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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

From the Department of Radiology, and the Gynecology Service/Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Center for Statistical Sciences, Brown University; Department of Diagnostic Imaging, Brown University/Rhode Island Hospital, Providence, RI; Department of Radiology, University of Miami Medical School, Miami; Division of Gynecologic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Radiology and Department of Medical Oncology, Mayo Clinic College of Medicine, Rochester, MN; Department of Radiology, University of Pennsylvania Health System; Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX; Mount Carmel Health System; Department of Radiology, Ohio State University Medical Center, Columbus, OH

Address reprint requests to Hedvig Hricak, MD, PhD, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room c-278, New York, NY 10021; e-mail: muellnea{at}mskcc.org

PURPOSE: To compare magnetic resonance imaging (MRI) and computed tomography (CT) with each other and to International Federation of Gynecology and Obstetrics (FIGO) clinical staging in the pretreatment evaluation of early invasive cervical cancer, using surgicopathologic findings as the reference standard.

PATIENTS AND METHODS: This prospective multicenter clinical study was conducted by the American College of Radiology Imaging Network and the Gynecologic Oncology Group from March 2000 to November 2002; 25 United States health centers enrolled 208 consecutive patients with biopsy-confirmed cervical cancer of FIGO stage IB who were scheduled for surgery based on clinical assessment. Patients underwent FIGO clinical staging, helical CT, and MRI. Surgicopathologic findings constituted the reference standard for statistical analysis.

RESULTS: Complete data were available for 172 patients; surgicopathologic findings were consistent with FIGO stages IA to IIA in 76% and stage IIB in 21%. For the detection of advanced stage ( IIB), sensitivity was poor for FIGO clinical staging (29%), CT (42%), and MRI (53%); specificity was 99% for FIGO clinical staging, 82% for CT, and 74% for MRI; and negative predictive value was 84% for FIGO clinical staging, 84% for CT, and 85% for MRI. MRI (area under the receiver operating characteristic curve [AUC], 0.88) was significantly better than CT (AUC, 0.73) for detecting cervical tumors (P = .014). For 85% of patients, FIGO clinical staging forms were submitted after MRI and/or CT was performed.

CONCLUSION: CT and MRI performed similarly; both had lower staging accuracy than in prior single-institution studies. Accuracy of FIGO clinical staging was higher than previously reported. The temporal data suggest that FIGO clinical staging was influenced by CT and MRI findings.

Supported by original research NCI Grants U01 CA079778 and U01 CA080098.

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

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