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Transrectal ultrasound and magnetic resonance imaging in the evaluation of tumor size following neoadjuvant chemotherapy for locally advanced cervical cancer
Author(s) -
Pinkavova I.,
Fischerova D.,
Zikan M.,
Burgetova A.,
Slama J.,
Svarovsky J.,
Dundr P.,
Dusek L.,
Cibula D.
Publication year - 2013
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.12455
Subject(s) - medicine , magnetic resonance imaging , intraclass correlation , radiology , ultrasound , cervical cancer , chemotherapy , nuclear medicine , neoadjuvant therapy , cancer , radiation therapy , prospective cohort study , breast cancer , pathology , surgery , clinical psychology , psychometrics
Objectives To assess the accuracy of magnetic resonance imaging ( MRI ) and transrectal ultrasound ( TRUS ) in the evaluation of tumor size and in the detection of residual tumor following neoadjuvant chemotherapy ( NACT ) in patients with cervical cancer . Methods This was a prospective study involving 42 women with locally advanced histologically confirmed cervical cancer referred for NACT . Clinical examination, TRUS and MRI were performed before and after NACT . The tumor volume was calculated using three standardized diameters (anteroposterior, laterolateral and craniocaudal) that were measured using both TRUS and MRI . Thereafter patients underwent surgical treatment and the same tumor measurements were taken by a pathologist using a fixed surgical specimen. Tumor volumes were calculated from tumor dimensions using the ellipsoid formula, and data obtained from both imaging methods were compared with pathological results as the gold standard . Results Twelve cases were excluded from the study owing to disease progression (these patients were referred for primary radiotherapy) or inability to perform MRI , leaving data from 30 patients for the final analysis. On average, tumor volume decreased after NACT by 84.6 and 87.1% as measured by MRI and TRUS , respectively. The agreement between measurements obtained by MRI and histology did not reach significance (intraclass correlation coefficient, 0.344 (95% CI , –0.013 to 0.610) , P = 0.059), while agreement between TRUS and histology was statistically significant (intraclass correlation coefficient, 0.795 (95% CI , 0.569–0.902) , P < 0.001). The accuracy of residual tumor detection (for non‐microscopic tumors > 5 mm 3 in volume) reached 77% for both MRI and TRUS . The sensitivity of TRUS was, however, lower than that of MRI (83 vs 96%). The positive predictive values were similar for the two methods . Conclusions TRUS should be considered as an accurate diagnostic method in the evaluation of tumor volume after NACT in patients with cervical cancer and may constitute a reliable alternative imaging method to MRI . Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd .