Introduction/Background US imaging due to its limited cost is under intense investigation as base for dose adaptation in cervical cancer brachytherapy. This work test inter/intra-observer uncertainties between MR and TRUS imaging defining maximum tumor width before first BT application in a prospective cohort of cervical cancer patients undergoing IGABT.
Methodology 110 consecutive cervical cancer patients were included. Before first BT implant underwent MR and TRUS scan with no applicator in place. Images were independently analyzed by three examiners, blinded to the other’s results. With clinical information at hand, maximum tumor width was measured on preBT TRUS and MR (figure.1). Quantitative agreement analysis was undertaken. Intra-class correlation coefficient (ICC), Passing-Bablok and Bland Altman plots were used to evaluate the intra/inter-observers agreement.
Results Average difference between HRCTVMR and HRCTVTRUS was 1.3±3.2 mm (p<0.001); 1.1±4.6 mm (p=0.01) and 0.7±3 mm (p=0.01). Error was less than 3 mm in 79%, 82% and 80% of the measurements for the three observers, respectively. Intra-observer ICC was 0.96 (CI 95% 0.94–0.97), 0.93 (CI 95% 0.9–0.95) and 0.96 (CI 95% 0.95–0.98) respectively. Inter-observer ICC for HRCTVMR width measures was 0.92 (CI 95% 0.89–0.94) with no difference among FIGO stages. Inter-observer ICC for HRCTVTRUS was 0.86 (CI 95% 0.81–0.9). For FIGO stage I/II, ICC HRCTVTRUS values were comparable to respective HRCTVMR values. For larger tumors HRCTVTRUS inter-observer ICC values were lower than respective HRCTVMR although remaining acceptable (table 1).
Conclusion TRUS is equivalent to MR in assessing preBT tumor maximum width in cervical cancer FIGO stage I/II. In advanced stages TRUS is slightly inferior to MR.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.