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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

Donald G. Mitchell, Bradley Snyder, Fergus Coakley, Caroline Reinhold, Gillian Thomas, Marco Amendola, Lawrence H. Schwartz, Paula Woodward, Harpreet Pannu, Hedvig Hricak

From the Department of Radiology, Thomas Jefferson University, Philadelphia, PA; Center for Statistical Sciences, Brown University, Providence, RI; Department of Radiology, University of California, San Francisco; Synarc Inc, San Francisco, CA; Department of Radiology, University of Miami Medical School, Miami, FL; Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, Armed Forces Institute of Pathology, Washington, DC; Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec; and the Department of Radiation Oncology, Toronto Sunnybrook Cancer Centre, Toronto, Ontario, Canada

Address reprint requests to Donald G. Mitchell, MD, Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 1094 Main Bldg, Philadelphia, PA 19107; e-mail: donald.mitchell{at}jefferson.edu

PURPOSE: To compare magnetic resonance imaging (MRI), computed tomography (CT), and clinical examination for delineating early cervical cancer and for measuring tumor size.

PATIENTS AND METHODS: A 25-center study enrolled 208 patients with biopsy-proven invasive cervical cancer for MRI and CT before attempted curative radical hysterectomy. Each imaging study was interpreted prospectively by one onsite radiologist and retrospectively by four independent offsite radiologists, who were all blinded to surgical, histopathologic, and other imaging findings. Likelihood of cervical stromal and uterine body involvement was rated on a 5-point scale. Tumor size measurements were attempted in three axes. Surgical pathology was the standard of reference.

RESULTS: Neither MRI nor CT was accurate for evaluating cervical stroma. For uterine body involvement, the area under the receiver operating characteristic curve was higher for MRI than for CT for both prospective (0.80 v 0.66, respectively; P = .01) and retrospective (0.68 v 0.57, respectively; P = .02) readings. Retrospective readers could measure diameter by CT in 35% to 73% of patients and by MRI in 79% to 94% of patients. Prospective readers had the highest Spearman correlation coefficient with pathologic measurement for MRI (r_s = 0.54), followed by CT (r_s = 0.45) and clinical examination (r_s = 0.37; P < .0001 for all). Spearman correlation of multiobserver diameter measurements for MRI (r_s = 0.58; P < .0001) was double that for CT (r_s = 0.27; P = .03).

CONCLUSION: In patients with cervical cancer, MRI is superior to CT and clinical examination for evaluating uterine body involvement and measuring tumor size, but no method was accurate for evaluating cervical stroma.

Supported by National Cancer Institute Grants No. U01 CA079778 and U01 CA080098.

Conducted jointly by the American College of Radiology Imaging Network (ACRIN) and the Gynecologic Oncology Group (GOG).

Presented in part at the 92nd Scientific Assembly Annual Meeting of the Radiological Society of North America, November 26-December 1, 2005, Chicago, IL.

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

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