Objectives To evaluate the accuracy of magnetic resonance imaging (MRI) for preoperative prediction of pathologic tumor size and the need of adjuvant radiotherapy in early-stage cervical cancer.
Methods We included patients with the following criteria: stage IB1-IIA2 cervical cancer; no diagnostic conization; visible tumors on MRI; no risk factors such as lympho-vascular space invasion, parametrial invasion, positive resection margin and lymph node metastasis. Adjuvant radiotherapy was applied in those with tumor size ≥4 cm and stromal invasion >1/2.
Results We collected data of 102 patients with the criteria mentioned above between 2000 and 2019. In TNM staging system, stage IB1, IB2, IB3, IIA1 and IIA2 disease were found in 32 (31.4%), 50 (49%), 12 (11.8%), 6 (5.9%) and 2 patients (2%), whereas 48 (47.1%) showed different stage by tumor size measured by MRI. In terms of pathologic tumor size ≥4 cm, MRI had sensitivity of 30.8% (4/9), specificity of 95.5% (85/89), positive predictive value (PPV) of 50% (4/4) and negative predictive value of 90.4% (85/94), showing accuracy of 91.1%. In regard to the need of adjuvant radiotherapy, MRI showed sensitivity of 40% (2/5), specificity of 96.9% (94/97), positive predictive value (PPV) of 40% (2/5) and negative predictive value (NPV) of 96.9% (94/97), showing accuracy of 93.1%.
Conclusions The accuracy of MRI for predicting TMN stage may not be effective. However, MRI may have high specificity and NPV for preoperative prediction of pathologic tumor size ≥4 cm and the need of adjuvant radiotherapy in early-stage cervical cancer.
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