Diagnostic Accuracy of MRI in Detecting Stromal Invasion in Early Cervical Cancer Patients Taking Histopathology as Gold Standard: Detecting Stromal Invasion in Cervical Cancer

Nosheen Ahmad; Maryum Mukhtar; Aamna Gilani; Adeela Abid Bukhari; Amber Manzoor; Ayesha Liaqat

doi:10.54393/pjhs.v6i4.2113

Authors

Nosheen Ahmad Faisalabad Medical University, Faisalabad, Pakistan
Maryum Mukhtar Madina Teaching Hospital, Faisalabad, Pakistan
Aamna Gilani Madina Teaching Hospital, Faisalabad, Pakistan
Adeela Abid Bukhari Department of Radiology, Shifa International Hospital, Faisalabad, Pakistan
Amber Manzoor Department of Radiology, Mujahid Hospital, Faisalabad, Pakistan
Ayesha Liaqat Madina Teaching Hospital, Faisalabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i4.2113

Keywords:

Cervical Cancer, Magnetic Resonance Imaging, Stromal Invasion, Histopathology, Diagnostic Accuracy

Abstract

Cervical cancer is a major cause of cancer-related deaths among women. MRI is a non- invasive imaging technique commonly used to evaluate tumor extent, but its diagnostic accuracy in detecting stromal invasion in early cervical cancer remains uncertain. Objective: To determine the diagnostic accuracy of MRI in detecting stromal invasion in early cervical cancer patients taking histopathology as gold standard. Methods: This Cross-sectional validation was conducted at the Department of Radiology, Faisalabad Medical University (FMU), Faisalabad, form 1st April 2024 to 30th September 2024. A total of 200 patients aged 30-70 years with early cervical cancer were included in the study. All patients underwent pelvic MRI scans using a 1.5 Tesla MRI machine. The MRI findings were assessed for the presence or absence of stromal invasion and compared with histopathology results. All the data was analyzed in SPSS and sensitivity, specificity, and diagnostic accuracy was calculated for MRI against histopathology. Results: The overall sensitivity, specificity, Positive Predictive Value (PPV), negative predictive value (NPV), and diagnostic accuracy of MRI in detecting stromal invasion in early cervical cancer patients, were 91.26%, 89.70%, 90.38%, 90.63%, and 90.50%, respectively with histopathology as the gold standard. Conclusion: This study concluded that MRI has a high diagnostic accuracy in detecting stromal invasion in early cervical cancer patients.

References

Balcacer P, Shergill A, Litkouhi B. MRI of cervical cancer with a surgical perspective: staging, prognostic implications and pitfalls. Abdominal Radiology. 2019 Jul; 44: 2557-71. doi: 10.1007/s00261-019-01984-7.

Chikaraddi AK, Kanakaraddi S, Kalwad P, Kadole A, Budni S. Cervical Cancer Diagnostics Using Machine Learning Algorithms. In2024 5th International Conference for Emerging Technology (INCET). 2024 May: 1-6. doi: 10.1109/INCET61516.2024.10593538.

Avesani G, Perazzolo A, Amerighi A, Celli V, Panico C, Sala E et al. The Utility of Contrast-Enhanced Magnetic Resonance Imaging in Uterine Cervical Cancer: A Systematic Review. Life. 2023 Jun; 13(6): 1368. doi: 10.3390/life13061368.

Smith GE and Gormly KL. Magnetic resonance imaging in the staging of cervical carcinoma: a pictorial review. Journal of Medical Imaging and Radiation Oncology. 2008 Oct; 52(5): 427-33. doi: 10.1111/j.1440-1673.2008.01999.x.

Chen J, Kitzing YX, Lo G. Systematic Review-Role of MRI in Cervical Cancer Staging. Cancers. 2024 May; 16(11): 1983. doi: 10.3390/cancers16111983.

Bi Q, Bi G, Wang J, Zhang J, Li H, Gong X et al. Diagnostic accuracy of MRI for detecting cervical invasion in patients with endometrial carcinoma: a meta-analysis. Journal of Cancer. 2021 Jan; 12(3): 754. doi: 10.7150/jca.52797.

Wu LM, Xu JR, Gu HY, Hua J, Haacke EM, Hu J. Predictive value of T2-weighted imaging and contrast-enhanced MR imaging in assessing myometrial invasion in endometrial cancer: a pooled analysis of prospective studies. European Radiology. 2013 Feb; 23: 435-49. doi: 10.1007/s00330-012-2609-9.

