Accuracy of Multiplanar MR Images in Determination of Actual Tumour Size in Comparison to the Pelvic Examination of Carcinoma Cervix

Abstract

Accurate staging of patients with cervical carcinoma is crucial for appropriate management planning and tumor size has consistently been a key component & major determinant when deciding management plan in especially with early-stages as it dictates whether a patient is a candidate for conservative surgery, radical hysterectomy or chemoradiation. Tumor size also provides a prognostic value, as larger tumors predict risk for distant spread of disease and poor prognostic outcomes. The objective of this study was to determine the sensitivity and specificity of Magnetic Resonance Imaging in the measurement of actual tumor size of invasive cervical carcinoma in comparison to pelvic examination taking histopathology as gold standard. This prospective cross sectional study was conducted in the Department of Radiology and Imaging, BSMMU, Dhaka during the period of September 2018 to August 2020. A total of 60 patients were selected purposively and all were undergone pelvic examination clinically by EUA. Then all of them underwent MRI in Department of Radiology and Imaging, BSMMU. Images of uterine cervix, corpus, vagina and parametrium are taken with a prefixed standard protocol and reporting was done by Radiologist. Comparison was done between the MRI and clinical assessment of actual tumour size. Out of 60 patients in this study the mean age was found 47.5±10.1 years with range from 22 to 60 years. Positive correlation (r=0.993; p=0.001) between histopathological size and MRI size of tumour. Positive correlation (r=0.950; p=0.001) between histopathological size and FIGO size of tumour. MRI findings more correlates with histopathology than clinically detected tumor size. Based on pathologic findings, accuracy was estimated by the degree of agreement with a difference of <0.5 or 1.0 cm between the measurements of tumor size obtained by pelvic examination and imaging modality. Pelvic examination and imaging modality had an accuracy of 53.3% and 75%, respectively, with a difference of <0.5 cm, and an accuracy of 88.3% and 100%, respectively, with a difference of 0.5-1.0 cm. The study also concluded MRI staging was more concordant with pathological stage compared to the clinical stage. Concordance rate of 95.0% in MRI and 65.0% in clinical staging respectively. FIGO staging concurred with histopathology in 39 (65.0%) cases and differed in 21 (35.0%) cases. Magnetic resonance imaging (MRI) is a sensitive and specific modality for accurate determination of tumour size as well as staging of cervical carcinoma in comparison to pelvic examination taking histopathology as gold standard.