The Importance of Clinical Examination under General Anesthesia: Improving Parametrial Assessment in Cervical Cancer Patients

Background: Parametrial tumor involvement is an important prognostic factor in cervical cancer and is used to guide management. Here, we investigate the diagnostic value of clinical examination under general anesthesia (EUA) and magnetic resonance imaging (MRI) in determining parametrial tumor spread. Methods: Post-operative pathological findings of 400 patients with primary cervical cancer were compared to the respective MRI data and the results from EUA. The gynecological oncologist had access to the MR images during clinical assessment (augmented EUA, aEUA). Results: Pathologically proven parametrial tumor invasion was present in 165 (41%) patients. aEUA exhibited a higher accuracy than MRI alone (83% vs. 76%; McNemar’s odds ratio [OR] = 2.0, 95%CI 1.25–3.27, p = 0.003). Although accuracy was not affected by tumor size in aEUA, MRI was associated with a lower accuracy in tumors ≥2.5 cm (OR for a correct diagnosis compared to smaller tumors 0.22, p < 0.001). There was also a decrease in specificity when evaluating parametrial invasion by MRI in tumors ≥2.5 cm in diameter (p < 0.0001) compared to smaller tumors (< 2.5 cm). Body mass index had no influence on performance of either method. Conclusions: aEUA has the potential to increase the diagnostic accuracy of MRI in determining parametrial tumor involvement in cervical cancer patients.

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Parametrial evaluation in cervical cancer by magnetic resonance imaging and clinical examination: Analysis of data from the prospective Leipzig School MMR study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.5525 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 5525-5525

Author(s):

Benjamin Wolf ◽

Paulina Sodeikat ◽

Massimiliano Lia ◽

Mireille Martin ◽

Lars-Christian Horn ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Cancer ◽

Logistic Regression ◽

Magnetic Resonance ◽

General Anesthesia ◽

Cancer Patients ◽

Clinical Examination ◽

Resonance Imaging ◽

Mr Images ◽

Regression Modelling

5525 Parametrial evaluation in cervical cancer by magnetic resonance imaging and clinical examination Background: In cervical cancer patients, assessment of parametrial tumor extension is important for staging and treatment planning. The 2019 cervical cancer guideline published by the Féderation Internationale de Gynécologie et d’Obstétrique (FIGO) for the first time includes recommendations for usage of magnetic resonance imaging (MRI) in this setting. However, valid data regarding the accuracy of this method, especially in patients with advanced disease, are sparce. The objective of this investigation was to compare the accuracy of parametrial assessment in cervical cancer patients using MRI and clinical examination under general anesthesia. Methods: A retrospective cohort study based on data from the prospective monocentric observational Leipzig School Mesometrial Resection study was conducted. Cervical cancer patients staged FIGO IB1 to FIGO IVA who underwent primary surgery between 1999 and 2017 were included. Data from pathological specimen of these patients was compared to the MRI findings and the results from clinical examination under general anesthesia. The gynecological oncologist had access to the MR images during clinical assessment. We calculated sensitivities, specificities, and predictive values for both examination methods. We performed logistic regression modelling to determine factors influencing the accuracy of either method. Results: 400 women were included. Pathologically proven parametrial tumor invasion was present in 165 (41%) patients. Examination under anesthesia augmented by intraoperative display of MR images exhibited a higher accuracy (83%) as compared to MRI alone (76%; McNemar’s odds ratio = 2.0, 95%CI 1.25 – 3.27, p = 0.003). While accuracy was not affected by tumor size in clinical examination, MRI was associated with a significant drop in accuracy in tumors ≥ 2.5 cm (univariable logistic regression, OR for a correct diagnosis compared to smaller tumors 0.22, p < 0.001). This association remained significant in a multivariable model. There was also a significant decrease in specificity when evaluating parametrial invasion by MRI in tumors ≥ 2.5 cm in diameter (p < 0.0001). Body mass index had no influence on performance of either method. Accuracy was significantly higher when test results were concordant (OR 7.5 and 6.0 on univariable and multivariable regression modelling, respectively, p < 0.0001 in both cases). Conclusions: Clinical evaluation of the parametrium by pelvic examination under anesthesia in conjunction with intraoperative presentation of MR images leads to more accurate staging in cervical cancer patients as compared to magnetic resonance imaging alone. Clinical examination should therefore remain an integral part of parametrial assessment in cervical cancer patients.

