| 1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin 2022;72:7-33. |
Review/Other-Dx |
N/A |
Cancer statistics. |
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths in the United States and compiles the most recent data on population-based cancer occurrence and outcomes. Incidence data (through 2018) were collected by the Surveillance, Epidemiology, and End Results program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2019) were collected by the National Center for Health Statistics. In 2022, 1,918,030 new cancer cases and 609,360 cancer deaths are projected to occur in the United States, including approximately 350 deaths per day from lung cancer, the leading cause of cancer death. Incidence during 2014 through 2018 continued a slow increase for female breast cancer (by 0.5% annually) and remained stable for prostate cancer, despite a 4% to 6% annual increase for advanced disease since 2011. Consequently, the proportion of prostate cancer diagnosed at a distant stage increased from 3.9% to 8.2% over the past decade. In contrast, lung cancer incidence continued to decline steeply for advanced disease while rates for localized-stage increased suddenly by 4.5% annually, contributing to gains both in the proportion of localized-stage diagnoses (from 17% in 2004 to 28% in 2018) and 3-year relative survival (from 21% to 31%). Mortality patterns reflect incidence trends, with declines accelerating for lung cancer, slowing for breast cancer, and stabilizing for prostate cancer. In summary, progress has stagnated for breast and prostate cancers but strengthened for lung cancer, coinciding with changes in medical practice related to cancer screening and/or treatment. More targeted cancer control interventions and investment in improved early detection and treatment would facilitate reductions in cancer mortality. |
4 |
| 2. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet 2018;143 Suppl 2:22-36. |
Review/Other-Dx |
N/A |
To discuss the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues. |
No results stated in abstract. |
4 |
| 3. Lei J, Ploner A, Elfstrom KM, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med 2020;383:1340-48. |
Review/Other-Dx |
1,672,983 patients |
To assess the association between HPV vaccination and the risk of invasive cervical cancer, controlling for age at follow-up, calendar year, county of residence, and parental characteristics, including education, household income, mother's country of birth, and maternal disease history. |
During the study period, we evaluated girls and women for cervical cancer until their 31st birthday. Cervical cancer was diagnosed in 19 women who had received the quadrivalent HPV vaccine and in 538 women who had not received the vaccine. The cumulative incidence of cervical cancer was 47 cases per 100,000 persons among women who had been vaccinated and 94 cases per 100,000 persons among those who had not been vaccinated. After adjustment for age at follow-up, the incidence rate ratio for the comparison of the vaccinated population with the unvaccinated population was 0.51 (95% confidence interval [CI], 0.32 to 0.82). After additional adjustment for other covariates, the incidence rate ratio was 0.37 (95% CI, 0.21 to 0.57). After adjustment for all covariates, the incidence rate ratio was 0.12 (95% CI, 0.00 to 0.34) among women who had been vaccinated before the age of 17 years and 0.47 (95% CI, 0.27 to 0.75) among women who had been vaccinated at the age of 17 to 30 years. |
4 |
| 4. Polterauer S, Hefler L, Seebacher V, et al. The impact of lymph node density on survival of cervical cancer patients. Br J Cancer. 2010;103(5):613-616. |
Observational-Tx |
88 patients |
To evaluate the prognostic value of lymph node density (LND) in patients with lymph node-positive cervical cancer. |
A significant correlation between LND and FIGO stage (P=0.03), but not patients' age (P=0.2), histological grade (P=0.8), and histological type (P=0.5), was observed. In a univariate survival analysis, LND (P=0.01; P=0.01), FIGO stage (P=0.01; P=0.008), and histological grade (P=0.03; P=0.04) were associated with disease-free and overall survival, respectively. Patients with LND >10% had impaired disease-free and overall survival rates compared with patients with LND |
2 |
| 5. Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecologic Oncology. 146(1):3-10, 2017 07. |
Review/Other-Dx |
N/A |
To provide an update on surveillance for gynecologic cancer recurrence in women who have had a complete response to primary cancer therapy. |
No results stated in abstract. |
4 |
| 6. Colombo N, Dubot C, Lorusso D, et al. Pembrolizumab for Persistent, Recurrent, or Metastatic Cervical Cancer. N Engl J Med 2021;385:1856-67. |
Observational-Dx |
1165 patients |
To assess the relative benefit of adding pembrolizumab to chemotherapy with or without bevacizumab. |
In 548 patients with a PD-L1 combined positive score of 1 or more, median progression-free survival was 10.4 months in the pembrolizumab group and 8.2 months in the placebo group (hazard ratio for disease progression or death, 0.62; 95% confidence interval [CI], 0.50 to 0.77; P<0.001). In 617 patients in the intention-to-treat population, progression-free survival was 10.4 months and 8.2 months, respectively (hazard ratio, 0.65; 95% CI, 0.53 to 0.79; P<0.001). In 317 patients with a PD-L1 combined positive score of 10 or more, progression-free survival was 10.4 months and 8.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.44 to 0.77; P<0.001). Overall survival at 24 months was 53.0% in the pembrolizumab group and 41.7% in the placebo group (hazard ratio for death, 0.64; 95% CI, 0.50 to 0.81; P<0.001), 50.4% and 40.4% (hazard ratio, 0.67; 95% CI, 0.54 to 0.84; P<0.001), and 54.4% and 44.6% (hazard ratio, 0.61; 95% CI, 0.44 to 0.84; P = 0.001), respectively. The most common grade 3 to 5 adverse events were anemia (30.3% in the pembrolizumab group and 26.9% in the placebo group) and neutropenia (12.4% and 9.7%, respectively). |
4 |
| 7. Koliopoulos G, Sotiriadis A, Kyrgiou M, Martin-Hirsch P, Makrydimas G, Paraskevaidis E. Conservative surgical methods for FIGO stage IA2 squamous cervical carcinoma and their role in preserving women's fertility. Gynecol Oncol. 2004;93(2):469-473. |
Review/Other-Dx |
N/A |
To present the published data on conservative surgical methods for FIGO stage IA2 squamous cervical carcinoma methods (radical vaginal, abdominal or laparoscopic trachelectomy and laparoscopic pelvic lymphadenectomy, deep cold-knife excision and lymphadenectomy, ovarian transposition and radiotherapy) and their clinical role in preserving women’s fertility. |
The recurrence rates after radical trachelectomy range from 0% to 8% and are comparable to reported results from series of patients treated with radical hysterectomy. There are over 35 reported live births out of approximately 210 women who had this operation. However, the rates of second trimester losses and preterm deliveries due to cervical weakness are high. Data from the other methods are limited. Vaginal radical trachelectomy is currently the fertility-sparing procedure with the most available data supporting its use. Although these results are encouraging, there is lack of level I evidence (ie, randomized controlled trials) comparing safety and survival rates between conservative and radical methods. Therefore, these techniques should be used by fully trained operators, with the understanding that this is not the standard treatment at present. |
4 |
| 8. Lakhman Y, Akin O, Park KJ, et al. Stage IB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology. 2013;269(1):149-158. |
Observational-Dx |
62 patients |
To determine whether magnetic resonance (MR) imaging evaluation of key morphologic tumor characteristics can improve patient selection for radical trachelectomy. |
Sensitivity and specificity of tumor detection were, respectively, 87% and 100% (reader 1) and 76% and 95% (reader 2). Six of six patients with negative cone biopsy margins and no tumor at postconization MR imaging were without tumor at trachelectomy pathologic analysis. Mean differences between MR imaging and histologic tumor sizes were 0.7 mm (range, -15 to 11 mm) for reader 1 and 2.2 mm (range, -9 to 15 mm) for reader 2. Sensitivities for deep cervical stromal invasion were 75% (reader 1) and 50% (reader 2). For each reader, nine of nine (100%) patients with tumor 5 mm or less from the internal os and three of five (60%) patients with tumor 6-9 mm from the internal os at MR imaging needed radical hysterectomy. For both readers, tumor size of 2 cm or larger (P < .001) and deep cervical stromal invasion (P |
