PV QA 4 - Poster Viewing Q&A 4
Purpose/Objective(s): Several criteria guide adjuvant radiation after hysterectomy for cervical cancer. Depth of invasion (DOI) and lymphovascular space invasion (LVSI) are based on pathologic examination; however, tumor diameter is measured clinically. Magnetic resonance imaging (MR) was not historically used to determine eligibility for hysterectomy at our institution. However, MR estimates tumor size preoperatively, and may assist in appropriately triaging patients to definitive chemoradiation.
Materials/Methods: A retrospective study of 234 cervical cancer patients treated from 2010-2016 was performed. Differences in clinical, pathologic, and MRI size were evaluated as well as treatment outcomes. Pearson correlation coefficients were calculated comparing clinical, pathologic and MR tumor size and stratified by histology.
Results: 71 patients had FIGO stage IB disease, 34 of 71 (48%) patients had MRI as part of their evaluation, 57 (80%) had clinical tumor size and 59 (83%) had pathologic tumor size available. Median MR, clinical, and pathologic tumor size was 24mm (range, 0-54mm), 20mm (range 0-90mm), and 17.5mm (range 0-85mm) respectively. The average absolute difference in clinical and pathologic maximum dimension (N=49, 69%) was 9.4mm (range -18 to 65mm); between MR and pathologic size (N=25, 74%) was 6.72mm (-21 to 14mm); and between MR and clinical size (N=28, 82%) was 9.3mm (-23 to 30mm). MR was ≥ pathologic size in 14 patients (41%; mean 11mm) and < pathologic size in 16 patients (47%; mean 7mm). The Pearson correlation coefficient was highest between MR and pathologic size (r=0.825), followed by MR and clinical size (r=0.617), and clinical and pathologic size (r=0.515). For SCC the correlation coefficient for MRI and pathologic size was greater than for clinical and pathologic size (r = 0.864 vs 0.562); this was also see in AC (r= 0.804 vs 0.5849). Of the 37 patients who did not have an MRI, 67% had definitive surgery, 19% received adjuvant radiation, and 14% had definitive radiation. Of the patients with MR, 56% had definitive surgery, 26% received adjuvant radiation, and 15% had definitive radiation (p=0.37 for receipt of adjuvant radiation after MR). In 6% of cases the MR size was ≥4cm, but clinical size was <4cm, and all required adjuvant radiation.
Conclusion: MR correlated better with pathologic size than with clinical evaluation, and this was seen in both SCC and AC. MR may reduce the need for radiation after surgery by appropriately triaging patients to either surgery alone or chemoradiation.
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