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- Title
Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery.
- Authors
Gui, Benedetta; Valentini, Anna Lia; Miccò, Maura; D'Agostino, Giuseppe Roberto; Tagliaferri, Luca; Zannoni, Gian Franco; Fanfani, Francesco; Manfredi, Riccardo; Bonomo, Lorenzo; D'Agostino, Giuseppe Roberto
- Abstract
<bold>Background: </bold>Imaging findings of residual cervical tumor after chemoradiotherapy can closely resemble those of post-irradiation inflammation. <bold>Purpose: </bold>To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC). <bold>Material and Methods: </bold>Retrospective analysis of prospectively collected data from 41 patients with histopathologically proven LACC (International Federation of Gynecology and Obstetrics stage ≥IB2) who underwent MRI before and after chemoradiotherapy. At each examination, a qualitative and semi-quantitative analysis of primary tumor, including tumor volume and signal intensity were assessed on T2-weighted (T2W) images. All patients had surgery after post-chemoradiotherapy MRI. MRI and histopathologic results were compared. <bold>Results: </bold>All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively. <bold>Conclusion: </bold>The differentiation of residual tumor from post-irradiation inflammation with early post- chemoradiotherapy MRI (within 28-60 days) is difficult with a high risk of false positive results. Combination of qualitative and semi-quantitative analysis does not improve the accuracy. Conversely, post-chemoradiotherapy MRI has a high negative predictive value with a low risk of false negative results. The role of conventional MRI combined with functional techniques should be evaluated.
- Subjects
CERVICAL cancer; CHEMORADIOTHERAPY; MAGNETIC resonance imaging; SURGERY; TUMORS; INFLAMMATION; CARCINOGENESIS; ANTHROPOMETRY; COMBINED modality therapy; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; RESEARCH; CERVIX uteri tumors; EVALUATION research; PREDICTIVE tests; RETROSPECTIVE studies; TUMOR treatment
- Publication
Acta Radiologica, 2016, Vol 57, Issue 9, p1123
- ISSN
0284-1851
- Publication type
journal article
- DOI
10.1177/0284185115617346