Elsevier

Gynecologic Oncology

Volume 112, Issue 1, January 2009, Pages 95-103
Gynecologic Oncology

Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study

https://doi.org/10.1016/j.ygyno.2008.10.005Get rights and content

Abstract

Purpose

To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy.

Methods

A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran–Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis.

Results

Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, the average AUC for predicting histologic lymph node involvement based on tumor size was higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not from CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant.

Conclusion

MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information.

Section snippets

Methods

Each imaging site was required to have a proven record of 20 surgical cases of cervical cancer per year, 1.5 T MRI and helical CT equipment, and an adequately qualified and committed radiologist, gynecologic oncologist, and pathologist. All institutions had study-specific institutional review board (IRB) approval. Between March 2000 and November 2002, 208 participants were accrued from 25 academic and community health centers. Methodology is described in further detail in earlier publications

Results

A more detailed description of this patient cohort and multiobserver analysis is described in prior publications [18], [19], [20], and summarized in Appendix 1. Surgical and pathological tumor characteristics are summarized in Table 1. A representative case is illustrated in Fig. 1.

Comment

Most evaluations of cross-sectional imaging have assessed its accuracy compared with a pathologic reference standard. However, the radical surgical specimen is not available for preoperative clinical decision making, and the pathological findings are far from perfect in predicting clinical outcome [2], [4], [6]. It is therefore important to study diagnostic methods that can be utilized prior to and during clinical treatment, and to verify these methods based on clinical outcome whenever

Conflict of interest statement

The authors have no conflicts of interest to declare.

Acknowledgments

This study was funded by NCI grant # U01 CA079778 and U01 CA080098 and was conducted jointly by the American College of Radiology Imaging Network (ACRIN) and the Gynecologic Oncology Group (GOG). Data were collected, managed and analyzed by the Biostatistics and Data Management Center of ACRIN. Both ACRIN and GOG participated in the study design, the data analysis, the writing of the report, and the decision to submit the paper for publication. The NCI did not participate in the study design,

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