Vaida Atstupėnaitė1, Ieva Kraujutienė1, Rūta Jonė Nakaitė1, Edita Bieliūnienė1, Algidas Basevičius1
1Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Background and aim. Magnetic resonance imaging (MRI) is one of the most useful and frequent methods of examinations to monitor patients after chemoradiotherapy, in order to assess residual tumor tissue and relapse of the disease. This study aims to evaluate the diagnostic value of MRI in the assessment of the effectiveness of the treatment of cancer of cervix uteri.
Materials and methods. Retrospective data of 52 patients were obtained. All these patients underwent pelvic MRI in the Hospital of Lithuanian University of Health Sciences Kauno klinikos to assess the malignant tumor of cervix six months after chemoradiotherapy in the year 2010. MRI diagnostic value characteristics were calculated, compared with clinical data, obtained in the period of 5 or more years after chemoradiotherapy.
Results. Residual tumor tissue was found in 25.0 % of patients. In 28.2 % of patients with non-keratinizing squamous cell carcinoma, in 20.0 % of patients with keratinizing squamous cell carcinoma and 0.0 % of patients with adenocarcinoma, the residual tumor was found. In 100 % of patients with G1 tumors, in 23.4 % of patients with G2 tumors and 25.0 % of patients with G3 tumors, residual tumor tissue was found. In 12.5 % of cases the residual tumor was diagnosed within the range of 1.0-3.0 cm, in 19.2 % – within the range of 3.0-5.0 cm, in 25.0 % – within the range of 5.0-7.0 cm, in 75.0 % – within the range of 7.0-9.0 cm, in 75.0 % – within the range of 7.0-9.0 cm. In 26.5 % of patients with tumor extension to parametrium, in 28.6 % of patients with tumor extension to corpus uteri/vagina, in 60.0 % of patients with tumor extension to bladder/rectum and 28.1 % of patients with abnormal pelvic lymph nodes, residual tumor tissue was found. The specificity of MRI in the detection of residual tumor was 100.0%, sensitivity – 63.6%, positive prognostic value (PPV) – 100.0%, negative prognostic value (NPV) – 78.9% and accuracy – 84.6%. Matthews correlation coefficient (MCC) was 0.71.
Conclusions. MRI allowed diagnosing residual tumor tissue in 25.0 % of patients. Residual tumor tissue was most commonly diagnosed in patients with non-keratinizing squamous cell carcinoma, G1 carcinoma, large tumors and tumors with invasion to bladder and rectum. In the diagnostic of residual tumor tissue, MRI showed moderate sensitivity, high specificity, accuracy, PPV and NPV.
Keywords: magnetic resonance imaging, cancer of cervix uteri, chemoradiotherapy, residual tumor tissue.