3 |
| 9. Mansoori B, Khatri G, Rivera-Colon G, Albuquerque K, Lea J, Pinho DF. Multimodality Imaging of Uterine Cervical Malignancies. [Review]. AJR Am J Roentgenol. 215(2):292-304, 2020 08. |
Review/Other-Dx |
N/A |
To provide an updated review on the role of imaging in initial staging, treatment monitoring, and follow-up of cervical cancer with a focus on the role of MRI and FDG PET/CT. |
No results stated in abstract. |
4 |
| 10. Mitchell DG, Snyder B, Coakley F, et al. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol. 2006;24(36):5687-5694. |
Observational-Dx |
208 patients |
To compare the ability of MRI, CT and clinical FIGO staging to delineate early cervical cancer and measure tumor size. Each imaging study was interpreted prospectively by one onsite radiologist and retrospectively by 4 independent offsite radiologists, who were all blinded to surgical, histopathologic, and other imaging findings. Surgical pathology was the standard of reference. |
Neither MRI nor CT was accurate for evaluating cervical stroma. For uterine body involvement, the area under the ROC curve was higher for MRI than for CT for both prospective (0.80 vs 0.66, respectively; P=.01) and retrospective (0.68 vs 0.57, respectively; P=.02) readings. Retrospective readers could measure diameter by CT in 35% to 73% of patients and by MRI in 79% to 94% of patients. Prospective readers had the highest Spearman correlation coefficient with pathologic measurement for MRI (r(s) = 0.54), followed by CT (r(s) = 0.45) and clinical examination (r(s) = 0.37; P<.0001 for all). Spearman correlation of multiobserver diameter measurements for MRI (r(s) = 0.58; P<.0001) was double that for CT (r(s) = 0.27; P=.03) MRI better than CT and clinical exam for measuring tumor size. Neither good for assessing cervical stroma. |
2 |
| 11. Bipat S, Glas AS, van der Velden J, Zwinderman AH, Bossuyt PM, Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol. 2003; 91(1):59-66. |
Review/Other-Dx |
57 articles |
To systematically review the available evidence on the diagnostic performance of CT and MRI in staging of cervical carcinoma. |
57 articles were included. In 49 articles one imaging modality was evaluated (MRI, 38; CT, 11), and in 8 articles, both. Inclusion criteria were: minimum of 10 patients included, histopathology as reference standard, sufficient data presented to construct 2(x) 2 tables. The exclusion criterion was: data reported elsewhere in more detail. Sensitivity estimates for parametrial invasion were 74% (95% CI, 68%-79%) for MRI and 55% (95% CI, 44%-66%) for CT, and for lymph node involvement, 60% (95% CI, 52%-68%) and 43% (95% CI, 37%-57%), respectively. MRI and CT had comparable specificities for parametrial invasion and lymph node involvement. For bladder invasion and rectum invasion the sensitivities for MRI were respectively 75% (95% CI, 66%-83%) and 71% (95% CI, 53%-83%), higher compared with CT. The specificity in evaluating bladder invasion for MRI was significantly higher compared with CT: 91% (95% CI, 83%-95%) for MRI and 73% (95% CI, 52%-87%) for CT. The specificities for rectum invasion were comparable. Differences in patient sample size, publication year, methodological criteria, and MRI techniques had no effect on the summary estimates. |
4 |
| 12. Woo S, Atun R, Ward ZJ, Scott AM, Hricak H, Vargas HA. Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: systematic review and meta-analysis. Eur Radiol. 30(10):5560-5577, 2020 Oct. |
Observational-Dx |
115 studies |
To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer. |
MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71-0.88 and 0.86-0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively-performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29-0.69) but high specificity (0.88-0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site). |
3 |
| 13. Scheidler J, Heuck AF. Imaging of cancer of the cervix. Radiol Clin North Am 2002;40:577-90, vii. |
Review/Other-Dx |
N/A |
To discuss imaging of cervical cancer. |
No results stated in abstract. |
4 |
| 14. Sarabhai T, Schaarschmidt BM, Wetter A, et al. Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur J Nucl Med Mol Imaging. 45(1):67-76, 2018 Jan. |
Observational-Dx |
53 patients |
To assess and compare the diagnostic performance of integrated PET/MRI and MRI alone for local tumor evaluation and whole-body tumor staging of primary cervical cancers. |
PET/MRI allowed for a correct determination of the T stage in 45/53 (85%) cases, while MRI alone enabled a correct identification of the tumor stage in 46/53 (87%) cases. In 24 of the 53 patients, lymph node metastases were present. For the detection of nodal-positive patients, sensitivity, specificity and accuracy of PET/MRI were 83%, 90% and 87%, respectively. The respective values for MRI alone were 71%, 83% and 77%. In addition, PET/MRI showed higher values for the detection of distant metastases than MRI alone (sensitivity: 87% vs. 67%, specificity: 92% vs. 90%, diagnostic accuracy: 91% vs. 83%). Among the patients with discrepant staging results in the two imaging modalities, PET/MRI enabled correct treatment recommendations for a higher number (n = 9) of patients than MRI alone (n = 3). |
3 |
| 15. Steiner A, Narva S, Rinta-Kiikka I, Hietanen S, Hynninen J, Virtanen J. Diagnostic efficiency of whole-body 18F-FDG PET/MRI, MRI alone, and SUV and ADC values in staging of primary uterine cervical cancer. Cancer Imaging. 21(1):16, 2021 Jan 22. |
Observational-Dx |
33 patients |
To assess the additional diagnostic value of PET over MRI alone in local and whole-body staging of cervical cancer, and to evaluate the benefit of standardized uptake value (SUV) and apparent diffusion coefficient (ADC) in staging. |
In total, 33 patients who underwent surgery (n = 23) or first-line chemoradiation (n = 10) were included. PET/MRI resulted in higher AUC compared with MRI alone in detecting parametrial (0.89 versus 0.73), vaginal (0.85 versus 0.74), and deep cervical stromal invasion (0.96 versus 0.74), respectively. PET/MRI had higher diagnostic confidence than MRI in identifying patients with radical cone biopsy and no residual at hysterectomy (sensitivity 89% versus 44%). PET/MRI and MRI showed equal AUC for pelvic nodal staging (both 0.73), whereas AUC for distant metastases was higher using PET/MRI (0.80 versus 0.67). Tumor SUVmax/ADC ratio, but not SUVmax or ADC alone, was significantly higher in the presence of metastatic pelvic lymph nodes (P < 0.05). |
3 |
| 16. Lee YY, Choi CH, Kim CJ, et al. The prognostic significance of the SUVmax (maximum standardized uptake value for F-18 fluorodeoxyglucose) of the cervical tumor in PET imaging for early cervical cancer: preliminary results. Gynecol Oncol. 2009;115(1):65-68. |
Observational-Dx |
44 patients |
Prospective study to evaluate the prognostic significance of the cervical tumor uptake of FDG measured as the SUVmax by PET in patients with early cervical cancer treated with surgery with or without adjuvant therapy. |
According to the tumor stage, the mean SUVmax significantly differed among groups (P=0.013). The SUVmax was significantly higher in patients with deep stromal invasion (=1 cm, P=0.0208), lymph-vascular space invasion (P=0.0429) and a pathologically confirmed large tumor size of more than 4 cm (P=0.0074) when compared to controls. Patients with a high SUVmax (=13.4) had a significantly reduced DFS rate compared to patients with a low SUVmax (P=0.021). In addition, the SUVmax (=13.4) was a significant independent predictor of recurrence of cervical cancer after treatment with surgery (+/-adjuvant therapy) (P=0.0207). Patients with early cervical cancer showing a high SUVmax (=13.4) of the cervical tumor should be considered at increased risk for disease recurrence after surgery and may need more aggressive multimodal treatment. |
2 |
| 17. Nakamura K, Okumura Y, Kodama J, Hongo A, Kanazawa S, Hiramatsu Y. The predictive value of measurement of SUVmax and SCC-antigen in patients with pretreatment of primary squamous cell carcinoma of cervix. Gynecol Oncol. 2010;119(1):81-86. |
Observational-Dx |
52 patients |
To examine the predictive value of measurement of SUVmax and serum squamous cell carcinoma antigen in patients with pretreatment of primary squamous cell carcinoma of cervix. |
