Diagnostic Accuracy of MRI for Cervical Malignancy with Histopathologic Correlation

Document Type : Original Article

Authors

1 Assistant Professor of Obstetrics & Gynaecology, Ain Shams University

2 Lecturer of Obstetrics & Gynaecology, Ain Shams University

3 Obstetrics & Gynaecology Department, Abbassia Square, Cairo

Abstract

Background and Aim: The determination of lymph node metastases, parametrial invasion, and pelvic side wall invasion—all known to be significant prognostic factors—as well as the precise measurement of tumor size present the greatest challenges in cervical cancer. The only gynaecological cancer that is currently primarily staged clinically, according to the FIGO classification, is cervical cancer. The aim of this work is to evaluate the role of MRI in the accurate staging of cancer cervix compared to clinical FIGO staging.  
Methods: This prospective study included 21 patients (19 with primarily untreated pathologically proven cervical cancer who underwent pretreatment MRI and 2 post chemo-radiotherapy cases who underwent post-treatment MRI).  
Results: This study found that 100% sensitivity and 100% specificity in detecting parametrial invasion contrasts with clinical staging's 20% sensitivity. Vaginal invasion may be detected with 100% sensitivity in both stage IIA and IIIA using MRI, which is very sensitive. A hyperintense vaginal thickening (tumor) or the mass itself next to the vaginal wall are the two most clear indicators of vaginal involvement on high-resolution T2-weighted sequences. These sequences also indicate the segmental discontinuity of the typical hypointense signal of the vaginal wall. Stage IIa is represented by vaginal invasion, and stage IIIa is represented when this invasion reaches the lower vaginal third. 
Conclusions: Research has demonstrated that MRI is superior to clinical examinations. When used as the first staging technique, it enables accurate evaluation of the tumor's volume and extension, which improves field planning for external pelvic radiation and brachytherapy.

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