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ECR 2011 / C-1595
Usefulness of MRI for evaluation of neoadjuvant chemotherapy effectiveness and preoperative staging of cervical cancer
Congress: ECR 2011
Poster No.: C-1595
Type: Scientific Paper
Keywords: Oncology, Genital / Reproductive system female, Pelvis, MR, Chemoembolisation, Staging, Surgery, Neoplasia, Pathology
Authors: S. Kharuzhyk, I. A. Kosenko, O. P. Matylevich, T. M. Litvinova, I. S. Dulinec; Minsk Region/BY
DOI:10.1594/ecr2011/C-1595

Results

Oil emboli deposition in the tumor after UACE was clearly seen on CT images as zones of high density (about 150 Hounsfield units) while MRI was not able to demonstrate this (Fig. 3).

 

Based on preoperative MRI data complete tumor response after NACT was observed in 7 of 40 (18%) patients. In those patients increased signal intensity zone corresponding to tumor was not visualized on T2W images any more with complete or partial recovery of hypointense cervical stroma (Fig. 4). Deficit of cervical tissues occurred after tumor resorption in some patients (Fig. 5). Pathomorphological examination revealed no residual tumor cells in 1 of those 7 cases, isolated cancer cells – in 5 (Figs. 4 and 5) and microinvasive cancer (stage IA) – in 1 (Fig. 6).

 

In the remaining 33 (83%) patients residual tumor was present on preoperative MRI and was confirmed on pathology. Sensitivity, specificity and accuracy of MRI in the detection of stage IA or greater residual tumor were 97%, 100% and 98% respectively.

 

Partial tumor response (Fig. 7) or tumor stabilization (Fig. 8) were achieved in 21 and 12 patients respectively. According to pathomorphological study tumor invasion to parametrium (stage IIB) was detected in 11 of 33 (33%) patients, to pelvic wall (stage IIIB) – in 2 (6%) and to the bladder (stage IVA) – in 1 (3%). Preoperative MRI and pathomorphology findings coincided in 23 of 33 (70%) cases (Fig. 7), MRI stage was overestimated in 6 (18%) and underestimated in 4 (12%) (Fig. 9). Sensitivity, specificity and accuracy of MRI in the evaluation of parametrial tumor invasion were 73%, 77% and 76% respectively.

 

Pelvic lymph nodes metastases were confirmed on pathology in 9 of 40 (23%) patients. MRI diagnosis was true positive in 4 patients (lymph nodes measured 1.4-2.7 cm in short axis on MRI), false positive – in 3 (1,1-1.2 cm) and false negative – in 5 (5-8 mm). Sensitivity, specificity and accuracy of MRI for lymph nodes metastases detection were 44%, 90% and 85% respectively.

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