The high SUVmax of the primary tumor (=15.6) plus lymph node metastasis (a short-axis diameter of over 10 mm with a SUVmax =3.5) were significant predictors for poor prognosis when compared with the low SUVmax of the primary tumor (<15.6) or the high SUVmax of the primary tumor plus negative lymph node metastasis (a short-axis diameter of under 10 mm or SUVmax <3.5) (OS rate; P=0.0211). Findings indicate that the high SUVmax of the primary tumor plus lymph node metastasis with pretreatment of primary SCC of cervix may be associated with a poor prognosis. |
3 |
| 18. Ho CM, Chien TY, Jeng CM, Tsang YM, Shih BY, Chang SC. Staging of cervical cancer: comparison between magnetic resonance imaging, computed tomography and pelvic examination under anesthesia. J Formos Med Assoc. 1992;91(10):982-990. |
Observational-Dx |
20 patients |
To compare MRI with CT and examination under anesthesia (EUA) in staging cervical carcinoma, with special emphasis on parametrial status. |
The overall accuracy rate of MRI in staging carcinoma of the cervix was 75%, compared with 32% for CT staging and 55% for clinical staging. The accuracy rate of these modalities for parametrial status was 90% for MRI, 55% for CT and 82.5% for EUA. MRI accurately excluded all 20 patients with pelvic side wall, bladder and rectal involvement. |
1 |
| 19. Kim SH, Choi BI, Han JK, et al. Preoperative staging of uterine cervical carcinoma: comparison of CT and MRI in 99 patients. J Comput Assist Tomogr. 1993;17(4):633-640. |
Observational-Dx |
99 patients |
To compare CT and MRI at 0.5 T in the preoperative staging of uterine cervical cancer in a large series of patients. Both CT and MRI findings were compared using surgical-pathologic findings as gold standards. |
MRI was superior to CT in tumor detection (sensitivity 75% vs 51%, P<0.005), in parametrial evaluation (accuracy 87% vs 80%, P<0.005), in overall tumor staging (accuracy 77% vs 69%, P<0.025), and in pelvic lymph node evaluation (accuracy 88% vs 83%, P<0.01). MRI had an accuracy of 76% in assessment of the thickness of cervical stromal invasion. MRI was superior to CT in preoperative staging of uterine cervical carcinoma and MRI should be used instead of CT for preoperative staging of this disease. |
2 |
| 20. Subak LL, Hricak H, Powell CB, Azizi L, Stern JL. Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol. 1995;86(1):43-50. |
Observational-Dx |
79 women had MRI (n=71) and/or CT (n=37); 29 had both MRI and CT |
Retrospective study. Women with untreated cervical cancer had MRI and/or CT prior to surgery in order to assess the accuracy of CT and MRI in the evaluation of invasive cervical cancer. |
MRI was 88% accurate evaluating the presence of stromal invasion and 78% accurate for depth of stromal invasion. CT could not evaluate tumor size or stromal invasion because it could not distinguish cancer from the surrounding normal cervical tissue. In evaluating stage of disease, MRI had an accuracy of 90%, compared with 65% for CT (P<.005). MRI was more accurate than CT (94% vs 76%, P<.005) in assessing parametrial invasion. Both modalities were comparable in evaluating lymph node metastases (86% each). In determining operative candidates (stage I and minimal IIA), MRI was 94% accurate, compared with 76% for CT (P<.005). Compared with CT, MRI offered significantly improved evaluation of tumor size, stromal invasion, and local and regional extent of disease in pretreatment imaging for cervical cancer. |
2 |
| 21. Balcacer P, Shergill A, Litkouhi B. MRI of cervical cancer with a surgical perspective: staging, prognostic implications and pitfalls. [Review]. Abdom Radiol. 44(7):2557-2571, 2019 07. |
Review/Other-Dx |
N/A |
To review MRI of cervical cancer with a surgical perspective with focus on staging, prognostic implications and pitfalls. |
No results stated in abstract. |
4 |
| 22. Woo S, Moon MH, Cho JY, Kim SH, Kim SY. Diagnostic Performance of MRI for Assessing Parametrial Invasion in Cervical Cancer: A Head-to-Head Comparison between Oblique and True Axial T2-Weighted Images. Korean J Radiol. 20(3):378-384, 2019 03. |
Observational-Dx |
71 patients |
To directly compare the diagnostic performance of true and oblique axial T2-weighted imaging (T2WI) for assessing parametrial invasion (PMI) in cervical cancer. |
At hysterectomy, 15 patients (21.1%) had PMI. For Radiologist 1, the area under the ROC curve (AUC) was greater for oblique axial than for true axial T2WI {0.941 (95% confidence interval [CI] = 0.858-0.983) vs. 0.917 (95% CI = 0.827-0.969), p = 0.027}. The difference was not significant for Radiologist 2 (0.879 [95% CI = 0.779-0.944] vs. 0.827 [95% CI = 0.719-0.906], p = 0.153). For tumors > 2.5 cm, AUC was greater with oblique than with true axial T2WI (0.906 vs. 0.860, p = 0.046 for Radiologist 1 and 0.839 vs. 0.765, p = 0.086 for Radiologist 2). Agreement between the radiologists was almost perfect for oblique axial T2WI (k = 0.810) and was substantial for true axial T2WI (k = 0.704). |
3 |
| 23. Cheng J, Hou Y, Li J, et al. Agreement Between Magnetic Resonance Imaging and Pathologic Findings in the Tumor Size Evaluation Before and After Neoadjuvant Chemotherapy Treatment: A Prospective Study. Int J Gynecol Cancer. 27(7):1472-1479, 2017 09. |
Observational-Dx |
497 patients |
To compare the agreement between magnetic resonance imaging (MRI) results and postsurgical pathologic findings for tumor size evaluation in cervical cancer patients before and after neoadjuvant chemotherapy (NACT) treatment. |
In general, the agreement between pretreatment MRI results and postsurgical pathologic findings of tumor size was 0.855 (95% confidence interval [CI], 0.763-0.909) in cervical cancer patients without NACT, whereas the agreement between posttreatment MRI results and postsurgical pathologic findings was 0.503 (95% CI, 0.421-0.576). Only 62.72% (249/397) of patients who underwent NACT treatment have the same chemotherapy response evaluation results; the kappa coefficient was 0.384(95% CI, 0.310-0.457) between posttreatment MRI and postsurgical pathologic findings. We still found International Federation of Gynecology and Obstetrics stage is associated with the chemotherapy response evaluation. |
3 |
| 24. Bhosale PR, Iyer RB, Ramalingam P, et al. Is MRI helpful in assessing the distance of the tumour from the internal os in patients with cervical cancer below FIGO Stage IB2?. Clin Radiol. 71(6):515-22, 2016 Jun. |
Observational-Dx |
79 patients |
To determine the ability of magnetic resonance imaging (MRI) in detecting tumour-free margins from the internal os (IO). |
For predicting a distance between the tumour and the IO of </=5 mm, MRI had a sensitivity of 73%, a specificity of 98.3%, a PPV of 95%, a NPV of 88.1%, and an accuracy of 89.8% for the main analysis, and sensitivity of 81.8%, a specificity of 93.2% a PPV of 69.2% a NPV of 96.5% and an accuracy of 91.4% for the subset analysis. |
3 |
| 25. Charles-Edwards EM, Messiou C, Morgan VA, et al. Diffusion-weighted imaging in cervical cancer with an endovaginal technique: potential value for improving tumor detection in stage Ia and Ib1 disease. Radiology. 2008;249(2):541-550. |
Observational-Dx |
59 patients |
To establish apparent diffusion coefficients (ADCs) of invasive cervical carcinoma compared with nontumor cervical epithelium and determine sensitivity and specificity of diffusion-weighted (DW) magnetic resonance (MR) imaging used in conjunction with T2-weighted MR imaging to help detect invasive cervical carcinoma in patients with stage Ia and Ib1 disease. |
In group 1, ADCs from cervical carcinoma (757 x 10(-6) mm(2)/sec +/- 110) and adjacent epithelium (1331 x 10(-6) mm(2)/sec +/- 159) or CIN (1291 x 10(-6) mm(2)/sec +/- 156) were significantly different (P < .0001). In group 2, respective sensitivity and specificity to help detect invasive cervical carcinoma on T2-weighted images were 55.6% and 75% for observer 1 and 66.7% and 41.7% for observer 2, and 88.9% and 66.7% for observer 1 and 77.8% and 58.3% for observer 2 when ADC maps with a threshold level of 1100 x 10(-6) mm(2)/sec were added. Interobserver agreement was fair (kappa = 0.37) for T2-weighted images alone and good (kappa = 0.80) with ADC included. |
2 |
| 26. Woo S, Suh CH, Kim SY, Cho JY, Kim SH. Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016. [Review]. Eur Radiol. 28(2):530-541, 2018 Feb. |
Meta-analysis |
14 studies |
To review the diagnostic performance of MRI for detection of parametrial invasion (PMI) in cervical cancer patients. |
