Role of preoperative MR imaging in the evaluation of patients with persistent or recurrent gynaecological malignancies before pelvic exenteration Journal Article


Authors: Donati, O. F.; Lakhman, Y.; Sala, E.; Burger, I. A.; Vargas, H. A.; Goldman, D. A.; Andikyan, V.; Park, K. J.; Chi, D. S.; Hricak, H.
Article Title: Role of preoperative MR imaging in the evaluation of patients with persistent or recurrent gynaecological malignancies before pelvic exenteration
Abstract: Purpose: To determine the diagnostic performance of MRI in assessing local tumour extent and evaluate associations between MRI features and survival in patients undergoing MRI before pelvic exenteration for persistent or recurrent gynaecological cancers. Methods and materials: The study included 50 patients with persistent or recurrent gynaecological malignancies who underwent pelvic exenteration between January 1999 and December 2011 and had MRI at most 90 days before surgery. Two radiologists independently assessed invasion of adjacent organs (on a 5-point scale). Diagnostic accuracy, inter-reader agreement, and associations between organ invasion on MRI and patient survival were evaluated. Results: Areas under receiver operating characteristic curves (AUCs) for invasion of the bladder, rectum and pelvic sidewall were 0.96, 0.90 and 0.98 for reader 1 and 0.95, 0.88 and 0.90 for reader 2. Corresponding sensitivities/specificities were 87.0 %/92.6 %, 81.3 %/97.0 % and 87.5 %/97.2 % for reader 1, and 87.0 %/100.0 %, 75.0 %/97.0 % and 75.0 %/94.4 % for reader 2. Inter-reader agreement was excellent for organ invasion (κ = 0.81-0.85). Pelvic sidewall invasion on MRI was associated with overall and recurrence-free survival (P = 0.01-0.04 for the two readers). Conclusion: Preoperative MRI is accurate in predicting organ invasion. It may guide surgical planning and serve as a predictive biomarker in patients undergoing pelvic exenteration for gynaecological malignancies. Key Points: • MRI can accurately assess bladder and rectal wall invasion before major surgery. • MRI identifies patients requiring extended pelvic exenteration by detecting sidewall invasion. • Inter-reader agreement for detecting organ invasion and tumor size is excellent. • Pelvic sidewall invasion on MRI is associated with shorter overall and recurrence-free survival. © 2013 European Society of Radiology.
Keywords: adult; cancer survival; clinical article; aged; cancer recurrence; nuclear magnetic resonance imaging; magnetic resonance imaging; pelvis; diagnostic accuracy; preoperative evaluation; ovary cancer; uterine cervix cancer; pelvis exenteration; contrast medium; gynecologic cancer; pelvis cancer; reading; receiver operating characteristic; rectum; bladder; recurrence free survival; vulva cancer; pelvic exenteration; vagina cancer; tumor invasion; predictive biomarker; recurrent gynaecological malignancy
Journal Title: European Radiology
Volume: 23
Issue: 10
ISSN: 0938-7994
Publisher: Springer  
Date Published: 2013-10-01
Start Page: 2906
End Page: 2915
Language: English
DOI: 10.1007/s00330-013-2875-1
PROVIDER: scopus
PUBMED: 23652852
DOI/URL:
Notes: --- - "Export Date: 1 November 2013" - "CODEN: EURAE" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Yuliya Lakhman
    34 Lakhman
  2. Evis Sala
    95 Sala
  3. Dennis S Chi
    496 Chi
  4. Kay Jung Park
    183 Park
  5. Hedvig Hricak
    333 Hricak
  6. Debra Alyssa Goldman
    97 Goldman
  7. Olivio Fabrizio Manolo Donati
    16 Donati
  8. Irene Andrea Burger
    10 Burger