Magnetic resonance imaging/positron emission tomography provides a roadmap for surgical planning and serves as a predictive biomarker in patients with recurrent gynecological cancers undergoing pelvic exenteration Journal Article


Authors: Vargas, H. A.; Burger, I. A.; Donati, O. F.; Andikyan, V.; Lakhman, Y.; Goldman, D. A.; Schöder, H.; Chi, D. S.; Sala, E.; Hricak, H.
Article Title: Magnetic resonance imaging/positron emission tomography provides a roadmap for surgical planning and serves as a predictive biomarker in patients with recurrent gynecological cancers undergoing pelvic exenteration
Abstract: Objective: Magnetic resonance imaging (MRI) is the modality of choice for staging gynecological cancers owing to its superb soft tissue resolution, whereas 18Ffluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) allows the assessment of glycolytic activity within the tumor microenvironment. In this study, we evaluated the incremental value of fused MRI/PET over MRI or fluorodeoxyglucose PET/CT alone for assessing local disease extent in patients with recurrent gynecological cancers undergoing pelvic exenteration and determined the associations between imaging findings and clinical outcomes in this patient population. Materials and Methods: The institutional review board approved this retrospective, Health Insurance Portability and Accountability Act (HIPAA)-compliant study of 31 patients who underwent pelvic MRI and PET/CT 3 months or less before pelvic exenteration for recurrent cancers of the uterine cervix, corpus, or vulva/vagina. Using a 1 to 5 scale (1, definitely not present; 5, definitely present), 2 readers independently evaluated MRI, PET/CT, and fused MRI/PET images for the presence of bladder, rectum, and pelvic sidewall invasion. Surgical pathology constituted the reference standard. Measurements of diagnostic accuracy, interreader agreement, and associations between imaging findings and progression-free survival and overall survival were calculated. Results: Compared with MRI or PET/CT, fused MRI/PET correctly improved readers' diagnostic confidence in detecting bladder, rectum, or pelvic sidewall invasion in up to 52% of patients. Interreader agreement was consistently in the highest ("almost perfect") range only for MRI/PET (J = 0.84-1.0). The highest sensitivities (0.82-1.0), specificities (0.91-1.0), and predictive values (0.80-1.0) were consistently achieved with fused MRI/ PET (although the differences were not statistically significant [P 9 0.05]). Pelvic sidewall invasion on MRI/PETwas the only finding significantly associated with both progressionfree and overall survival for both readers (P = 0.0067Y0.0440). Conclusions: In patients with recurrent gynecological cancers undergoing pelvic exenteration, fused MRI/PET served as a predictive biomarker and yielded greater diagnostic confidence and interreader agreement than either MRI or PET/CT. Copyright © 2013 by IGCS and ESGO.
Keywords: adult; cancer survival; clinical article; controlled study; aged; overall survival; cancer recurrence; cancer patient; nuclear magnetic resonance imaging; outcome assessment; positron emission tomography; recurrent cancer; endometrial cancer; diagnostic accuracy; sensitivity and specificity; metastasis; progression free survival; retrospective study; health insurance; uterine cervix cancer; computer assisted emission tomography; pelvis exenteration; pet; rectum cancer; gynecologic cancer; fluorodeoxyglucose; health care planning; pelvis cancer; mri; predictive value; cervical cancer; pet scanner; nuclear magnetic resonance scanner; computed tomography scanner; vulva cancer; institutional review; diagnostic test accuracy study; bladder metastasis; pelvic exenteration; vagina cancer; tumor invasion; diatrizoate; human; female; priority journal; article; mri/pet fusion
Journal Title: International Journal of Gynecological Cancer
Volume: 23
Issue: 8
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2013-10-01
Start Page: 1512
End Page: 1519
Language: English
DOI: 10.1097/IGC.0b013e3182a41e61
PROVIDER: scopus
PUBMED: 24257566
DOI/URL:
Notes: Export Date: 2 January 2014 -- CODEN: IJGCE -- Source: Scopus
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MSK Authors
  1. Yuliya Lakhman
    34 Lakhman
  2. Evis Sala
    95 Sala
  3. Dennis S Chi
    496 Chi
  4. Heiko Schoder
    289 Schoder
  5. Hedvig Hricak
    333 Hricak
  6. Debra Alyssa Goldman
    97 Goldman
  7. Olivio Fabrizio Manolo Donati
    16 Donati
  8. Irene Andrea Burger
    10 Burger