Stukan Maciej, Buderath Paul, Szulczyński Bartosz, Gębicki Jacek, Kimmig Rainer
Department of Gynecologic Oncology, Gdynia Oncology Center, Pomeranian Hospitals, ul. Powstania Styczniowego 1, 81519 Gdynia, Poland.
Division of Propedeutics of Oncology, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81519 Gdynia, Poland.
Diagnostics (Basel). 2021 Sep 23;11(10):1749. doi: 10.3390/diagnostics11101749.
We aimed to evaluate the accuracy of ultrasonography with gynecologic examination performed by a gynecological oncologist and magnetic resonance imaging (MRI) interpreted by a radiologist for the local and regional staging of patients with early-stage cervical cancer. The study was a single-site sub-analysis of the multi-institutional prospective, observational Total Mesometrial Resection (TMMR) Register Study, which included all consecutive study patients from Gdynia Oncology Center. Imaging results were compared with pathology findings. A total of 58 consecutive patients were enrolled, and 50 underwent both ultrasonography and MRI. The accuracy of tumor detection and measurement errors was comparable across ultrasonography and MRI. There were no significant differences between ultrasonography and MRI in the accuracy of detecting parametrial involvement (92%, confidence interval (CI) 84-100% vs. 76%, CI 64-88%, = 0.3), uterine corpus infiltration (94%, CI 87-100% vs. 86%, CI 76-96%, = 0.3), and vaginal fornix involvement (96%, CI 91-100% vs. 76%, CI 64-88%, = 0.3). The importance of uterine corpus involvement for the first-line lymph node metastases was presented in few cases. The accuracy of ultrasonography was higher than MRI for correctly predicting tumor stage: International Federation of Gynecology and Obstetrics (FIGO)-2018: 69%, CI 57-81% vs. 42%, CI 28-56%, = 0.002, T (from TNM system): 79%, CI 69-90% vs. 52%, CI 38-66%, = 0.0005, and ontogenetic tumor staging: 88%, CI 80-96% vs. 70%, CI 57-83%, = 0.005. For patients with cervical cancer who are eligible for TMMR and therapeutic lymphadenectomy, the accuracy of ultrasonography performed by gynecological oncologists is not inferior to that of MRI interpreted by a radiologist for assessing specific local parameters, and is more accurate for local staging of the disease and is thus more clinically useful for planning adequate surgical treatment.
我们旨在评估由妇科肿瘤学家进行的妇科检查超声检查以及由放射科医生解读的磁共振成像（MRI）对早期宫颈癌患者进行局部和区域分期的准确性。该研究是对多机构前瞻性观察性全子宫系膜切除术（TMMR）登记研究的单中心子分析，纳入了格但斯克肿瘤中心所有连续的研究患者。将影像学结果与病理结果进行比较。共纳入58例连续患者，其中50例接受了超声检查和MRI检查。超声检查和MRI在肿瘤检测准确性和测量误差方面相当。超声检查和MRI在检测宫旁组织受累（92%，置信区间[CI]84 - 100%对76%，CI 64 - 88%，P = 0.3）、子宫体浸润（94%，CI 87 - 100%对86%，CI 76 - 96%，P = 0.3）和阴道穹窿受累（96%，CI 91 - 100%对76%，CI 64 - 88%，P = 0.3）的准确性方面无显著差异。很少有病例显示子宫体受累对一线淋巴结转移的重要性。在正确预测肿瘤分期方面，超声检查的准确性高于MRI：国际妇产科联盟（FIGO）-2018分期：69%（CI 57 - 81%）对42%（CI 28 - 56%），P = 0.002；TNM系统中的T分期：79%（CI 69 - 90%）对52%（CI 38 - 66%），P = 0.0005；以及个体发育肿瘤分期：88%（CI 80 - 96%）对70%（CI 57 - 83%），P = 0.005。对于符合TMMR和治疗性淋巴结清扫术的宫颈癌患者，由妇科肿瘤学家进行的超声检查在评估特定局部参数方面的准确性不低于由放射科医生解读的MRI，并且在疾病局部分期方面更准确，因此在规划适当的手术治疗方面更具临床实用性。
