Department of Radiology, Saint-Étienne Teaching Hospital (CHU), Saint-Étienne, France.
Department of Gynaecology and Obstetrics, Saint-Étienne Teaching Hospital (CHU), Saint-Étienne, France.
Br J Radiol. 2021 Sep 1;94(1125):20210197. doi: 10.1259/bjr.20210197. Epub 2021 Jul 8.
The main standard of care for locally advanced cervix carcinoma (LACC) is radiochemotherapy (RCT) followed by brachytherapy. A surgical approach may still be discussed based on pelvic MRI-derived residual tumour evaluation. As no interobserver agreement study has ever been conducted to our knowledge, the aim of the present study was to report on pelvic MRI accuracy and interobserver agreement in LACC.
We carried out a retrospective study in a French university hospital. Medical records of all consecutive patients treated with curative intent for LACC by RCT followed by brachytherapy and completion pelvic surgery between January 2014 and January 2020 were reviewed. Local response was assessed through pelvis MRI and histological analysis after completion surgery. MRI data were independently evaluated by two radiologists with varying experience. The two main interobserving criteria we used were complete response and residual tumour.
23 patients fulfilled the inclusion criteria. Agreement between the junior and senior radiologist was moderate to strong. Indeed, regarding main criteria, κ was 0.65 for complete response and 0.57 for residual tumour. Interestingly, the present study shows a lower sensitivity whatever the radiologists than in the international literature.
The present study highlights a low interobserver variability regarding pelvic MRI in the assessment of RCT followed by brachytherapy in LACC. Yet, sensitivity was lower than in literature.
Radiology is part of treatment decision-making, the issue of heterogeneity regarding radiologists' training and experience to cancer (sensitivity and specificity) turns essential, so does MRI accuracy.
局部晚期宫颈癌（LACC）的主要治疗标准是放化疗（RCT）后行近距离放疗。根据盆腔 MRI 评估残留肿瘤，仍可讨论手术方法。据我们所知，目前尚无关于观察者间一致性的研究，因此本研究旨在报告 LACC 中盆腔 MRI 的准确性和观察者间一致性。
我们进行了一项法国大学医院的回顾性研究。回顾了 2014 年 1 月至 2020 年 1 月期间，所有接受 RCT 联合近距离放疗和完成盆腔手术的局部晚期宫颈癌患者的连续病历。通过完成手术后的盆腔 MRI 和组织学分析评估局部反应。两名经验不同的放射科医生独立评估 MRI 数据。我们使用的两个主要观察指标是完全缓解和残留肿瘤。
23 例患者符合纳入标准。初级和高级放射科医生之间的一致性为中度到高度。实际上，对于主要标准，κ 值为完全缓解时为 0.65，残留肿瘤时为 0.57。有趣的是，本研究显示出比国际文献更低的敏感性。
本研究强调了在 RCT 联合近距离放疗治疗 LACC 后评估盆腔 MRI 时观察者间的变异性较低。然而，敏感性低于文献报道。
放射学是治疗决策的一部分，放射科医生的培训和经验（敏感性和特异性）存在异质性的问题至关重要，因此 MRI 的准确性也很重要。
