Transvaginal ultrasound - noninvasive method for the prediction of response to concurrent chemoradiotherapy in cases of cervical cancer

The objective of this paper is to study the differences in tumor size, color score and Doppler indices prior, during and after the treatment with concurrent chemoradiotherapy in cases of locally advanced cervical carcinoma and to predict the response to the treatment. The study group comprised fifty-two patients with histologically confirmed invasive carcinoma of the cervix. All patients were scheduled for concurrent chemoradiotherapy and were assessed by transvaginal ultrasound before the initiation, before 4th course of chemotherapy and 3 months after the therapy. Maximum cervical tumor length, anterior-posterior diameter and width have been measured and tumor volume was calculated. Complete clinical response (CR) was defined when no residual tumor was found. Partial clinical response (PR) was determined when the tumor volume had decreased more than 50 %. Intratumoral blood flow was subjectively evaluated by Color Doppler examination, the lowest resistance index (RI) and the highest peak systolic velocity (PSV) were used for the analysis. The results of this study demonstrate that transvaginal ultrasound is a valuable non-invasive diagnostic tool for the assessment of the response to concurrent chemoradiotherapy in cases of advanced cervical cancer

Early-stage cervical cancer: agreement between ultrasound and histopathological findings with regard to tumor size and extent of local disease

Objectives To determine the agreement between ultrasound and histological examination of the cervix in patients with early stage cervical cancer with regard to tumor size and local extent of the disease. Methods Eighteen patients with histologically proven cervical cancer Stage IB1-IIA according to traditional clinical staging (FIGO 1988) who were scheduled for radical surgery underwent a standardized transvaginal ultrasound examination. The maximum tumor length, anteroposterior tumor diameter, tumor width, tumor area, depth of cervical stroma invasion, and the minimal thickness of tumor-free cervical stroma on sagittal and transverse planes through the cervix were measured, and the local extent of the disease within the parametria and vagina were evaluated. The surgical specimens were examined using a specifically devised method of histopathological examination. The results of the ultrasound and histopathological examinations were compared. Results Limits of agreement were wide and the intra-class correlation coefficient (ICC) was low (0.51-0.58) for three of the four measurements taken to represent the minimal depth of tumor-free cervical stroma, i.e. the results of the measurements taken posteriorly and laterally. However, the limits of agreement were narrower and the ICC values were higher (0.74-0.92) for the depth of cervical stroma invasion and for the tumor size measurements. Histological examination revealed parametrial cancer infiltration in four patients, which was detected during ultrasound examination, with no false-positive results. Conclusions Transvaginal sonography is acceptably accurate for evaluation of tumor size and depth of cervical stroma invasion in clinical practice. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd

Interobserver agreement of transvaginal ultrasound and magnetic resonance imaging in local staging of cervical cancer

Objective: To evaluate interobserver agreement for the assessment of local tumor extension in women with cervical cancer, among experienced and less experienced observers, using transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI). Methods: The TVS observers were all gynecologists and consultant ultrasound specialists, six with and seven without previous experience in cervical cancer imaging. The MRI observers were five radiologists experienced in pelvic MRI and four less experienced radiology residents without previous experience in MRI of the pelvis. The less experienced TVS observers and all MRI observers underwent a short basic training session in the assessment of cervical tumor extension, while the experienced TVS observers received only a written directive. All observers were assigned the same images from cervical cancer patients at all stages (n = 60) and performed offline evaluation to answer the following three questions: (1) Is there a visible primary tumor? (2) Does the tumor infiltrate > ⅓ of the cervical stroma? and (3) Is there parametrial invasion? Interobserver agreement within the four groups of observers was assessed using Fleiss kappa (κ) with 95% CI. Results: Experienced and less experienced TVS observers, respectively, had moderate interobserver agreement with respect to tumor detection (κ (95% CI), 0.46 (0.40–0.53) and 0.46 (0.41–0.52)), stromal invasion > ⅓ (κ (95% CI), 0.45 (0.38–0.51) and 0.53 (0.40–0.58)) and parametrial invasion (κ (95% CI), 0.57 (0.51–0.64) and 0.44 (0.39–0.50)). Experienced MRI observers had good interobserver agreement with respect to tumor detection (κ (95% CI), 0.70 (0.62–0.78)), while less experienced MRI observers had moderate agreement (κ (95% CI), 0.51 (0.41–0.62)), and both experienced and less experienced MRI observers, respectively, had good interobserver agreement regarding stromal invasion (κ (95% CI), 0.80 (0.72–0.88) and 0.71 (0.61–0.81)) and parametrial invasion (κ (95% CI), 0.69 (0.61–0.77) and 0.71 (0.61–0.81)). Conclusions: We found interobserver agreement for the assessment of local tumor extension in patients with cervical cancer to be moderate for TVS and moderate-to-good for MRI. The level of interobserver agreement was associated with experience among TVS observers only for parametrial invasion. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Correlation of sonographic characteristics and pathomorphological findings in cases of early-stage cervical cancer: preliminary results.

