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Accuracy of pre-operative tumor size assessment compared to final pathology and frequency of adjuvant treatment in patients with FIGO 2018 stage IB2 cervical cancer
    1. 1Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
    2. 2Gynecology, Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia, Medellin, Colombia
    3. 3Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Spain
    4. 4Department of Obstetrics and Gynecology, Universidad Nacional de Colombia Facultad de Medicina, Bogotá, Bogotá, Colombia
    5. 5Department of Gynecology, Obstetrics and Human reproduction, Section of Gynecologic Oncology, Fundacion Santa Fe de Bogota, Bogotá, Bogotá, Colombia
    6. 6Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    7. 7Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    8. 8Department of Gynecology, Universidad de Navarra, Pamplona, Spain
    9. 9Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    10. 10Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
    1. Correspondence to Dr Teresa L Pan; pan.teresalucia{at}gmail.com

    Abstract

    Objective The primary aim of our study was to compare tumor size assessment by pre-operative evaluation (physical examination and/or imaging) with tumor size on final pathology. As a secondary outcome, we evaluated the rate of adjuvant treatment in patients who underwent radical hysterectomy whose tumor size was ≥3 cm on final pathology.

    Methods Patient details were collected from three separate databases: the University of Texas MD Anderson Cancer Center Radical Hysterectomy Database, the SUCCOR Study Group Database, and the Multi-institutional Database LATAM (encompassing Latin America and Europe). Patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer on pre-operative evaluation (physical examination or imaging) who underwent radical hysterectomy with a therapeutic intent were included. Any histological subtype, any tumor grade, and pre-operative evaluation with clinical evaluation and/or imaging (ultrasound, MRI, CT, or PET/CT) was considered.

    Results A total of 675 patients met eligibility criteria (SUCCOR=350, LATAM=250, MD Anderson=75). The median age was 46 years (range 22–82) and the median body mass index was 25.6 kg/m2 (range 15.1–68). The most common histologic subtype was squamous carcinoma (68%, n=456), and the majority had either grade 2 or 3 disease . Overall pre-operative imaging modalities used were MRI (52%, n=352), ultrasound (21%, n=140), CT (5%, n=32), and PET/CT (1%, n=10). Most patients underwent open surgery (60%, n=404). In total, 113 (17%) patients had lymph node involvement and 58 (9%) patients had parametrial involvement. A total of 343 (51%) patients received adjuvant therapy, with the majority of those receiving chemoradiation (54%, n=186) followed by radiation alone (44%, n=152). The results of the Bland-Altman analysis showed that pre-operative physical examination, MRI, ultrasound, and CT all overestimated tumor size, but only the bias found for physical examination (p<0.0001) and MRI (p=0.0102) were statistically significant. However, in patients who underwent a pre-operative MRI, a total of 293 (83.2%) patients with tumor size 2–4 cm by MRI had concordance with tumor measurement on final pathology. Similarly, when evaluating accuracy of physical examination with tumor size by MRI, we found that there was agreement in 319 (91.1%) patients. Similarly, we found that concordance of physical examination with tumor size on final pathology was 80.6%. There were 340 (50%) patients who had tumor size on pathology ≥3 cm, and 207 (61%) of these received adjuvant therapy. Additionally, there was a significantly higher incidence of positive lymph nodes with increasing tumor size on pathology (2–2.99 cm, 13% (29/222) vs 3–4 cm, 21% (66/316), p=0.022).

    Conclusions Our study showed that there is a high concordance between tumor size assessment by physical examination and MRI, as well as estimates of measurement by MRI and final pathology. In addition, we noted that the majority of patients with FIGO 2018 stage IB2 received adjuvant therapy after radical hysterectomy.

    • Cervical Cancer
    • Pathology
    • Surgical Oncology
    • Radiation Oncology

    Data availability statement

    In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Data availability statement

    In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @Pan_Teresa_MD, @RParejaGineOnco, @julianalrc, @nabilmanzours, @frumovitz, @pedroramirezMD

    • Contributors Study concept and design: TLP, MDI, MFM, PTR. Provision of materials or patients: PTR, MDI, JR, RP, LC, NM. Analysis and interpretation of data: MFM, PTR, TLP, RP. Manuscript writing: TLP, RP, MFM, PTR. Critical review of the manuscript: all authors contributed. Final approval of manuscript: all authors contributed. Guarantor: TLP, PTR.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.