Pooled sensitivity was 0.76 (95% CI 0.67-0.84) and specificity was 0.94 (95% CI 0.91-0.95). The possibility of heterogeneity was considered low: Cochran's Q-test (p = 0.471), Tau(2) (0.240), Higgins I(2) (0%). With meta-regression analysis, magnet strength, use of DWI, and antispasmodic drugs were significant factors affecting heterogeneity (p < 0.01). Subgroup analysis for studies solely using radical hysterectomy as reference standard yielded pooled sensitivity and specificity of 0.73 (95% CI 0.60-0.83) and 0.93 (95% CI 0.90-0.95), respectively. |
Good |
| 27. Akita A, Shinmoto H, Hayashi S, et al. Comparison of T2-weighted and contrast-enhanced T1-weighted MR imaging at 1.5 T for assessing the local extent of cervical carcinoma. Eur Radiol. 2011;21(9):1850-1857. |
Observational-Dx |
40 patients |
To compare two MR sequences at 1.5 T-T2-weighted and contrast-enhanced T1-weighted images-by using macroscopic sections to determine which image type enables the most accurate assessment of cervical carcinoma. |
31 of 40 patients underwent hysterectomies and nine of 40 underwent trachelectomies. In 36 patients, lesions were identified on at least one sequence. The tumours at stage 1B or higher were detected in 94.7% on contrast-enhanced T1-weighted images and in 76.3% on T2-weighted images (P < 0.05). Tumour margins appeared significantly more distinct on contrast-enhanced T1-weighted images than on T2-weighted images (P < 0.001). The CNRs obtained using contrast-enhanced T1-weighted images were significantly higher (P < 0.001) than those obtained using T2-weighted images. |
3 |
| 28. Huang JW, Song JC, Chen T, Yang M, Ma ZL. Making the invisible visible: improving detectability of MRI-invisible residual cervical cancer after conisation by DCE-MRI. Clin Radiol. 74(2):166.e15-166.e21, 2019 02. |
Observational-Dx |
59 patients |
To determine whether dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) quantitative parameters increase the detectability of MRI-invisible residual cervical cancer after conisation. |
For patients with residual cervical cancer, the K(trans) and Ve values were significantly higher than in their counterparts with non-residual cervical cancer (0.610+/-0.395 versus 0.366+/-0.305/min, p=0.013; and 0.703+/-0.270 versus 0.540+/-0.280%, p=0.028; respectively). The K(trans) showed the highest area under the ROC curve (AUC) of 0.705 (p=0.004) with a sensitivity of 67.6% and specificity of 68%. |
3 |
| 29. Bourgioti C, Chatoupis K, Panourgias E, et al. Endometrial vs. cervical cancer: development and pilot testing of a magnetic resonance imaging (MRI) scoring system for predicting tumor origin of uterine carcinomas of indeterminate histology. Abdom Imaging 2015;40:2529-40. |
Observational-Dx |
77 patients |
To report discriminant MRI features between cervical and endometrial carcinomas and to design an MRI- scoring system, with the potential to predict the origin of uterine cancer (cervix or endometrium) in histologically indeterminate cases. |
K value was excellent for most of the imaging criteria. Using ROC curve analysis, the estimated optimal cut-off for the MRI-scoring system was 4 with 96.6% sensitivity and 100% specificity. Using a >/=4 cut-off for cervical cancers and <4 for endometrial cancers, 97.4% of the patients were correctly classified. 2/58 patients with cervical cancer had MRI score <4 and none of the patients with endometrial cancer had MRI score >4. The area under curve of the MRI-scoring system was 0.99 (95% CI 0.98-1.00). When the MRI-score was applied to 20/77 patients with indeterminate initial biopsy and to 5/26 surgically treated patients with erroneous pre-op histology, all cases were correctly classified. |
3 |
| 30. Alcazar JL, Garcia E, Machuca M, et al. Magnetic resonance imaging and ultrasound for assessing parametrial infiltration in cervical cancer. A systematic review and meta-analysis. Med. ultrasonography. 22(1):85-91, 2020 03 01. |
Meta-analysis |
9 studies |
To provide information on the current evidence regarding the diagnostic performance of ultrasound and MRI for assessing parametrial involvement in cervical cancer using the histological report as the reference standard. |
Our extended search identified 205 citations but after exclusions we finally included 9 articles in the meta-analysis. The risk of bias for most studies was low for four domains were assessed in QUADAS-2. Overall, for ultrasound pooled estimated sensitivity and specificity for diagnosing parametrial infiltration was 78% (95% confidence interval [CI]:48%-93%) and 96% (95% CI=89%-99%), respectively. For MRI these figures were 68% (95% CI=54%-80%) and 91% (95% CI=84%-95%), respectively. No statistical differences were found when comparing both methods (p=0.548). Heterogeneity was low/moderate for MRI and high for ultrasound. |
Good |
| 31. Zheng W, Chen K, Peng C, et al. Contrast-enhanced ultrasonography vs MRI for evaluation of local invasion by cervical cancer. Br J Radiol. 91(1091):20170858, 2018 Nov. |
Observational-Dx |
108 patients |
To compare contrast-enhanced ultrasound (CEUS) to MRI for evaluating local invasion of cervical cancer. |
Measurements by MRI and CEUS were strongly correlated in the three dimensions: left-right r = 0.84, craniocaudal r = 0.86 and anteroposterior r = 0.88. Vaginal and parametrial invasion were detected by both MRI and CEUS with moderate concordance, and invasion of uterine corpus, bladder and rectum with good concordance. |
3 |
| 32. Epstein E, Testa A, Gaurilcikas A, et al. Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound - a European multicenter trial. Gynecol Oncol. 128(3):449-53, 2013 Mar. |
Observational-Dx |
209 women |
To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. |
Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (<2cm) and detecting parametrial invasion (kappa values 0.78 and 0.75, respectively). The agreement between MRI and histology was good for classifying tumors as <2cm, or >4cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy. |
2 |
| 33. Gee MS, Atri M, Bandos AI, Mannel RS, Gold MA, Lee SI. Identification of Distant Metastatic Disease in Uterine Cervical and Endometrial Cancers with FDG PET/CT: Analysis from the ACRIN 6671/GOG 0233 Multicenter Trial. Radiology 2018;287:176-84. |
Observational-Dx |
153 cervical cancer patients and 203 endometrial cancer patients |
To assess the accuracy of staging positron emission tomography (PET)/computed tomography (CT) in detecting distant metastasis in patients with local-regionally advanced cervical and high-risk endometrial cancer in the clinical trial by the American College of Radiology Imaging Network (ACRIN) and the Gynecology Oncology Group (GOG) (ACRIN 6671/GOG 0233) and to compare central and institutional reader performance. |
Overall prevalence of distant metastasis was 13.7% (21 of 153) for cervical cancer and 11.8% (24 of 203) for endometrial cancer. Central reader PET/CT interpretation demonstrated sensitivity, specificity, positive predictive value (PPV), and negative predictive value of 54.8%, 97.7%, 79.3%, and 93.1% for cervical cancer metastasis versus 64.6%, 98.6%, 86.1%, and 95.4% for endometrial cancer, respectively. By comparison, local institutional review demonstrated sensitivity, specificity, PPV, and negative predictive value of 47.6%, 93.9%, 55.6%, and 91.9% for cervical cancer metastasis and 66.7%, 93.9%, 59.3%, and 95.5% for endometrial cancer, respectively. For central readers, the specificity and PPV of PET/CT detection of cervical and endometrial cancer metastases were all significantly higher compared with that of local institutional review (P < .05). Central reader area under the receiver operating characteristic curve (AUC) values were 0.78 and 0.89 for cervical and endometrial cancer, respectively; these were not significantly different from local institutional AUC values (0.75 and 0.84, respectively; P > .05 for both). |
2 |
| 34. Lin A, Ma S, Dehdashti F, et al. Detection of distant metastatic disease by positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) at initial staging of cervical carcinoma. Int J Gynecol Cancer. 29(3):487-491, 2019 03. |
Observational-Dx |
1158 patients |
To describe the frequency and sites of distant metastatic disease at diagnosis in patients with cervical cancer as detected by positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET). |
