This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Amendola, M. A. Articles by Gatsonis, C. Search for Related Content PubMed PubMed Citation Articles by Amendola, M. A. Articles by Gatsonis, C. Social Bookmarking                            What's this?

Utilization of Diagnostic Studies in the Pretreatment Evaluation of Invasive Cervical Cancer in the United States: Results of Intergroup Protocol ACRIN 6651/GOG 183

From the Department of Radiology, University of Miami Medical School, Miami, FL; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA; Center for Statistical Sciences, Brown University, Providence, RI; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Medical Oncology, Mayo Clinic, Rochester, MN; College of Medicine Division of Gynecologic Oncology, Lee Moffitt Cancer Center, Tampa, FL

Address reprint requests to Hedvig Hricak MD, PhD, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021; e-mail: hricakh{at}mskcc.org

PURPOSE: To review the current utilization of diagnostic tests prescribed by the International Federation of Gynecology and Obstetrics (FIGO) clinical staging guidelines in the pretreatment work-up of invasive cervical cancer, and to compare the data with those of previous patterns of care studies.

PATIENTS AND METHODS: This interdisciplinary American College of Radiology Imaging Network/Gynecologic Oncology Group prospective clinical trial was conducted between March 1, 2000, and November 11, 2002. Twenty-five participating institutions, all from the United States, enrolled a total of 208 patients. Only patients scheduled for surgery with biopsy-confirmed cervical cancer of clinical FIGO stage IB or higher were eligible. The patterns of care data analysis was based on 197 patients who met all inclusion criteria. The conventional FIGO-recommended tests used for pre-enrollment FIGO clinical stage classification were at the discretion of the treating physician; overall frequency of use was tabulated for each test.

RESULTS: Use of cystoscopy (8.1%) and sigmoidoscopy or proctoscopy (8.6%) was significantly lower than in 1988 to 1989 (P < .0001 in each instance). Intravenous urography was used in only 1% of patients as compared with 42% in 1988 to 1989 and 91% in 1983. No patient included in the data analysis had barium enema or lymphangiography. Only 26.9% of patients had examination under anesthesia for FIGO clinical staging.

CONCLUSION: There is a large discrepancy between the diagnostic tests recommended by FIGO and the actual tests used for cervical cancer staging, suggesting a need to reassess the relevance of the FIGO guidelines to current clinical practice in the United States.

Supported by Grants No. U01 CA07978 and U01 CA80098 from the National Cancer Institute.

ACRIN and GOG participated in the study design, data analysis, the critical revision of the report, and the decision to submit for publication.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P. V. Pandharipande, G. Choy, M. G. del Carmen, G. S. Gazelle, A. H. Russell, and S. I. Lee MRI and PET/CT for Triaging Stage IB Clinically Operable Cervical Cancer to Appropriate Therapy: Decision Analysis to Assess Patient Outcomes Am. J. Roentgenol., March 1, 2009; 192(3): 802 - 814. [Abstract] [Full Text] [PDF]

				T. Toita, T. Kodaira, T. Uno, A. Shinoda, Y. Akino, M. Mitsumori, and T. Teshima Patterns of Pretreatment Diagnostic Assessment and Staging for Patients with Cervical Cancer (1999-2001): Patterns of Care Study in Japan Jpn. J. Clin. Oncol., January 17, 2008; (2008) hym136v1. [Abstract] [Full Text] [PDF]

				D. G. Mitchell, B. Snyder, F. Coakley, C. Reinhold, G. Thomas, M. Amendola, L. H. Schwartz, P. Woodward, H. Pannu, and H. Hricak Early Invasive Cervical Cancer: Tumor Delineation by Magnetic Resonance Imaging, Computed Tomography, and Clinical Examination, Verified by Pathologic Results, in the ACRIN 6651/GOG 183 Intergroup Study J. Clin. Oncol., December 20, 2006; 24(36): 5687 - 5694. [Abstract] [Full Text] [PDF]

				H. Hricak, C. Gatsonis, D. S. Chi, M. A. Amendola, K. Brandt, L. H. Schwartz, S. Koelliker, E. S. Siegelman, J. J. Brown, R. B. McGhee Jr, et al. Role of Imaging in Pretreatment Evaluation of Early Invasive Cervical Cancer: Results of the Intergroup Study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183 J. Clin. Oncol., December 20, 2005; 23(36): 9329 - 9337. [Abstract] [Full Text] [PDF]