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Diagnostic Value of Serum N1-Methylnicotinamide in Cervical Cancer Patients

Clinical Laboratory ◽

10.7754/clin.lab.2020.200422 ◽

2021 ◽

Vol 67 (02/2021) ◽

Author(s):

Mei Ji ◽

Na Na ◽

Shaochun Lin

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Diagnostic Value

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Cervical cancer: The diagnostic value of rectosonography for the judgement of parametrial invasion in regard of inflammatory stromal reaction

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/j.1471-0528.1993.tb14244.x ◽

1993 ◽

Vol 100 (7) ◽

pp. 696-697 ◽

Cited By ~ 5

Author(s):

Gerald Gitsch ◽

Josef Deutinger ◽

Alexander Reinthaller ◽

Gerhard Breitenecker ◽

Gerhard Bernaschek

Keyword(s):

Cervical Cancer ◽

Diagnostic Value ◽

Stromal Reaction ◽

Parametrial Invasion

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REGIONAL HYPERTHERMIA AND CHEMORADIATION IN ADVANCED CERVICAL CANCER PATIENTS WITH DIFFERENT TYPES OF PARAMETRIAL INVASION

10.26226/morressier.597eedbed462b80296ca0a0b ◽

2017 ◽

Author(s):

Kreynina Julya

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Advanced Cervical Cancer ◽

Regional Hyperthermia ◽

Parametrial Invasion ◽

Different Types

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The Discovery of Comorbidity Deviation in the Cervical Cancer Patients Treated by the Intravenous Pyelography Examination and Clinical Examination (Based on Federation International de Gyneclogie et d’Obstetrique).

Medico-Legal Update ◽

10.37506/mlu.v20i1.379 ◽

2020 ◽

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Clinical Examination ◽

Intravenous Pyelography

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MiR-221 represents an innovative bio-marker in cervical carcinoma detection

10.21203/rs.3.rs-46927/v1 ◽

2020 ◽

Author(s):

Shuangqing Cao ◽

Lei Zheng

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Expression Pattern ◽

Cervical Carcinoma ◽

Roc Curve ◽

Figo Stage ◽

Diagnostic Value ◽

Expression Level ◽

Healthy Controls ◽

Tumorigenesis And Progression

Abstract Background MiR-221 has been identified to play an important role in tumorigenesis and progression. In the present study, we aimed at to investigate the expression pattern of serum miR-221 and evaluate its diagnostic value in cervical cancer. Methods Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the expression pattern of miR-221 in cervical cancer patients and healthy controls. The association of miR-221 with clinicopathological data was analyzed with χ2 test. Then receiver operating characteristic (ROC) curve was built to evaluate the diagnostic value of serum miR-221 by calculating the area under the ROC curve (AUC). Results The results indicated that the miR-221 expression level was statistically elevated in cervical cancer patients compared with healthy individuals. The increased miR-221 expression was significantly associated with lymph node metastasis (P = 0.026) and FIGO stage (P = 0.028). ROC curve suggested that serum miR-221 had a high diagnostic value in differentiating cervical cancer patients from healthy controls with AUC of 0.932 (95%CI: 0.903–0.960) corresponding with sensitivity of 77.6% and specificity of 94.8%. Conclusions Taken together, the expression level of miR-221 is increased in cervical carcinoma and it may serve as a promoting bio-marker in the diagnosis of cervical cancer patients.

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Postoperative pelvic radiotherapy for cervical cancer patients with positive parametrial invasion

Gynecologic Oncology ◽

10.1016/j.ygyno.2004.09.061 ◽

2005 ◽

Vol 96 (2) ◽

pp. 335-340 ◽

Cited By ~ 10

Author(s):

Takashi Uno ◽

Hisao Ito ◽

Koichi Isobe ◽

Yuko Kaneyasu ◽

Naotake Tanaka ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Pelvic Radiotherapy ◽

Parametrial Invasion

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Topographic distribution of lymph node metastasis in patients with stage IB1 cervical cancer: an analysis of 8314 lymph nodes

Radiation Oncology ◽

10.1186/s13014-021-01781-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jing Cai ◽

Xiaoqi He ◽

Hongbo Wang ◽

Weihong Dong ◽

Yuan Zhang ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Pelvic Lymphadenectomy ◽

Individual Treatment ◽

Nodal Metastases ◽

Tumor Spread ◽

Node Metastasis ◽

Parametrial Invasion

Abstract Background Systematic pelvic lymphadenectomy or whole pelvic irradiation is recommended for the patients with stage IB1 cervical cancer. However, the precise pattern of lymphatic tumor spread in cervical cancer is unknown. In the present study we evaluated the distribution of nodal metastases in stage IB1 cervical cancer to explore the possibilities for tailoring cancer treatment. Methods A total of 289 patients with cervical cancer of stage IB1, according to FIGO 2009, were retrospectively analyzed. All patients underwent laparoscopic radical hysterectomy (Querleu and Morrow type C2) and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy (level 2 or level 3 according to Querleu and Morrow) from October 2014 to December 2017. Lymph nodes removed from 7 well-defined anatomical locations as well as other tissues were examined histopathologically, and typed, graded, and staged according to the WHO/IARC classification. Results Totally 8314 lymph nodes were analyzed with the average number of 31.88 ± 10.34 (Mean ± SD) lymph nodes per patient. Nodal metastases were present in 44 patients (15.22%). The incidence of lymphatic spread to different anatomic sites ranged from 0% (presacral) to 30.92% (obturator nodes). Tumor size above 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion were shown to be significantly correlated with the higher risk of lymphatic metastasis, while obesity (BMI ≥ 25) was independently negatively associated with lymphatic metastases. Conclusions The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. Individual treatment could be considered for the selected low-risk patients who have smaller tumors and obesity and lack of the parametrial invasion or LVSI.

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