From 1997 to 2017, 72 (6.2%) of 1158 consecutively evaluated cervical cancer patients exhibited FDG-avid distant disease at diagnosis; 27 (38%) of these had biopsy confirmation of distant disease. Only 35 (49%) of FDG-detected metastases were clinically apparent. The sites of distant disease were lung (35%), multiple sites (25%), omentum (16.5%), bone (16.5%), and liver (7%). There were 12 (17%) patients with distant disease who did not display FDG-avid lymph nodes. Median overall survival among patients with distant FDG-avid disease was 7.0 months (95% CI 4.3 to 9.7). Patients with multiple sites of distant disease demonstrated the worst overall survival. |
3 |
| 35. Park KJ, Braschi-Amirfarzan M, DiPiro PJ, et al. Multimodality imaging of locally recurrent and metastatic cervical cancer: emphasis on histology, prognosis, and management. [Review]. Abdom Radiol. 41(12):2496-2508, 2016 12. |
Review/Other-Dx |
N/A |
To provide an overview of imaging and treatment of cervical cancer patients with locoregional recurrence and metastatic disease, with emphasis on characteristic patterns of spread based on histology (squamous cell carcinoma and other subtypes), prognostic factors, diagnosis, and treatment response assessment, as well as updated therapeutic options. |
No results stated in abstract. |
4 |
| 36. Choi HJ, Ju W, Myung SK, Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: meta-analysis. Cancer Sci. 2010; 101(6):1471-1479. |
Meta-analysis |
41 articles |
Meta-analysis was performed to compare diagnostic performances of CT, MRI, and PET or PET/CT, for detection of metastatic lymph nodes in patients with cervical cancer. |
In a patient-based data analysis, PET or PET/CT showed the highest pooled sensitivity (82%) and specificity (95%), while CT showed 50% and 92%; and MRI, 56% and 91%, respectively. The AUC (0.9641) and Q* (0.9106) of PET or PET/CT were significantly higher than those of MRI (AUC = 0.8270; Q* = 0.7599), both P<0.001. In region- or node-based data analysis, sensitivities of CT (52%) and PET or PET/CT (54%) were higher than that of MRI (38%), P<0.02 and P<0.001, respectively, while specificities of MRI (97%) and PET or PET/CT (97%) were higher than that of CT (92%), both P<0.001. The AUC and Q* showed no significant difference among CT, MRI, and PET or PET/CT. |
M |
| 37. NCCN Clinical Practice Guidelines in Oncology. Cervical Cancer. Version 1.2022. Available at: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf |
Review/Other-Dx |
N/A |
To present clinical practice guidelines for cervical cancer. |
No results stated in abstract. |
4 |
| 38. Atri M, Zhang Z, Dehdashti F, et al. Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial. Gynecol Oncol. 142(3):413-9, 2016 Sep. |
Observational-Dx |
153 patients |
To assess if FDG PET combined with diagnostic CT improves diagnostic CT accuracy to detect lymph node (LN) metastasis in advanced cervical cancer. |
Forty-three of 153 patients had metastasis to abdominal LNs. Sample size calculation required review of the first 40 abdominal positive and 40 randomly selected abdominal negative studies. Patients were 24 to 74years (48.9+/-10.6) old. Mean sensitivities of PET-DCT/DCT for detection of LN metastasis in abdomen were 0.50 (CI: 0.44, 0.56) and 0.42 (CI: 0.36, 0.48) (p=0.052) and in pelvis 0.83 (CI: 0.78, 0.87) and 0.79 (CI: 0.73, 0.83) (p=0.15). Corresponding specificities were 0.85 (CI: 0.80, 0.89) and 0.89 (CI: 0.84, 0.92) (p=0.21) and 0.63 (CI: 0.54, 0.70) and 0.62 (CI: 0.53, 0.69) (p=0.83). Mean AUC values were 0.70 (CI: 0.61, 0.79) and 0.68 (CI: 0.59, 0.77) (p=0.43) and 0.80 (CI: 0.71, 0.88) and 0.76 (CI: 0.67, 0.85) (p=0.21) respectively. |
3 |
| 39. Salvo G, Odetto D, Saez Perrotta MC, et al. Measurement of tumor size in early cervical cancer: an ever-evolving paradigm. Int J Gynecol Cancer 2020;30:1215-23. |
Review/Other-Dx |
N/A |
To review the methods for measurement of tumor size in early cervical cancer. |
No results stated in abstract. |
4 |
| 40. Park JY, Kim EN, Kim DY, et al. Comparison of the validity of magnetic resonance imaging and positron emission tomography/computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol 2008;108:486-92. |
Observational-Dx |
53 patients |
To compare positron emission tomography/computed tomography (PET/CT) with magnetic resonance imaging (MRI) in the preoperative detection of primary lesions and lymph node (LN) and distant metastases in patients with uterine corpus cancer. |
In detecting primary lesions, MRI and PET/CT showed no differences in sensitivity (91.5% vs. 89.4%), specificity (33.3% vs. 50.5%), accuracy (84.9% vs. 84.9%), positive predictive value (PPV) (91.5% vs. 93.3%) and negative predictive value (NPV) (33.3% vs. 37.5%). With MRI, the sensitivity, specificity, accuracy, PPV and NPV for detecting metastatic LNs on LN area-by-area analysis were 46.2%, 87.9%, 83.9%, 28.6% and 94.0%, respectively; With PET/CT, those were 69.2%, 90.3%, 88.3%, 42.9%, and 96.6%, respectively. PET/CT showed higher sensitivity, but it did not reach statistical significance (p=0.250). There were also no differences in specificity, accuracy, PPV and NPV. In detecting distant metastasis, the sensitivity, specificity, accuracy, PPV and NPV of PET/CT were 100%, 93.8%, 92.5%, 62.5% and 100%, respectively. |
3 |
| 41. Berchuck A, Anspach C, Evans AC, et al. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma. Gynecol Oncol 1995;59:20-4. |
Observational-Tx |
354 patients |
To examine the effect of postsurgical surveillance on survival of patients with FIGO stage I/II endometrial adenocarcinoma. |
Among the 354 patients in this study, 44 (12%) developed recurrent disease. Sites of recurrence included 12 (27%) isolated vaginal, 12 (27%) pelvic with vagina or abdomen, 4 (10%) isolated lung, 13 (29%) pelvic/abdominal with other distant sites, and 3 (7%) other distant sites. At diagnosis of recurrence 61% of patients had symptoms related to their cancer, 68% had physical exam findings suggestive of recurrence, and 84% had symptoms and/or signs. Findings consistent with recurrent cancer were detected by Pap smear in 25% and on chest radiograph in 20%. Among the 44 patients who developed recurrent disease, 8 (18%) remain alive without evidence of disease, including 6/12 (50%) with isolated vaginal disease and 2/34 (6%) with other patterns of recurrent disease (P = 0.01). Among the 12 patients with isolated vaginal recurrence, 1/3 (33%) in whom recurrent disease was diagnosed by Pap smear alone was salvaged compared to 5/9 (56%) who had symptoms or signs of vaginal recurrence. None of the three patients in whom an abnormal chest radiograph was the only evidence of recurrence survived. |
2 |
| 42. Fung-Kee-Fung M, Dodge J, Elit L, et al. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol 2006;101:520-9. |
Review/Other-Dx |
16 studies |
To determine the optimum follow-up of women who are clinically disease-free following potentially curative treatment for endometrial cancer. |
Sixteen non-comparative retrospective studies were identified. The overall risk of recurrence was 13% for all patients and 3% or less for patients at low risk. Approximately 70% of all recurrences were symptomatic, and 68% to 100% of recurrences occurred within approximately the first 3 years of follow-up. No reliable differences in survival were detected between patients with symptomatic or asymptomatic recurrences nor were differences in patient outcomes reported by type of follow-up strategy employed. Detection of asymptomatic recurrences ranged from 5% to 33% of patients with physical examination, 0% to 4% with vaginal vault cytology, 0% to 14% with chest X-ray, 4% to 13% with abdominal ultrasound, 5% to 21% with abdominal/pelvic CT scan, and 15% in selected patients with CA 125. |
4 |
| 43. Dhull VS, Sharma P, Sharma DN, et al. Prospective evaluation of 18F-fluorodeoxyglucose positron emission tomography-computed tomography for response evaluation in recurrent carcinoma cervix: does metabolic response predict survival?. Int J Gynecol Cancer. 24(2):312-20, 2014 Feb. |
Observational-Dx |
36 patients |
To assess the role of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) in response assessment of patients with recurrent carcinoma cervix and in evaluating the predictive value of metabolic response for progression-free survival (PFS) and overall survival (OS). |
