Stage IB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy

• Published in: Radiology Vol. 269; no. 1; pp. 149 - 158
• Main Authors: Lakhman, Yulia, Akin, Oguz, Park, Kay J, Sarasohn, Debra M, Zheng, Junting, Goldman, Debra A, Sohn, Michael J, Moskowitz, Chaya S, Sonoda, Yukio, Hricak, Hedvig, Abu-Rustum, Nadeem R
• Format: Journal Article
• Language: English
• Published: United States Radiological Society of North America, Inc 01.10.2013
• Subjects: Adult; Conization - methods; Female; Humans; Hysterectomy - methods; Infertility, Female - etiology; Infertility, Female - prevention & control; Magnetic Resonance Imaging - methods; Neoplasm Staging; Organ Sparing Treatments - methods; Original Research; Patient Selection; Preoperative Care; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Surgery, Computer-Assisted - methods; Treatment Outcome; Uterine Cervical Neoplasms - complications; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 0033-8419; 1527-1315
• DOI: 10.1148/radiol.13121746

To determine whether magnetic resonance (MR) imaging evaluation of key morphologic tumor characteristics can improve patient selection for radical trachelectomy. The institutional review board approved and waived informed consent for this study of 62 patients (mean age, 32 years; age range, 23-42 years) with International Federation of Gynecology and Obstetrics stage IB1 cervical carcinoma who underwent attempted radical trachelectomy between November 2001 and January 2011 and had preoperative MR imaging. Retrospectively, two radiologists reviewed MR images for tumor presence and size, distance between tumor and internal os, and presence of deep cervical stromal invasion. Associations between MR imaging findings and surgery type were tested. Sensitivity and specificity of tumor detection were, respectively, 87% and 100% (reader 1) and 76% and 95% (reader 2). Six of six patients with negative cone biopsy margins and no tumor at postconization MR imaging were without tumor at trachelectomy pathologic analysis. Mean differences between MR imaging and histologic tumor sizes were 0.7 mm (range, -15 to 11 mm) for reader 1 and 2.2 mm (range, -9 to 15 mm) for reader 2. Sensitivities for deep cervical stromal invasion were 75% (reader 1) and 50% (reader 2). For each reader, nine of nine (100%) patients with tumor 5 mm or less from the internal os and three of five (60%) patients with tumor 6-9 mm from the internal os at MR imaging needed radical hysterectomy. For both readers, tumor size of 2 cm or larger (P < .001) and deep cervical stromal invasion (P ≤ .003) at MR imaging were associated with increased chance of radical hysterectomy. Pretrachelectomy MR imaging can help identify high-risk patients likely to need radical hysterectomy or confirm the absence of residual tumor in the cervix after a cone biopsy with negative margins.