Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study Journal Article


Authors: Mitchell, D. G.; Snyder, B.; Coakley, F.; Reinhold, C.; Thomas, G.; Amendola, M. A.; Schwartz, L. H.; Woodward, P.; Pannu, H.; Atri, M.; Hricak, H.
Article Title: Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study
Abstract: Purpose: To compare MRI, CT, clinical exam and histopathological analysis for predicting lymph node involvement in women with cervical carcinoma, verified by lymphadenectomy. Methods: A 25-center ACRIN/GOG study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT prior to attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist, and retrospectively by 4 independent offsite radiologists, all blinded to surgical, histopathological and other imaging findings. Likelihood of parametrial and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in 3 axes. Association with histologic lymph node involvement, scored as absent, pelvic only and common iliac or paraaortic, was evaluated using Cochran-Mantel Haenszel statistics, univariate and multivariate logistic regression, generalized estimating equations, accuracy statistics and ROC analysis. Results: Lymphatic metastases were found in 34% of women; 13% had common iliac nodal metastases, and 9% had paraortic nodal metastases. Based on the retrospective multi-observer re-reads, the average AUC for predicting histologic lymph node involvement based on tumor size was higher for MRI versus CT, although formal statistic comparisons could not be conducted. Multivariate analysis showed improved model fit incorporating predictors from MRI, but not from CT, over and above the initial clinical and biopsy predictors, although the increase in discriminatory ability was not statistically significant. Conclusion: MRI findings may help predict the presence of histologic lymph node involvement in women with early invasive cervical carcinoma, thus providing important prognostic information. © 2008 Elsevier Inc. All rights reserved.
Keywords: controlled study; human tissue; retrospective studies; major clinical study; histopathology; area under the curve; comparative study; nuclear magnetic resonance imaging; magnetic resonance imaging; lymph node metastasis; staging; hysterectomy; lymph nodes; lymphatic metastasis; neoplasm staging; prospective study; lymph node excision; prospective studies; lymphadenectomy; accuracy; computer assisted tomography; statistics; observer variation; tumor volume; logistic models; tomography, x-ray computed; retrospective study; histology; statistical significance; radiologist; early cancer; early diagnosis; uterine cervix cancer; predictive value of tests; imaging; multivariate logistic regression analysis; multivariate analysis; univariate analysis; uterine cervical neoplasms; radical hysterectomy; uterine cervix biopsy; computed tomography; mantel haenszel test; clinical examination; cervical cancer; figo; receiver operating characteristic
Journal Title: Gynecologic Oncology
Volume: 112
Issue: 1
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2009-01-01
Start Page: 95
End Page: 103
Language: English
DOI: 10.1016/j.ygyno.2008.10.005
PUBMED: 19019414
PROVIDER: scopus
PMCID: PMC2606919
DOI/URL:
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "CODEN: GYNOA" - "Source: Scopus"
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MSK Authors
  1. Lawrence H Schwartz
    290 Schwartz
  2. Hedvig Hricak
    405 Hricak