation using magnetic resonance. Radiol Med 1990;80(3):314–320.
  45. Carcinoma of the cervix: value of MR imaging in detecting parametrial involvement. AJR Am J Roentgenol 1991;156(4):753–756. DOI: 10.2214/ajr.156.4.2003441.
  46. The surgical treatment of cancer of the cervix: stage I and II. Am J Roentgenol Radium Ther Nucl Med 1968;102(1):147–151. DOI: 10.2214/ajr.102.1.147.
  47. Cervical carcinoma: assessment of parametrial invasion and lymph node metastasis with magnetic resonance imaging. Zhonghua Yi Xue Za Zhi (Taipei) 2000;63(8):634–640.
  48. The role of MR imaging in determining surgical eligibility for pelvic exenteration. AJR Am J Roentgenol 1993;160(3):525–531. DOI: 10.2214/ajr.160.3.8430546.
  49. Invasive cervical carcinoma: comparison of MR imaging and surgical findings. Radiology 1988;166(3):623–631. DOI: 10.1148/radiology.166.3.3340756.
  50. Carcinoma of the cervix: predictive value of clinical and magnetic resonance (MR) imaging assessment of prognostic factors. Int J Radiat Oncol Biol Phys 1993;27(4):791–801. DOI: 10.1016/0360-3016(93)90451-z.
  51. Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol 2000;175(3):759–766. DOI: 10.2214/ajr.175.3.1750759.
  52. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol 2007;188(6):1577–1587. DOI: 10.2214/AJR.06.1196.
  53. Role of magnetic resonance imaging and positron emission tomography/computed tomography in preoperative lymph node detection of uterine cervical cancer. Am J Obstet Gynecol 2010;203(2):156.e1-5. DOI: 10.1016/j.ajog.2010.02.041.
  54. Relation between FIGO stage, primary tumor volume, and presence of lymph node metastases in cervical cancer patients referred for radiotherapy. Int J Gynecol Cancer 2003;13(5):657–663. DOI: 10.1136/ijgc-00009577-200309000-00014.
  55. Uterine body invasion of carcinoma of the uterine cervix as seen from surgical specimens. Gynecol Oncol 1988;30(2):173–182. DOI: 10.1016/0090-8258(88)90021-2.
  56. Staging of cervical cancer. Clin Obstet Gynecol 1975;18(3):215–232. DOI: 10.1097/00003081-197509000-00023.
  57. Early invasive cervical cancer: Tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 intergroup study. J Clin Oncol 2006;24(36):5687–5694. DOI: 10.1200/JCO.2006.07.4799.
  58. PET/CT and cross sectional imaging of gynecologic malignancy. Cancer Imaging 2007;7 Spec No A(Special issue A):S130–S138. DOI: 10.1102/1470-7330.2007.9015.
  59. Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study. Gynecol Oncol 2009;112(1):95–103. DOI: 10.1016/j.ygyno.2008.10.005.
  60. Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study. J Comput Assist Tomogr 2004;28(5):620–627. DOI: 10.1097/01.rct.0000138007.77725.0a.
  61. An investigation of the reliability of stage-grouping in cancer of the uterine cervix. Acta Obstet Gynecol Scand 1953;32(1):65–79. DOI: 10.3109/00016345309157564.
  62. Magnetic resonance imaging in cervical cancer: a basis for objective classification. Gynecol Oncol 1989;33(1):61–67. DOI: 10.1016/0090-8258(89)90604-5.
  63. Tumor size evaluated by pelvic examination compared with 3-D quantitative analysis in the prediction of outcome for cervical cancer. Int J Radiat Oncol Biol Phys 1997;39(2):395–404. DOI: 10.1016/s0360-3016(97)00318-0.
  64. Staging of cervical cancer: comparison between magnetic resonance imaging, computed tomography and pelvic examination under anesthesia. J Formos Med Assoc 1992;91(10):982–990.
  65. Staging, volume estimation and assessment of nodal status in carcinoma of the cervix: comparison of magnetic resonance imaging with surgical findings. Clin Radiol 1994;49(7):443–452. DOI: 10.1016/s0009-9260(05)81738-6.
  66. Preoperative staging of uterine cervical carcinoma: comparison of CT and MRI in 99 patients. J Comput Assist Tomogr 1993;17(4):633–640. DOI: 10.1097/00004728-199307000-00022.
  67. Magnetic resonance tomography in malignant genital tumors. Schweiz Med Wochenschr 1992;122(19):719–726.
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