On the basis of metabolic response on posttherapy PET-CT, 6 patients had CMR, 12 patients had PMR, 7 patients had SMD, and 11 patients had PMD. Progression-free survival for patients with cervical carcinoma ranged from 0.5 to 26.5 months (mean [SD], 6.7 [6.1] months). Median PFS for patients with PMD was 3.1 months, whereas median PFS for those without PMD was not reached. Patients who did not show PMD on posttherapy PET-CT had a significantly better PFS than those patients who showed PMD (P < 0.0001; HR, 0.14). There was no statistically significant difference in OS between the 2 groups (P = 0.187; HR, 0.39). |
4 |
| 44. Kalash R, Glaser SM, Rangaswamy B, et al. Use of Functional Magnetic Resonance Imaging in Cervical Cancer Patients With Incomplete Response on Positron Emission Tomography/Computed Tomography After Image-Based High-Dose-Rate Brachytherapy. Int J Radiat Oncol Biol Phys. 102(4):1008-1013, 2018 11 15. |
Observational-Dx |
244 patients |
To investigate the correlation between positron emission tomography/computed tomography (PET/CT) response and outcome in the era of magnetic resonance imaging (MRI)-based planning and to assess whether the addition of diffusion-weighted MRI (DW-MRI) could more accurately classify treatment response and prognosis. |
An complete response on posttreatment PET/CT (PET-CR) was discovered in 50 of 244 patients (20%) at a median interval of 3.3 months (range, 2.1-7.7 months) after treatment. After a median follow-up of 27 months, 2-year overall survival was 83% in all patients. Metabolic response significantly impacted 2-year overall survival (94% complete response on posttreatment PET/ CT vs 62.4% PET-IR, P < .001). Of those with a PET-IR, 16 of 50 patients (32%) suffered a local recurrence. A total of 27 of 50 patients with a PET-IR underwent DW-MRI; 11 of 27 posttreatment DW-MRI scans (40%) were interpreted as positive by central review (median apparent diffusion coefficient of 0.973 x 10(-3) mm(2)/s). Of the DW-MRI-positive patients, 9 of 11 (81.8%) suffered a histologically confirmed local recurrence, and 2 of 11 patients are without evidence of disease. Additionally, 16 of 27 DW-MRI studies were interpreted as negative, and 2 of 16 (12.5%) of these patients suffered a local recurrence. Diffusion-weighted MRI findings significantly impacted 2-year overall survival (83% negative DW-MRI vs 36% positive DW-MRI, P = .049). |
3 |
| 45. Lima GM, Matti A, Vara G, et al. Prognostic value of posttreatment 18F-FDG PET/CT and predictors of metabolic response to therapy in patients with locally advanced cervical cancer treated with concomitant chemoradiation therapy: an analysis of intensity- and volume-based PET parameters. Eur J Nucl Med Mol Imaging. 45(12):2139-2146, 2018 11. |
Observational-Dx |
82 patients |
To investigate the prognostic value of posttreatment (18)F-FDG PET/CT in patients with locally advanced cervical cancer (LACC) treated with concomitant chemoradiation therapy (CCRT). |
Kaplan-Meier analysis showed a highly significant difference in OS between the CMR and N-CMR groups (log-rank test p < 0.0001). Significant independent predictors of response to therapy were MTV (p = 0.019, odds ratio = 1.015, 95% CI = 1.002-1.028, Nagelkerke R(2) = 0.110), TLG (p = 0.045, odds ratio = 1.001, 95% CI = 1.000-1.002, Nagelkerke R(2) = 0.081) and nodal involvement (p = 0.088, odds ratio = 2.361, 95% CI = 0.879-6.343, Nagelkerke R(2) = 0.051). |
3 |
| 46. Liu FY, Su TP, Wang CC, et al. Roles of posttherapy 18F-FDG PET/CT in patients with advanced squamous cell carcinoma of the uterine cervix receiving concurrent chemoradiotherapy. Eur J Nucl Med Mol Imaging. 45(7):1197-1204, 2018 07. |
Observational-Dx |
55 patients |
To assess the clinical roles of [(18)F]fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) performed 2-3 months after completion of concurrent chemoradiotherapy (CCRT), along with pretherapy characteristics, in patients with advanced squamous cell carcinoma of the uterine cervix enrolled in a prospective randomized clinical trial. |
PET/CT scans (n = 55) were positive, equivocal and negative in 9, 13 and 33 patients, respectively. All patients with positive scans were confirmed to have residual or metastatic disease and died despite salvage therapies. There is a significant OS difference between patients with positive and equivocal scans (P < .001) but not between patients with equivocal and negative scans (P = .411). Positive pretherapy PALN is associated with positive posttherapy PET/CT (P = .033) and predicts a poorer survival in patients with equivocal or negative posttherapy PET/CT (P < .001). |
3 |
| 47. Yoon JW, Kim S, Kim SW, Kim YT, Kang WJ, Nam EJ. PET/CT Response Criteria (European Organization for Research and Treatment of Cancer) Predict Survival Better Than Response Evaluation Criteria in Solid Tumors in Locally Advanced Cervical Cancer Treated With Chemoradiation. Clin Nucl Med. 41(9):677-82, 2016 Sep. |
Observational-Dx |
172 patients |
To investigate whether the ratio of SUVs measured with F-FDG PET/CT between pretreatment and posttreatment has prognostic value in patients with locally advanced cervical cancer treated with primary chemoradiation therapy. |
In total, 142 patients receiving chemoradiation showed radiologic responses (median 56% decrease in maximal diameter), whereas 160 and 146 patients showed metabolic responses measured with SUVmax and SUVmean, respectively (73% decrease in SUVmax; 48% decrease in SUVmean). Radiologic response and metabolic response were significantly correlated for SUVmax and SUVmean (P = 0.0009; P = 0.0457, respectively). Kaplan-Meier analysis revealed significant differences in overall survival and progression-free survival between the responder and nonresponder groups, based on the European Organization for Research and Treatment of Cancer criteria (both P < 0.001), whereas no significant difference was found when using RECIST criteria (P = 0.058, P = 0.088, respectively). |
3 |
| 48. Rufini V, Collarino A, Calcagni ML, et al. The role of 18F-FDG-PET/CT in predicting the histopathological response in locally advanced cervical carcinoma treated by chemo-radiotherapy followed by radical surgery: a prospective study. Eur J Nucl Med Mol Imaging. 47(5):1228-1238, 2020 05. |
Observational-Dx |
88 patients |
To evaluate whether (18)F-FDG-PET/CT performed before, during and after neoadjuvant chemo-radiotherapy (CRT) could predict histopathological response in patients with locally advanced cervical cancer (LACC) treated with CRT followed by radical surgery. |
At histopathology, 40 patients had complete response (CR, pR0), 48 had partial response (PR: 21 microscopic [pR1] and 27 macroscopic [pR2]). At baseline, SUVmax and SUVmean were significantly higher in pR0 than in pR1-pR2 patients. At early evaluation, MTV and TLG were significantly higher in pR1-pR2 than in pR0 patients. At final evaluation, SUVmax, SUVmean and TLG were significantly higher in pR1-pR2 than in pR0 patients. Delta SUV parameters and delta TLG were significantly lower in PR group both during and after CRT. Delta MTV was significantly lower in patients with PR in the early phase only. In receiver operating characteristic (ROC) curve analysis, baseline SUVmean, early delta TLG, and final delta SUVmax better discriminated PR, providing 83.3%, 67.6% and 85% positive predictive value (PPV) and 60.3%, 90% and 70.8% negative predictive value (NPV), respectively. For LN assessment, high NPV was observed at early and final (18)F-FDG-PET/CT (93.5% and 92.3%, respectively). |
3 |
| 49. Voglimacci M, Gabiache E, Lusque A, et al. Chemoradiotherapy for locally advanced cervix cancer without aortic lymph node involvement: can we consider metabolic parameters of pretherapeutic FDG-PET/CT for treatment tailoring?. Eur J Nucl Med Mol Imaging. 46(7):1551-1559, 2019 Jul. |
Observational-Dx |
93 patients |
To assess impact of pretherapeutic FDG-PET/CT metabolic parameters on response to chemoradiotherapy (CRT) and survival in locally advanced cervical cancer (LACC) patients without paraaortic lymph node involvement. |
The overall survival (OS) rates at 2 and 5 years were 83.0% [95%CI: 72.5-89.8] and 71.2% [57.5-81.2] respectively. The RFS rates at 2 and 5 years were 72.5% [61.5-80.9] and 64.4% [52.3-74.2] respectively. Higher cervical SUVmax and TLG were significantly associated with poor response to CRT. In multivariate analysis, cervical SUVmax was the main predictive factor for OS. |
3 |
| 50. Han S, Kim H, Kim YJ, Suh CH, Woo S. Prognostic Value of Volume-Based Metabolic Parameters of 18F-FDG PET/CT in Uterine Cervical Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol. 211(5):1112-1121, 2018 11. |
Meta-analysis |
12 studies |
