Clinical Stage I Carcinoma of the Uterine Cervix Value of Preoperative Magnetic Resonance Imaging in Assessing Parametrial Invasion

Aims and Background The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer. Methods A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference. Results In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging. Conclusions Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.

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Utilization and outcomes of adjuvant systemic chemotherapy alone in high risk, early stage cervical cancer in the United States

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002655 ◽

2021 ◽

pp. ijgc-2021-002655

Author(s):

Koji Matsuo ◽

David J Nusbaum ◽

Shinya Matsuzaki ◽

Maximilian Klar ◽

Muneaki Shimada ◽

...

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Systemic Chemotherapy ◽

Early Stage ◽

External Beam Radiotherapy ◽

The United States ◽

Nodal Metastasis ◽

External Beam ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer

ObjectiveTo examine trends and outcomes related to adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer.MethodsThis retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000 to 2016. Surgically treated women with American Joint Commission on Cancer stages T1–2 cervical cancer who had high risk factors (nodal metastasis and/or parametrial invasion) and received additional therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for systemic chemotherapy versus external beam radiotherapy with chemotherapy.ResultsAmong 2462 patients with high risk factors, 185 (7.5%) received systemic chemotherapy without external beam radiotherapy, of which the utilization significantly increased over time in multivariable analysis (adjusted odds ratio per 1 year increment 1.06, 95% confidence interval (CI) 1.02 to 1.09). In weighted models, adjuvant chemotherapy and combination therapy (external beam radiotherapy and chemotherapy) had comparable overall survival among patients aged <40 years (hazard ratio (HR) 0.73, 95% CI 0.41 to 1.33), in adenocarcinoma or adenosquamous histologies (HR 0.90, 95% CI 0.62 to 1.32), and in those with nodal metastasis alone without parametrial tumor invasion (HR 1.17, 95% CI 0.84 to 1.62). In contrast, systemic chemotherapy alone was associated with increased all cause mortality compared with combination therapy in patients aged ≥40 years (HR 1.57, 95% CI 1.19 to 2.06), with squamous histology (HR 1.63, 95% CI 1.19 to 2.22), and with parametrial invasion alone (HR 1.87, 95% CI 1.09 to 3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95% CI 1.06 to 2.52).ConclusionUtilization of adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer is increasing in the United States in the recent years. Our study suggests that survival effects of adjuvant systemic chemotherapy may vary based on patient and tumor factors. External beam radiotherapy with chemotherapy remains the standard for high risk, early stage cervical cancer, and use of adjuvant systemic chemotherapy without external beam radiotherapy should be considered with caution.

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Faculty Opinions recommendation of Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.6508957.6637055 ◽

2010 ◽

Author(s):

Gary Leiserowitz ◽

Susannah Mourton

Keyword(s):

Cervical Cancer ◽

Patient Group ◽

Early Stage ◽

Low Risk ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer

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Utilization and outcome of systemic chemotherapy for high-risk early-stage cervical cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17521 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17521-e17521

Author(s):

Munetaka Takekuma ◽

Shinya Matsuzaki ◽

Koji Matsuo

Keyword(s):

Cervical Cancer ◽

High Risk ◽

Systemic Chemotherapy ◽

Risk Group ◽

Early Stage ◽

Nodal Metastasis ◽

High Risk Group ◽

Parametrial Invasion ◽

All Cause Mortality ◽

Early Stage Cervical Cancer

e17521 Background: To examine trends and outcomes of systemic chemotherapy for high-risk early-stage cervical cancer. Methods: This retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000-2016. Surgically-treated women with stage T1-2 cervical cancer who had high-risk factors (lymph node metastasis and/or parametrial invasion) and received adjuvant therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for chemotherapy use versus external beam with chemotherapy (CCRT). Results: Among 2, 462 women with high-risk factor, 185 (7.5%) received systemic chemotherapy. Utilization of chemotherapy has significantly increased over time in multivariable analysis (adjusted-odds ratio per 1-year increment, 1.06, 95% confidence interval [CI] 1.02-1.09). In weighted models, adjuvant chemotherapy and CCRT had comparable survival among women aged < 40 (hazard ratio [HR] for all-cause mortality 0.73, 95%CI 0.41-1.33), adenocarcinoma or adenosquamous histologies (HR 0.90, 95%CI 0.62-1.32), and high-risk group based on nodal metastasis alone (HR 1.17, 95%CI 0.84-1.62). In contrast, chemotherapy was associated with increased all-cause mortality compared to CCRT among women aged ≥40 (HR 1.57, 95%CI 1.19-2.06), squamous histology (HR 1.63, 95%CI 1.19-2.22), and high-risk group per parametrial invasion alone (HR 1.87, 95%CI 1.09-3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95%CI 1.06-2.52). Conclusions: Utilization of systemic chemotherapy for high-risk early-stage cervical cancer is increasing in the United States. Survival effects of adjuvant chemotherapy varied per patient and tumor factors, and this indication may be limited to those who are < 40 years with non-squamous histology and absence of parametrial invasion.