Xiao M, Yan B, Li Y, Lu J, Qiang J. Diagnostic performance of MR imaging in evaluating prognostic factors in patients with cervical cancer: a meta-analysis. European Radiology. 2020 Mar; 30: 1405-18. doi: 10.1007/s00330-019-06461-9.

Lin G, Huang YT, Chao A, Lin YC, Yang LY, Wu RC et al. Endometrial cancer with cervical stromal invasion: diagnostic accuracy of diffusion-weighted and dynamic contrast enhanced MR imaging at 3T. European Radiology. 2017 May; 27: 1867-76. doi: 10.1007/s00330-016-4583-0.

Ren J, Li Y, Yang JJ, Zhao J, Xiang Y, Xia C et al. MRI-based radiomics analysis improves preoperative diagnostic performance for the depth of stromal invasion in patients with early stage cervical cancer. Insights into Imaging. 2022 Jan; 13(1): 17. doi: 10.1186/s13244-022-01156-0.

Shi J, Dong Y, Jiang W, Qin F, Wang X, Cui L et al. MRI-based peritumoral radiomics analysis for preoperative prediction of lymph node metastasis in early-stage cervical cancer: a multi-center study. Magnetic Resonance Imaging. 2022 May; 88: 1-8. doi: 10.1016/j.mri.2021.12.008.

Woo S, Atun R, Ward ZJ, Scott AM, Hricak H, Vargas HA. Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis. European Radiology. 2020 Oct; 30: 5560-77. doi: 10.1007/s00330-020-06909-3.

Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM. The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights into Imaging. 2017 Oct; 8: 471-81. doi: 10.1007/s13244-017-0567-0.

Ditto A, Leone Roberti Maggiore U, Evangelisti G, Bogani G, Chiappa V, Martinelli F et al. Diagnostic Accuracy of Magnetic Resonance Imaging in the Pre-Operative Staging of Cervical Cancer Patients Who Underwent Neoadjuvant Treatment: A Clinical-Surgical-Pathologic Comparison. Cancers. 2023 Mar; 15(7): 2061. doi: 10.3390/cancers15072061.

Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology. 2013 Mar; 266(3): 717-40. doi: 10.1148/radiol.12120315.

Patel-Lippmann K, Robbins JB, Barroilhet L, Anderson B, Sadowski EA, Boyum J. MR imaging of cervical cancer. Magnetic Resonance Imaging Clinics. 2017 Aug; 25(3): 635-49. doi: 10.1016/j.mric.2017.03.007.

Balleyguier C, Sala E, Da Cunha T, Bergman A, Brkljacic B, Danza F et al. Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology. European radiology. 2011 May; 21: 1102-10. doi: 10.1007/s00330-010-1998-x.

Amin MI, Amin AE, Badr SE, Ebaid NY. 1H magnetic resonance spectroscopy in the differentiation between low-and high-grade cervical carcinoma: is it efficient?. Polish Journal of Radiology. 2024 Aug; 89: e378. doi: 10.5114/pjr/190840.

Lu H, Wu Y, Liu X, Huang H, Jiang H, Zhu C et al. The role of dynamic contrast-enhanced magnetic resonance imaging in predicting treatment response for cervical cancer treated with concurrent chemoradiotherapy. Cancer Management and Research. 2021 Aug: 6065-78. doi: 10.2147/CMAR.S314289.

de Boer P, Adam JA, Buist MR, van de Vijver MJ, Rasch CR, Stoker J et al. Role of MRI in detecting involvement of the uterine internal os in uterine cervical cancer: systematic review of diagnostic test accuracy. European Journal of Radiology. 2013 Sep; 82(9): e422-8. doi: 10.1016/j.ejrad.2013.04.027.

Hricak H, Gatsonis C, Chi DS, Amendola MA, Brandt K, Schwartz LH et al. 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. Journal of Clinical Oncology. 2005 Dec; 23(36): 9329-37. doi: 10.1200/JCO.2005.02.0354.

Charles-Edwards E, Morgan V, Attygalle AD, Giles SL, Ind TE, Davis M et al. Endovaginal magnetic resonance imaging of stage 1A/1B cervical cancer with A T2-and diffusion-weighted magnetic resonance technique: effect of lesion size and previous cone biopsy on tumor detectability. Gynecologic Oncology. 2011 Mar; 120(3): 368-73. doi: 10.1016/j.ygyno.2010.10.013.