To perform a systematic review and meta-analysis of volume-based (18)F-FDG PET/CT parameters regarding the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with uterine cervical cancer. |
Prognoses were worse in patients with high MTV and TLG, with pooled HRs of 5.89 (95% CI, 3.85-9.01; p < 0.00001) and 5.82 (95% CI, 3.62-9.35; p < 0.00001), respectively, for EFS and 6.62 (95% CI, 3.44-12.73; p < 0.00001) and 7.75 (95% CI, 3.48-17.27; p < 0.00001), respectively, for OS. At multiple subgroups analyses, the prognostic values of MTV and TLG for EFS were consistently significant, with pooled HRs of 5.08-7.30 and 4.80-15.83, respectively. |
Good |
| 51. Kim YJ, Han S, Kim YS, Nam JH. Prognostic value of post-treatment 18F-fluorodeoxyglucose positron emission tomography in uterine cervical cancer patients treated with radiotherapy: a systematic review and meta-analysis. J. gynecol. oncol.. 30(5):e66, 2019 Sep. |
Meta-analysis |
12 studies |
To perform a systematic review and meta-analysis of the prognostic value of post-treatment (1)(8)F-fluorodeoxyglucose positron emission tomography ((1)(8)F-FDG PET) in uterine cervical cancer patients treated with radiotherapy (RT) with or without chemotherapy. |
Eleven studies with 12 patient cohorts including 1,104 patients were included. For a quantitative synthesis of OS, 7 cohorts were included. Two cohorts which reported disease-specific survival instead of OS were also included with flexibility. Pooled HR of complete metabolic response (CMR) compared to partial metabolic response (PMR) was 0.19 (95% confidence interval [CI]=0.11-0.31). Pooled HR of CMR compared to progressive metabolic disease (PMD) was more evident at 0.07 (95% CI=0.04-0.12), and that of CMR compared to both PMR and PMD was 0.20 (95% CI=0.12-0.34). Quantitative synthesis for PFS was performed with a total of 8 cohorts. Pooled HR of CMR was 0.17 (95% CI=0.10-0.29) compared to PMR, 0.02 (95% CI=0.01-0.06) compared to PMD and 0.12 (95% CI=0.07-0.19) compared to both PMR and PMD. |
Good |
| 52. Su TP, Lin G, Huang YT, et al. Comparison of positron emission tomography/computed tomography and magnetic resonance imaging for posttherapy evaluation in patients with advanced cervical cancer receiving definitive concurrent chemoradiotherapy. Eur J Nucl Med Mol Imaging. 45(5):727-734, 2018 05. |
Observational-Dx |
55 patients |
To assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) and pelvic/abdominal magnetic resonance imaging (MRI) after concurrent chemoradiotherapy (CCRT) for posttherapy evaluation in patients with advanced cervical cancer. |
The study included 55 patients and 15 (27%) patients had active residual tumor. The diagnostic performance of PET/CT is significantly superior to that of MRI in patient-based analysis (P = 0.025) and in the detection of local (P = 0.045) and regional (P = 0.014) disease. The patient-based sensitivity, specificity, and accuracy of PET/CT are 60%, 100%, and 89% while those of MRI are 27%, 100%, and 80%. |
2 |
| 53. Shih IL, Yen RF, Chen CA, et al. PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival. J Magn Reson Imaging. 53(1):305-318, 2021 01. |
Observational-Dx |
54 patients |
To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer. |
In advanced tumors (T >/= 1b2, M1, stage >/= IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin , and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008). |
3 |
| 54. Papadopoulou I, Stewart V, Barwick TD, et al. Post-Radiation Therapy Imaging Appearances in Cervical Carcinoma. [Review]. Radiographics. 36(2):538-53, 2016 Mar-Apr. |
Review/Other-Tx |
N/A |
To review the post radiation therapy effects on cervical carcinome. |
No results stated in abstract. |
4 |
| 55. Engin G. Cervical cancer: MR imaging findings before, during, and after radiation therapy. Eur Radiol 2006;16:313-24. |
Review/Other-Dx |
N/A |
To review magnetic resonance (MR) imaging findings of patients with varying stages of cervical carcinoma |
No results stated in abstract. |
4 |
| 56. Woo S, Kim HS, Chung HH, Kim SY, Kim SH, Cho JY. Early stage cervical cancer: role of magnetic resonance imaging after conization in determining residual tumor. Acta Radiol. 57(10):1268-76, 2016 Oct. |
Observational-Dx |
55 patients |
To evaluate the value of MRI after conization in determining residual tumor in patients with FIGO stage IA-IB1 cervical cancer. |
Residual tumor at final pathology was found in 30 (54.5%) patients. Patients with residual tumor were older, had greater SCC antigen, and more frequently had positive conization margins and identifiable tumor on MRI (P < 0.008). Multivariate analysis showed that age (P = 0.008; odds ratio [OR] = 1.140), positive conization margin (P = 0.016; OR = 11.919), and identifiable tumor on MRI (P = 0.038; OR = 6.926) were independently predictive of residual tumor. Areas under the curve (AUCs) calculated with age (0.693), SCC antigen (0.755), and identifiable tumor on MRI (0.727) were greater than lymphovascular space invasion (0.517) and histological subtype (0.520, P </= 0.049). Otherwise, there were no significant differences in the AUCs derived from different variables (P = 0.053-0.970). |
3 |
| 57. Arend F, Oechsner M, Weidenbacher CB, Combs SE, Borm KJ, Duma MN. Correlations of UICC tumor stage and tumor regression on T2-weighted MRI sequences during definitive radiotherapy of cervical cancer. Tumori. 107(2):139-144, 2021 Apr. |
Observational-Dx |
32 patients |
To detect a correlation between the preradiation tumor staging and the relative volumetric regression of the primary tumor through external beam radiation therapy (EBRT). |
Mean ptGTV reduction during RT was 61.4+/-28.9%. T1 tumors shrank by 88.2+/-13.4%, T2 by 67.6+/-28.7%, T3 by 50.8+/-23.6%, and T4 by 38.7+/-27.2%. The difference in tumor shrinkage was statistically significant between the lower T stages and the higher T stages (p < 0.05). There was no statistical difference in the mean ptGTV before treatment in the group with lymph node metastases (LNM) (54.1+/-47.7 cm(3)) as compared to the group without LNM (76.6+/-52.2 cm(3)). Nonetheless, ptGTV shrank significantly differently: by 68.9+/-25.7% (N1 patients) and by 29.0+/-17.7% (N0 patients). No significant differences in ptGTV shrinkage were observed in M0 versus M1 and G2 versus G3 tumors. |
3 |
| 58. Angeles MA, Baissas P, Leblanc E, et al. Magnetic resonance imaging after external beam radiotherapy and concurrent chemotherapy for locally advanced cervical cancer helps to identify patients at risk of recurrence. Int J Gynecol Cancer. 29(3):480-486, 2019 03. |
Observational-Dx |
185 patients |
To evaluate the prognostic value of tumor size reduction rate after external beam radiotherapy and chemotherapy prior to brachytherapy. |
Median tumor size after external beam radiotherapy and chemotherapy was 2.0 cm (range 0.0-8.0) and median tumor size reduction rate was 62.4% (range 0.0-100.0%). Tumor size and tumor reduction rate at 45 Gy external beam radiotherapy MRI were significantly associated with local recurrence free survival (P<0.001), disease free survival, and overall survival (P<0.05). Tumor reduction rate >/=60% was significantly associated with a decreased risk of relapse and death (HR (95% CI) 0.21 (0.09 to 0.50), P=0.001 for local recurrence free survival; 0.48 (0.30 to 0.77) P=0.002 for disease free survival; and 0.51 (0.29 to 0.88), P=0.014 for overall survival). |
3 |
| 59. Zhang J, Tian W, Bu X, Wang X, Tian F, Wu L. Diagnostic significance of magnetic resonance imaging in patients with cervical cancer after brachytherapy: a meta-analysis. Acta Radiol. 60(5):670-676, 2019 May. |
Meta-analysis |
4 studies |
To determine the diagnostic significance of MRI in detecting residual tumor tissue after BCT. |
Four clinical studies consisting of 163 patients (147 of whom were included in the present analysis) who were diagnosed with uterine cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) staging system were included in the study. All the patients received BCT and underwent MRI detection of residual tumors tissue. In studies where the accuracy of MRI detection was confirmed by histological tests or gynecological tests, the summary estimates of specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were 88.5%, 83.5%, 53.5%, 97.1%, and 84.3%, respectively. |
Good |
| 60. Gui B, Valentini AL, Micco M, et al. Cervical cancer response to neoadjuvant chemoradiotherapy: MRI assessment compared with surgery. Acta Radiol. 57(9):1123-31, 2016 Sep. |
Observational-Dx |
41 patients |
