J Gynecol Oncol.  2012 Apr;23(2):80-85. 10.3802/jgo.2012.23.2.80.

Indications for endoscopy according to the revised FIGO staging for cervical cancer after MRI and CT scanning

• Jeong BK
• Huh SJ
• Choi DH
• Park W
• Oh D
• Kim T
• Lee HB

• KMID: 2177579
• DOI: http://doi.org/10.3802/jgo.2012.23.2.80

Abstract

OBJECTIVE
A recent revision of the FIGO staging system does not recommend the mandatory use of cystoscopy and sigmoidoscopy. The objective of this study was to assess the clinical utility of CT or MRI scans for ruling out bladder or rectal invasion and determine the indication for endoscopy in patients with cervical cancer.
METHODS
We retrospectively reviewed 769 patients with cervical cancer, who underwent imaging and endoscopic work-up between January 1997 and December 2010. Using endoscopy as the standard reference for comparison, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the imaging modality for bladder or rectal invasion.
RESULTS
The CT scan showed 68.2% and 85.7% for sensitivity and 96.4% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. CT scan provided a low PPV (51.7%, 54.5%) and a high NPV (98.2%, 99.8%). MRI scan showed 88.0% and 75.0% for sensitivity and 93.1% and 98.9% for specificity in detecting bladder and rectal invasion, respectively. MRI scan provided a low PPV (35.6%, 42.9%) and a high NPV (99.4%, 99.7%). The accuracies of CT and MRI scans in identifying bladder invasion were 94.9% and 92.8%, respectively. The accuracies of CT and MRI in identifying rectal invasion were 98.7% and 98.6%, respectively.
CONCLUSION
The results of this study demonstrate that additional invasive endoscopy is not necessary for patients who present with no invasion on imaging work-up, and therefore, endoscopy should be considered a tool for confirming cases that are positive for invasion based on imaging work-up.

Keyword

Computed tomography; Cystoscopy; Magnetic resonance imaging; Sigmoidoscopy; Uterine cervical neoplasms

MeSH Terms

Cystoscopy
Endoscopy
Humans
Magnetic Resonance Imaging
Retrospective Studies
Sensitivity and Specificity
Sigmoidoscopy
Urinary Bladder
Uterine Cervical Neoplasms

Figure

• 

  Fig. 1 A 37-year-old woman who was diagnosed with squamous cell carcinoma of the uterine cervix. Magnetic resonance imaging (A, axial; B, sagittal) shows that the mass is focally in contact with the posterior wall of the bladder, and there is a fat plane and no definitive evidence of invasion. Cystoscopic finding (C) of an erythematous flat elevated lesion that is present on the bladder posterior wall.

Reference

1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011. 61:69–90.

2. 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. J Clin Oncol. 2005. 23:9329–9337.

3. Togashi K, Morikawa K, Kataoka ML, Konishi J. Cervical cancer. J Magn Reson Imaging. 1998. 8:391–397.

4. Liang CC, Tseng CJ, Soong YK. The usefulness of cystoscopy in the staging of cervical cancer. Gynecol Oncol. 2000. 76:200–203.

5. Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet. 2009. 105:107–108.

6. Hancke K, Heilmann V, Straka P, Kreienberg R, Kurzeder C. Pretreatment staging of cervical cancer: is imaging better than palpation? Role of CT and MRI in preoperative staging of cervical cancer: single institution results for 255 patients. Ann Surg Oncol. 2008. 15:2856–2861.

7. Hawighorst H, Schoenberg SO, Knapstein PG, Knopp MV, Schaeffer U, Essig M, et al. Staging of invasive cervical carcinoma and of pelvic lymph nodes by high resolution MRI with a phased-array coil in comparison with pathological findings. J Comput Assist Tomogr. 1998. 22:75–81.

8. Hricak H, Lacey CG, Sandles LG, Chang YC, Winkler ML, Stern JL. Invasive cervical carcinoma: comparison of MR imaging and surgical findings. Radiology. 1988. 166:623–631.

9. Sheu MH, Chang CY, Wang JH, Yen MS. Cervical carcinoma: assessment of parametrial invasion and lymph node metastasis with magnetic resonance imaging. Zhonghua Yi Xue Za Zhi (Taipei). 2000. 63:634–640.

10. Subak LL, Hricak H, Powell CB, Azizi L, Stern JL. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol. 1995. 86:43–50.

11. Hricak H, Yu KK, Powell CB, Subak LL, Stem J, Arenson RL. Comparison of diagnostic studies in the pretreatment evaluation of stage Ib carcinoma of the cervix. Acad Radiol. 1996. 3:Suppl 1. S44–S46.

12. Sharma DN, Thulkar S, Goyal S, Shukla NK, Kumar S, Rath GK, et al. Revisiting the role of computerized tomographic scan and cystoscopy for detecting bladder invasion in the revised FIGO staging system for carcinoma of the uterine cervix. Int J Gynecol Cancer. 2010. 20:368–372.

13. Nam H, Huh SJ, Park W, Bae DS, Kim BG, Lee JH, et al. Prognostic significance of MRI-detected bladder muscle and/or serosal invasion in patients with cervical cancer treated with radiotherapy. Br J Radiol. 2010. 83:868–873.

14. Sundborg MJ, Taylor RR, Mark J, Elg SA. Cystoscopy after computed tomography scan to identify bladder invasion in cervical cancer. Obstet Gynecol. 1998. 92:364–366.

15. Chung H, Ahn HS, Kim YS, Lee EJ, Ryu HS, Chang KH, et al. The value of cystoscopy and intravenous urography after magnetic resonance imaging or computed tomography in the staging of cervical carcinoma. Yonsei Med J. 2001. 42:527–531.

16. Janus CL, Mendelson DS, Moore S, Gendal ES, Dottino P, Brodman M. Staging of cervical carcinoma: accuracy of magnetic resonance imaging and computed tomography. Clin Imaging. 1989. 13:114–116.

17. Massad LS, Calvello C, Gilkey SH, Abu-Rustum NR. Assessing disease extent in women with bulky or clinically evident metastatic cervical cancer: yield of pretreatment studies. Gynecol Oncol. 2000. 76:383–387.