Kim Woo Young, Chang Suk-Joon, Chang Ki-Hong, Yoo Seung-Chul, Lee Eun Ju, Ryu Hee-Sug
Department of Obstetrics and Gynecology, Myongji Hospital, Kwandong University School of Medicine, Goyang, Korea.
J Reprod Med. 2011 Nov-Dec;56(11-12):485-90.
To find out whether a negative finding on magnetic resonance imaging (MRI) can rule out bladder or rectum mucosal invasion safely without cystoscopy or sigmoidoscopy.
We retrospectively reviewed the medical records of patients with cervical cancer between January 2005 and December 2009. MRI findings on bladder or rectum were classified as follows: (1) definite evidence of mucosal invasion, (2) suggestive of mucosal invasion or (3) no evidence of mucosal invasion. We correlated MRI findings with the cystoscopy and sigmoidoscopy findings.
A total of 257 patients were enrolled in this study. Sixteen patients had at least suspicious bladder invasion, and 1 patient had definite rectal invasion on MRI. Of these 17 patients, 6 patients had actual bladder mucosa invasion, and 1 patient had rectal mucosa invasion. The remaining 240 had negative MRI, cystoscopy and sigmoidoscopy findings. The MRI sensitivity, specificity, positive predictive value, negative predictive value and accuracy of bladder or rectum mucosal invasion were 100%, 96.0%, 41.25%, 100% and 96.1%, respectively.
Skipping cystoscopy or sigmoidoscopy based on the absence of invasion on MRI is safe enough without concern for understaging.
探究磁共振成像（MRI）的阴性结果能否在不进行膀胱镜检查或乙状结肠镜检查的情况下安全地排除膀胱或直肠黏膜侵犯。
我们回顾性分析了2005年1月至2009年12月期间宫颈癌患者的病历。膀胱或直肠的MRI表现分为以下几类：（1）黏膜侵犯的确切证据，（2）提示黏膜侵犯，或（3）无黏膜侵犯证据。我们将MRI表现与膀胱镜检查和乙状结肠镜检查结果进行了关联。
本研究共纳入257例患者。16例患者MRI至少提示膀胱侵犯可疑，1例患者MRI提示直肠侵犯明确。在这17例患者中，6例患者实际存在膀胱黏膜侵犯，1例患者存在直肠黏膜侵犯。其余240例患者MRI、膀胱镜检查和乙状结肠镜检查结果均为阴性。MRI对膀胱或直肠黏膜侵犯的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为100%、96.0%、41.25%、100%和96.1%。
基于MRI未发现侵犯而跳过膀胱镜检查或乙状结肠镜检查足够安全，无需担心分期过低。
