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The Negative Predictive Value of Clinical Examination With or Without Anesthesia Versus Magnetic Resonance Imaging for Parametrial Infiltration in Cervical Cancer Stages IB1 to IIA
  1. Suzanne M. Bleker, MA, MSc*,
  2. Shandra Bipat, PhD,
  3. Anje M. Spijkerboer, PhD,
  4. Jacobus van der Velden, PhD*,
  5. Jaap Stoker, MD, PhD and
  6. Gemma G. Kenter, MD, PhD*
  1. *Departments of Gynecology and Obstetrics and
  2. Radiology, Academic Medical Center, University of Amsterdam, the Netherlands.
  1. Address correspondence and reprint requests to Gemma G. Kenter, MD, PhD, Center of Gynecological Oncology Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 1105 AZ, the Netherlands. E-mail: ggkenter{at}


Objective This study aimed to compare the negative predictive value (NPV) of clinical examination with or without anesthesia and magnetic resonance imaging (MRI) in identifying patients with cervical carcinoma without parametrial infiltration.

Methods This retrospective cohort study was conducted at the Academic Medical Center in Amsterdam. The medical files of 203 patients diagnosed with cervical cancer stages IB1-IIA, who underwent surgical treatment between January 1, 2003, and January 31, 2011, were reviewed. We compared clinical International Federation of Gynecology and Obstetrics staging and MRI during the staging procedure. The results were compared with the parametrial status by surgical-pathological investigation, which was considered to be the reference standard.

Results Based on the surgical-pathological findings, 16.7% of the patients treated surgically had parametrial infiltration. For parametrial infiltration, examination under anesthesia (EUA) had an NPV of 65.3% and MRI of 76.9%, respectively. We found no significant difference between these NPVs.

Conclusions Examination under anesthesia and MRI are equal in identifying cervical cancer patients without parametrial infiltration with a tendency for MRI to perform better than EUA. When outpatient clinical staging is considered inconclusive, pretreatment staging may be limited to MRI. In these cases, EUA seems to have no additional value.

  • Cervical cancer
  • Parametrial infiltration
  • Examination under anesthesia
  • Magnetic resonance imaging

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  • The authors declare no conflicts of interest.