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Diagnostic performance of ultrasound in the assessment of parametrial involvement before surgery in cervical cancer patients (diagnostic accuracy study)
  1. D Fischerova1,
  2. T Ballaschova1,
  3. L Dostalek1,
  4. F Frühauf1,
  5. M Zikan2,
  6. J Slama1,
  7. R Kocian1,
  8. A Germanova1,
  9. K Němejcova3,
  10. J Jarkovsky4 and
  11. D Cibula1
  1. 1Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University
  2. 2Department of Obstetrics and Gynecology, Bulovka Hospital, First Faculty of Medicine, Charles University
  3. 3Department of Pathology, First Faculty of Medicine and General University Hospital, Charles University in Prague
  4. 4Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic


Introduction/Background To evaluate the performance of 2-dimensional (2D) ultrasound in preoperative assessment of parametria involvement in patients with cervical cancer planned for primary surgical treatment. Histopathological findings from radical hysterectomy/trachelectomy/parametrectomy were used as a reference standard.

Methodology Patients with biopsy-proven cervical cancer evaluated on ultrasound and planned for primary surgery 01/2004 and 12/2017 were prospectivelly enrolled. The predefined protocol for ultrasound assessment included the presence of tumor, maximum tumor size, tumor-free distance (TFD), the parametrial involvement status, grade of parametrial infiltration and lymph node status.

Abstract – Table 1

Study cohort characteristics (mean (standard deviation)/median (5; 95th percentile), histot.1-squamoc., 2- adenoca, 3-adenosquam, 4-other

Results Altogether, 722 patients were included, out of them 77 patients (11%) were excluded for tumor duplicity, absence of index test or reference standard. Data of 645 patients were analysed, 555 early stage cases (T1[except T1b3], T2a1, FIGO 2018) and 90 locally advanced stage (T1b3 and higher [except T2a1], FIGO 2018). The median age was 42 years and BMI was 24.5. Sixty-two patients (10%) underwent neoadjuvant chemotherapy (NACT). The maximum tumor size was 19.5 mm.

The histologically confirmed prevalence of infiltrated parametria was 3.9% (25/645), with 12 cases correctly identified by the ultrasound. Ultrasound did not detect 11 cases (1.7%) with microscopic spread (<2 mm) and 2 cases (0.3%) with macroscopic infiltration (2.75 and 10.0 mm). The accuracy of ultrasound in parametrial detection reached 97% with diagnostic odds ratio 62.7.

Conclusion Ultrasound is very good method for preoperative assessment of parametrial involvement in cervical cancer with a minimal risk of failure to detect infiltration >2 mm.

Disclosure This work was supported by Charles University in Prague (UNCE 204065 and PROGRES Q28/LF1) and by a grant from the Czech Research Council (No 16-31643A). None of the authors declare any conflict of interest.

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