TY - JOUR
T1 - PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery
AU - Testa, Antonia Carla
AU - Moro, Francesca
AU - Pasciuto, Tina
AU - Moruzzi, M. C.
AU - Di Legge, A.
AU - Fuoco, G.
AU - Autorino, R.
AU - Collarino, A.
AU - Gui, Benedetta
AU - Zannoni, Gian Franco
AU - Gambacorta, Maria Antonietta
AU - Micco', Maura
AU - Rufini, Vittoria
AU - Scambia, Giovanni
AU - Ferrandina, Maria Gabriella
PY - 2018
Y1 - 2018
N2 - Objective: To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. Methods: Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2–IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver–operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. Results: Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. Conclusions: Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
AB - Objective: To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. Methods: Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2–IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver–operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. Results: Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. Conclusions: Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
KW - Adult
KW - Aged
KW - Carcinoma, Squamous Cell
KW - Chemoradiotherapy
KW - Female
KW - Humans
KW - Hysterectomy
KW - Middle Aged
KW - Neoadjuvant Therapy
KW - Neoplasm, Residual
KW - Obstetrics and Gynecology
KW - Prospective Studies
KW - Radiological and Ultrasound Technology
KW - Radiology, Nuclear Medicine and Imaging
KW - Reproducibility of Results
KW - Reproductive Medicine
KW - Sensitivity and Specificity
KW - Ultrasonography, Doppler, Color
KW - Uterine Cervical Neoplasms
KW - Young Adult
KW - cervical cancer
KW - chemoradiation
KW - ultrasound
KW - Adult
KW - Aged
KW - Carcinoma, Squamous Cell
KW - Chemoradiotherapy
KW - Female
KW - Humans
KW - Hysterectomy
KW - Middle Aged
KW - Neoadjuvant Therapy
KW - Neoplasm, Residual
KW - Obstetrics and Gynecology
KW - Prospective Studies
KW - Radiological and Ultrasound Technology
KW - Radiology, Nuclear Medicine and Imaging
KW - Reproducibility of Results
KW - Reproductive Medicine
KW - Sensitivity and Specificity
KW - Ultrasonography, Doppler, Color
KW - Uterine Cervical Neoplasms
KW - Young Adult
KW - cervical cancer
KW - chemoradiation
KW - ultrasound
UR - http://hdl.handle.net/10807/127675
UR - http://obgyn.onlinelibrary.wiley.com/hub/journal/10.1002/(issn)1469-0705/
U2 - 10.1002/uog.18953
DO - 10.1002/uog.18953
M3 - Article
SN - 0960-7692
VL - 52
SP - 110
EP - 118
JO - Ultrasound in Obstetrics and Gynecology
JF - Ultrasound in Obstetrics and Gynecology
ER -