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Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer

Journal of Translational Medicine ◽

10.1186/s12967-018-1531-6 ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 7

Author(s):

Yohann Dabi ◽

◽

Claire Willecocq ◽

Marcos Ballester ◽

Xavier Carcopino ◽

...

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Low Risk ◽

Risk Population ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer

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Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2010.08.005 ◽

2010 ◽

Vol 119 (3) ◽

pp. 426-430 ◽

Cited By ~ 22

Author(s):

Dae-Chul Jung ◽

Mi-Kyung Kim ◽

Sokbom Kang ◽

Sang-Soo Seo ◽

Jeong Yeon Cho ◽

...

Keyword(s):

Cervical Cancer ◽

Patient Group ◽

Early Stage ◽

Low Risk ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer

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The Role of Magnetic Resonance Imaging in Pretreatment Evaluation of Early-Stage Cervical Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000169 ◽

2014 ◽

Vol 24 (7) ◽

pp. 1292-1298 ◽

Cited By ~ 18

Author(s):

Wei Zhang ◽

Jie Zhang ◽

Jiaxin Yang ◽

Huadan Xue ◽

Dongyan Cao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Cancer ◽

Lymph Node ◽

Magnetic Resonance ◽

Tumor Size ◽

Early Stage ◽

Pelvic Examination ◽

Resonance Imaging ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer

ObjectiveThe aim of this study is to evaluate the accuracy of magnetic resonance imaging (MRI) in the preoperative assessments of primary tumor size, parametrial invasion, and pelvic lymph node metastasis in patients with early-stage cervical cancer.Materials and MethodsA cohort of 125 patients with International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer who had preoperative MRI and underwent radical hysterectomy were enrolled and analyzed. The accuracy of preoperative MRI scan and pelvic examination in the measurement of tumor size was assessed based on postoperative measurement and pathologic findings. The accuracy of detection of lymph node status and parametrial invasion was also assessed by comparing the MRI and pathologic findings.ResultsThe mean diameter of the tumor size measured by postoperative measurement, MRI, and pelvic examination was 2.97 ± 1.39 cm, 2.78 ± 1.24 cm, and 1.97 ± 1.70 cm, respectively. There were significant differences in the mean diameter of the tumor size between pelvic examinations and MRI scan or postoperative measurement (P < 0.0001). Based on postoperative measurement findings, accuracy of tumor size measurement between pelvic examination and MRI was determined by the degree of agreement with a difference of less than 0.5 or 1.0 cm. Pelvic examination and MRI had an accuracy of 24.75% and 39.60%, respectively, with a difference of less than 0.5 cm, and had an accuracy of 43.56% and 61.39%, respectively, with a difference of less than 1.0 cm. Correlation with postoperative measurement in tumor size was higher for MRI (r[s] = 0.481) than that for pelvic examination (r[s] = 0.362). The sensitivity, specificity, and accuracy of MRI in detecting lymph node metastasis were 27.78%, 85.98%, 77.60%, respectively. The negative predictive value of MRI in detecting parametrial invasion is 100%.ConclusionsMagnetic resonance imaging is an accurate noninvasive modality for preoperative evaluation of tumor size and also gives important information to parametrial invasion and lymph node status in patients with early-stage cervical cancer.

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Loop Electrosurgical Excision Procedure Findings for Identification of Patients With Early-Stage Cervical Cancer Suitable for Less Radical Surgery

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31825fb63b ◽

2012 ◽

Vol 22 (7) ◽

pp. 1214-1219 ◽

Cited By ~ 10

Author(s):

Mi-Kyung Kim ◽

Min A Kim ◽

Jae Weon Kim ◽

Hyun Hoon Chung ◽

Noh-Hyun Park ◽

...

Keyword(s):

Cervical Cancer ◽

Subgroup Analysis ◽

Resection Margin ◽

Early Stage ◽

Low Risk ◽

Depth Of Invasion ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer ◽

Loop Electrosurgical Excision ◽

Loop Electrosurgical Excision Procedure

ObjectiveTo define a subset of patients with early-stage cervical cancer at low risk for parametrial invasion through pathologic parameters of loop electrosurgical excision procedure (LEEP).Materials and MethodsA retrospective analysis of data from 131 patients who underwent LEEP before radical hysterectomy or radical trachelectomy for stage IA2 to IB1 cervical cancer was performed. Subgroup analysis was performed to define a group of patients at the lowest risk for parametrial invasion based on LEEP findings.ResultsOverall, 7 (5.3%) of 131 patients showed parametrial involvement, all of whom had residual tumors in hysterectomy specimens. Risk factors for residual disease included a tumor width greater than 30 mm and a positive endocervical or deep resection margin. A subgroup analysis demonstrated that LEEP parameters, including a depth of invasion of 5 mm or less and a negative endocervical resection margin, were able to define the subgroup of patients at low risk for parametrial invasion. In 24 patients (18.3%) who met these criteria, there was no evidence of parametrial spread as well as nodal metastasis.ConclusionA subgroup of patients with early-stage cervical cancer selected by the 2 LEEP variables, depth of invasion of 5 mm or less and a negative endocervical resection margin, demonstrated no risk for parametrial invasion.

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