Title: Diagnostic Accuracy in Staging of Carcinoma Cervix Using Magnetic Resonance Imaging versus Clinical Staging
Authors: Nisha Unni, Brahmadathan.M.N, Suny Thomas, Paul V Puthussery
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.64
Abstract
Cervical cancer is the second most common cancer for women world Wide. The management of the ca cervix depends on the stage of the disease, hence, accurate staging of the disease is necessary for the selection of therapeutic strategy. The current staging system, that is the FIGO clinical staging system, has got some limitation and inconvenience to the patient. It is inadequate in the evaluation of prognostic factors like tumor size, parametrial invasion and nodal status. MRI is a noninvasive method of imaging without using ionizing radiations. Recent technical advances in MR imaging and proven ability of MRI in evaluation of parametrial invasion, tumor size, lymph node metastasis made MRI an optimal option for evaluation of the main prognostic factors and selection of therapeutic strategy.
Objectives: The present study was aimed to find out the sensitivity, specificity, positive and negative predictive value and accuracy of MRI in staging carcinoma cervix by comparing with the FIGO clinical staging system, which was taken as the reference.
Methods: Our study was a diagnostic test evaluation study involving 61 objects who were newly diagnosed cases of carcinoma cervix, already staged clinically by the FIGO system and referred to the radiology department for MRI imaging of pelvis during the period January 2016 to June 2017. MRI imaging of the pelvis and screening of abdomen was done for these patients. Patient was then staged with MRI. Then the predicted stage for each patient with the two methods were compared. The analysis done by standard Chi square test. The sensitivity, specificity, positive and negative predictive values were obtained.
Results: In assessing whether the lesion was confined to cervix or extended beyond cervix sensitivity, specificity, PPV, NPV, & accuracy was 60%, 100%, 100% 92.7% and 93% respectively. In assessing the parametrial extension MRI had a sensitivity, specificity, PPV, NPV, & accuracy of 100%, 60%, 88.5%, 100%, 90.1% respectively. In assessing the bladder mucosal invasion MRI had a sensitivity, specificity, PPV, NPV, & accuracy of 100%, 94%, 78.6%, 100%, 95% respectively. In assessing the rectal mucosal invasion MRI had a sensitivity, specificity, PPV, NPV, & accuracy of 100%, 96.5%, 66.7%, 100%, 96.7% respectively. Clinical staging and MR staging concurred in 85% of cases and differed in 15% of cases.
Conclusion: Magnetic resonance imaging in carcinoma cervix has a good sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy in differentiating between different stages of the disease .In addition to the information regarding tumor size and its local extension, MRI also provided details regarding the pelvic lymphadenopathy, abdominal and inguinal lymphadenopathy, abdominal, pelvic metastasis as well as possibility of lung metastasis if pleural effusion or basal lung lesion were present.
Keywords: Carcinoma cervix, MRI carcinoma cervix, FIGO clinical staging.
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