Early stage cervical cancer: tumor delineation bv magnetic resonance imaging and ultrasound in a preoperative staging, verified by pathological results: the results of an European multicentre trial

Objectives: To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. Methods: This prospective multi-center trial was conducted from September 2007 to April 20 10 and enrolled 209 consecutive women with biopsy-proven cervical cancer of FIGO clinical stage IA2-IIA who underwent standardized US and MRI examination and were scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology results: presence of tumour, its size in three axis, tumor stromal invasion < 2/3 or > 2/3 and parametria! invasion. Results: Complete data were available for 182 patients. The agreement between ultrasound and pathology was excellent for tumour detection, to correctly classify bulky tumors (>4 cm), and to detect stromal invasion > 2/3, and it was good with regard to correctly classify small tumours (< 2 cm) and to detect parametrial invasion (kappa values; 0.84 0.82, 0.8 1, 0.78 and 0.75, respectively). The agreement between MRI and histology was good with regard to correctly classify tumours as < 2 cm, or > 4 cm, and to detect stromal invasion > 2/3; it was moderate in the detection of tumor and in the assessment of parametrial invasion (kappa values 0.71, 0.76, 0.77, 0.52, and 0.45, respectively). The agreement between histology and US was significantly better with regard to the assessment of tumour presence (P < 0.001) and parametria] invasion (P < 0.001) than the results for MRI. In addition, the results of imaging methods (US, MRI) were not significantly influenced by previous cone biopsy. Conclusions: Ultrasound and V1R1 have a high diagnostic accuracy in the preoperative assessment of women with early stage cervical cancer. Ultrasound might have a higher accuracy in the detection of tumours and in the assessment of parametrial invasion.