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Preoperative MR staging of cervical carcinoma: are oblique and contrast-enhanced sequences necessary?

BACKGROUND: As the choice of treatment in patients with cervical carcinoma depends on cancer stage at diagnosis, accurate staging is essential. PURPOSE: To compare three different combinations of magnetic resonance (MR) sequences for preoperative staging. MATERIAL AND METHODS: Fifty-seven consecutiv...

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Detalles Bibliográficos
Autores principales: Fridsten, Susanne, Hellström, Ann-Cathrin, Hellman, Kristina, Sundin, Anders, Söderén, Boel, Blomqvist, Lennart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122173/
https://www.ncbi.nlm.nih.gov/pubmed/27900204
http://dx.doi.org/10.1177/2058460116679460
Descripción
Sumario:BACKGROUND: As the choice of treatment in patients with cervical carcinoma depends on cancer stage at diagnosis, accurate staging is essential. PURPOSE: To compare three different combinations of magnetic resonance (MR) sequences for preoperative staging. MATERIAL AND METHODS: Fifty-seven consecutive patients with biopsy proven cervical carcinoma underwent MR imaging (MRI) staging followed by primary surgical treatment. Thirty-two of 57 patients had had a cone biopsy prior to MRI. Three MR pulse sequence combinations were retrospectively reviewed by two experienced radiologists. The first imaging protocol consisted of pre-contrast sagittal and transverse images (protocol A), the second protocol included additionally oblique high-resolution T2-weighted (T2W) MR images of the cervix (protocol A+B), and the third included also contrast-enhanced sequences (protocol A+B+C). The imaging findings in the three steps (A, A+B, A+B+C) were recorded. The TNM stage was used for comparison between preoperative imaging and histopathology. Histopathology, together with surgical findings, served as gold standard. RESULTS: In 4/57 (7%) patients, the MR assessment of tumor stage (mrT) was altered when oblique sequences were added to the standard two plane imaging protocol (A+B). The mrT stage was altered in 1/57 (2%) patient when contrast-enhanced sequences were added to standard and oblique sequences (protocol A+B+C). The correlation between visible tumor on MRI and presence of tumor in the resected specimen did not change by adding oblique or contrast-enhanced images. CONCLUSION: It is not necessary to perform oblique and contrast-enhanced sequences in small cervical carcinomas, i.e. without parametrial invasion. To avoid erroneous interpretation, information on previous cone biopsy is essential.