Diagnostic Accuracy of Magnetic Resonance Imaging in the Pre-Operative Staging of Cervical Cancer Patients Who Underwent Neoadjuvant Treatment: A Clinical–Surgical–Pathologic Comparison

SIMPLE SUMMARY: Magnetic resonance imaging plays a key role in preoperative staging and the evaluation of treatment responses of patients affected by cervical cancer. This is due to the ability to identify the involvement of adjacent structures such as the vagina and parametrium as well as lymph nodes. In those patients eligible for neoadjuvant treatment, the assessment of treatment response could help to plan a proper strategy to improve survival outcomes while minimizing side effects. This study aims to compare the diagnostic accuracy of magnetic resonance imaging for cervical cancer staging in subjects who underwent neoadjuvant treatment plus surgery with those who underwent direct surgery. Secondary objectives include accuracy comparison between magnetic resonance imaging and physical examination for detecting parametrium and vaginal involvement, and the accuracy in the evaluation of lymph node status. Our results show that the overall accuracy rate of magnetic resonance imaging in preoperative staging of cervical cancer does not seem to be satisfactory, especially when it is applied to pretreated patients. ABSTRACT: Magnetic resonance imaging (MRI) has been proven to ensure high diagnostic accuracy in the identification of vaginal, parametrial, and lymph node involvement in patients affected by cervical cancer (CC), thus playing a crucial role in the preoperative staging of the disease. This study aims to compare the accuracy of MRI for the preoperative staging of patients with CC who underwent neoadjuvant treatment (NAT) or direct surgery. Retrospective data analysis of 126 patients with primary CC International Federation of Gynecology and Obstetrics stage IB3-IIB who underwent NAT before radical surgery (NAT group = 94) or received surgical treatment alone (control arm = 32) was prospectively performed. All enrolled patients were clinically assessed with both a pelvic examination and MRI before surgical treatment. Data from the clinical examination were compared with the histopathological findings to assess the accuracy of MRI for staging purposes after NAT or before direct surgery. MRI showed an overall accuracy of 46.1%, proving it to be not superior to pelvic and physical examination. The overall MRI accuracy for the evaluation of parametrial, vaginal, and lymph node status was 65.8%, 79.4%, and 79.4%, respectively. In the NAT group, the accuracy for the detection of parametrial, lymph node, and vaginal involvement was lower than the control group; however, the difference was not significant (p ≥ 0.05). The overall accuracy of MRI for the preoperative staging of CC after NAT is shown to be not unsatisfactory. The limits of MRI staging are especially evident when dealing with pre-treated patients.