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Early Invasive Cervical Cancer: CT and MR Imaging in Preoperative Evaluation—ACRIN/GOG Comparative Study of Diagnostic Performance and Interobserver Variability¹

¹ From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (H.H., L.H.S.); Center for Statistical Sciences, Brown University, Providence, RI (C.G., B.S.); Department of Radiology, University of California San Francisco, San Francisco, Calif (F.V.C.); Department of Diagnostic Radiology, McGill University Health Center, Montreal, Quebec, Canada and Synarc, San Francisco, Calif (C.R.); Department of Radiology, Armed Forces Institute of Pathology, Washington, DC (P.J.W.); Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Md (H.K.P.); Department of Radiology, University of Miami Medical School, Miami, Fla (M.A.); and Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.). From the 2005 RSNA Annual Meeting. Received November 21, 2006; revision requested January 5, 2007; revision received April 24; final version accepted May 4. Supported by National Cancer Institute grants U01 CA079778 and U01 CA080098. Address correspondence to H.H. (e-mail: muellnea{at}mskcc.org).

Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard.

Materials and Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22–81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage IB). Four radiologists (experience, 7–15 years) interpreted the CT scans, and four radiologists (experience, 12–20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P .05 considered to indicate a significant difference). Descriptive statistics for staging and statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard.

Results: For CT and MR imaging, respectively, multirater values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and –0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (IIB), sensitivities were 0.14–0.38 and 0.40–0.57, positive predictive values (PPVs) were 0.38–1.00 and 0.32–0.39, specificities were 0.84–1.00 and 0.77–0.80, and negative predictive values (NPVs) were 0.81–0.84 and 0.83–0.87. MR imaging was significantly better than CT for tumor visualization (P < .001) and detection of parametrial invasion (P = .047).

Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.

© RSNA, 2007