Objectives: To correlate the sonographic two-dimensional (2D) gray-scale features with pathological findings in early-stage invasive cervical cancer. Methods: Eighteen patients with biopsy-confirmed invasive cervical carcinoma (stages IB1 IIA according to FIGO staging) who underwent surgery were enrolled in the study. Transvaginal 2D gray-scale sonography was performed in all of them at the Hospital of Kaunas University of Medicine prior to hysterectomy. The largest diameters of tumor mass, tumor shape, tumor area, as well as the deepest cervical stromal invasion and the largest thickness of tumorfree cervical stroma in sagittal and axial planes were correlated with their pathomorphological equivalents using Pearson correlation coefficients. Toshiba NICE and Canvas X Scientific Edition software packages were employed for the analysis and correlation of sonographic and pathomorphological images. The interobserver variability was evaluated by having two blinded sonologists interpret each examination and calculating kappa statistics. The intraobserver variability was assayed in nine patients at 24-h intervals. Results: At 2D gray-scale analysis 15 patients (83%) showed detectable tumor masses. The largest diameters of the tumor mass (maximum length, depth and width) measured at sonographic and pathomorphological examinations correlated well (R = 0.87, R = 0.89 and R = 0.76, respectively). The largest tumor area measured in both sagittal and axial planes also showed a strong correlation (R = 0.78 and R = 0.84, respectively). Poor correlation was seen in the deepest cervical stromal invasion (R = 0.14). A discrepancy of more than 10% of the tumor shape in the sagittal plane seen during sonography and pathomorphological examination occurred in seven cases (47%). Conclusions: Two-dimensional gray-scale sonography is accurate in the assessment of early-stage cervical cancer. This method should be considered in all patients with early-stage cervical cancer scheduled for radical treatment

Early-stage cervical cancer: agreement between ultrasound and histopathological findings with regard to tumor size and extent of local disease.

OBJECTIVES: To determine the agreement between ultrasonographic and histological examination of the cervix in patients with early stage cervical cancer with regard to tumor size and local extent of the disease. METHODS: Eighteen patients with histologically proven cervical cancer stage IB1-IIA according to traditional clinical staging (FIGO 1988) and scheduled for radical surgery underwent a standardized transvaginal ultrasound examination: the maximum tumor length, anterior-posterior tumor diameter, tumor width, tumor area, depth of cervical stroma invasion, and the minimal thickness of tumor free cervical stroma on sagittal and transverse planes through the cervix were measured, and the local extent of the disease into the parametria and vagina was evaluated. The surgical specimens were examined using a dedicated method of histopathological examination. The results of the ultrasound and histopathological examinations were compared. RESULTS: Limits of agreement were wide and the Inter-Class Correlation Coefficient (Inter-CC) was low (0.51 to 0.58) for three of the four measurements taken to represent the minimal depth of tumor free cervical stroma, i.e. the results for the measurements taken posteriorly and laterally. The limits of agreement were smaller and the Inter-CC values were higher (0.74 - 0.92) for the depth of cervical stroma invasion and for the tumor size measurements. Histological examination revealed parametrial cancer infiltration in four patients. All these cases were detected at ultrasound examination with no false positive results

Early stage cervical cancer: tumor delineation bv magnetic resonance imaging and ultrasound in a preoperative staging, verified by pathological results: the results of an European multicentre trial

Objectives: To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. Methods: This prospective multi-center trial was conducted from September 2007 to April 20 10 and enrolled 209 consecutive women with biopsy-proven cervical cancer of FIGO clinical stage IA2-IIA who underwent standardized US and MRI examination and were scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology results: presence of tumour, its size in three axis, tumor stromal invasion 2/3 and parametria! invasion. Results: Complete data were available for 182 patients. The agreement between ultrasound and pathology was excellent for tumour detection, to correctly classify bulky tumors (>4 cm), and to detect stromal invasion > 2/3, and it was good with regard to correctly classify small tumours ( 4 cm, and to detect stromal invasion > 2/3; it was moderate in the detection of tumor and in the assessment of parametrial invasion (kappa values 0.71, 0.76, 0.77, 0.52, and 0.45, respectively). The agreement between histology and US was significantly better with regard to the assessment of tumour presence (P < 0.001) and parametria] invasion (P < 0.001) than the results for MRI. In addition, the results of imaging methods (US, MRI) were not significantly influenced by previous cone biopsy. Conclusions: Ultrasound and V1R1 have a high diagnostic accuracy in the preoperative assessment of women with early stage cervical cancer. Ultrasound might have a higher accuracy in the detection of tumours and in the assessment of parametrial invasion

Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound - A European multicenter trial

OBJECTIVE: To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. PATIENTS AND METHODS: Prospective multi-center trial enrolling 209 consecutive women with early-stage cervical cancer (FIGO IA2-IIA) scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology: remaining tumor, size, tumor stromal invasion<2/3 (superficial) or 652/3 (deep), and parametrial invasion. RESULTS: Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (4cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy. CONCLUSION: US and MRI are highly accurate for the preoperative assessment of women with early-stage cervical cancer, although US may be more accurate in detecting residual tumors and assessing parametrial invasion