To determine the diagnostic performance of magnetic resonance imaging (MRI) in evaluating residual disease after chemoradiotherapy in patients with locally advanced cervical carcinoma (LACC). |
All patients showed significant difference in tumor volume and signal intensity between pre- and post-chemoradiotherapy MRI (P < 0.0001). According to pathology, 27/41 (66%) patients had true negative and 2/41 (5%) had true positive post-chemoradiotherapy MRI. Eleven out of 41 (27%) patients showed inflammation with false positive post-chemoradiotherapy MRI and 1/41 (2%) had a false negative post-chemoradiotherapy MRI. Sensitivity, specificity, accuracy, positive predictive values, and negative predictive values of post-chemoradiotherapy MRI in predicting residual disease were 69%, 71%, 71%, 15%, and 96%, respectively. |
3 |
| 61. Jalaguier-Coudray A, Villard-Mahjoub R, Delouche A, et al. Value of Dynamic Contrast-enhanced and Diffusion-weighted MR Imaging in the Detection of Pathologic Complete Response in Cervical Cancer after Neoadjuvant Therapy: A Retrospective Observational Study. Radiology. 284(2):432-442, 2017 08. |
Observational-Dx |
52 patients |
To evaluate the association between dynamic contrast material-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging with pathologic complete response after preoperative combined chemotherapy and radiation therapy for cervical carcinoma and evaluate the risk of local recurrence. |
An initial increase in signal intensity on DCE MR images that was greater in the cervical lesion than in the myometrium was defined as time-signal intensity curve type B and showed a significant association with incomplete response (P = .0004). DCE MR imaging parameters (ie, maximum slope enhancement, area under the gadolinium concentration-time curve during the first 90 seconds after gadolinium injection [AUGC90], and volume transfer constant [K(trans)]) and a low signal intensity on apparent diffusion coefficient (ADC) maps were significantly associated with an incomplete response (P = .027, P = .041, P = .037, and P = .032, respectively). A mean ADC of 0.0014 m(2)/sec or less (hazard ratio [HR] = 8.3), low ADC signal intensity (HR = 7.3), high signal intensity at DW imaging (HR = 7.1), and time-signal intensity curve type B (HR = 4.3) were associated with earlier recurrence (P < .05). Excellent agreement between readers was found for time-signal intensity curve analysis (kappa > 0.9) and the following parameters: AUGC90, K(trans), and maximum slope enhancement (intraclass correlation coefficient, >0.9). |
3 |
| 62. Meyer HJ, Wienke A, Surov A. Pre-treatment Apparent Diffusion Coefficient Does Not Predict Therapy Response to Radiochemotherapy in Cervical Cancer: A Systematic Review and Meta-analysis. Anticancer Res. 41(3):1163-1170, 2021 Mar. |
Meta-analysis |
16 studies |
To compare pre-treatment ADC values to predict treatment outcome of radiochemotherapy for CC based upon a large patient sample. |
For the response group, 416 patients were included in the analysis (72.5%) and for the no-response group 158 patients were included (27.5%). The mean ADC value of patients with CC with treatment response was 0.87x10(-3) mm(2)/s (95% confidence interval=0.81-0.94x10(-3) mm(2)/s), and for the patients with no response was 0.92x10(-3) mm(2)/s (95% confidence interval=0.85-0.98x10(-3) mm(2)/s). |
Good |
| 63. Zhang A, Song J, Ma Z, Chen T. Combined dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging to predict neoadjuvant chemotherapy effect in FIGO stage IB2-IIA2 cervical cancers. Radiol Med (Torino). 125(12):1233-1242, 2020 Dec. |
Observational-Dx |
63 patients |
To explore the value of histogram analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative parameters and apparent diffusion coefficient (ADC) values in predicting the neoadjuvant chemotherapy (NACT) response for cervical cancers. |
SR group and non-SR group were documented in 35 and 28 patients. The mean K(trans) value, 90th percentile K(trans) value, maximal K(trans) value, and 90th percentile ADC value of tumors in SR were significantly higher than those in non-SR group (P = 0.012, P = 0.022, P = 0.005, P = 0.033, respectively), and the mean Ve value and 10th percentile Ve value of tumors were significantly lower in SR group (P = 0.041, P = 0.033, respectively). Kep values did not significantly differ between SR and non-SR. The 90th percentile K(trans) value combined with the 90th percentile ADC value had the highest area under the curve at 0.740 (P = 0.003) to predict NACT effectiveness. |
3 |
| 64. Zheng X, Guo W, Dong J, Qian L. Prediction of early response to concurrent chemoradiotherapy in cervical cancer: Value of multi-parameter MRI combined with clinical prognostic factors. Magn Reson Imaging. 72:159-166, 2020 10. |
Observational-Dx |
85 patients |
To investigate the prediction of early response to concurrent chemoradiotherapy (CCRT) through a combination of pretreatment multi-parametric magnetic resonance imaging (MRI) with clinical prognostic factors (CPF) in cervical cancer patients. |
here were 52 patients in non- and 33 in residual group. The residual group showed a lower perfusion fraction (f) value and volume transfer constant (K(trans)) value, a higher apparent diffusion coefficient (ADC) value, diffusion coefficient (D) value and volume fraction of extravascular extracellular space (Ve) value, and a higher stage than the non-residual tumor group (all P < .05). D, K(trans), Ve and stage were independent prognostic factors. The combination of D, K(trans) and Ve improved the diagnostic performance compared with individual MRI parameters. A further combination of these three MRI parameters with stage exhibited the highest predictive performance. |
3 |
| 65. Onal C, Erbay G, Guler OC. Treatment response evaluation using the mean apparent diffusion coefficient in cervical cancer patients treated with definitive chemoradiotherapy. J Magn Reson Imaging. 44(4):1010-9, 2016 10. |
Observational-Dx |
44 patients |
To investigate the pre- and posttreatment mean apparent diffusion coefficient (ADCmean ) of cervical cancer tumors treated with definitive chemoradiotherapy (CRT) and evaluate their correlation with recurrence and survival rates. |
The pre- and posttreatment ADCmean values were 0.882 +/- 0.096 x 10(-3) mm(2) /sec and 1.159 +/- 0.168 x 10(-3) mm(2) /sec, respectively, and the difference was statistically significant (P < 0.001). The median percent ADC change was 33.7% (range, 5.0-70.0%). Patients with disease recurrence had lower ADC values, both pretreatment (0.822 +/- 0.096 x 10(-3) mm(2) /sec vs. 0.936 +/- 0.058 x 10(-3) mm(2) /sec; P < 0.001) and posttreatment (1.060 +/- 0.116 x 10(-3) mm(2) /sec vs. 1.248 +/- 0.160 x 10(-3) mm(2) /sec; P < 0.001). The ADC change was lower in patients with recurrence (25.7% +/- 13.0% vs. 42.8% +/- 15.7; P < 0.001) than in patients without recurrence. In multivariate analysis, pelvic lymph node metastasis and pretreatment ADCmean were prognostic factors for overall survival (OS) and disease-free survival (DFS). ADC change between pre- and posttreatment DW-MRI was a prognostic factor for OS. |
4 |
| 66. Tsuruoka S, Kataoka M, Hamamoto Y, et al. Tumor growth patterns on magnetic resonance imaging and treatment outcomes in patients with locally advanced cervical cancer treated with definitive radiotherapy. Int J Clin Oncol. 24(9):1119-1128, 2019 Sep. |
Observational-Dx |
102 patients |
To evaluate the prognostic value of tumor growth patterns on magnetic resonance (MR) images in patients with locally advanced cervical cancer (LACC) treated with definitive radiotherapy or concurrent chemoradiotherapy (RT/CCRT). |
The median age was 60 years (range 26-90 years). The median follow-up time was 47.7 months (range 5.7-123 months). The numbers of patients with stages IB, II, III, and IVA were 17, 39, 43, and 3, respectively. The 3-year overall survival (OS) rates for stages IB, II, III, and IV were 87%, 76%, 74%, and 67%, respectively. Regarding growth patterns on MR images, 31 were of expansive type and 71 were of infiltrative type. The infiltrative type was significantly associated with lower OS and locoregional recurrence-free survival (LRRFS) than the expansive type (3-year OS, 70% vs. 93%, p = 0.003; 3-year LRRFS, 64% vs. 94%, p = 0.001). On multivariate analysis, infiltrative tumor growth patterns were a significant independent factor for low OS (hazard ratio [HR], 3.81; 95% confidence interval [CI] 1.26-16.7; p = 0.015) and low LRRFS (HR, 4.27; 95% CI 1.43-18.5; p = 0.007). |
3 |
| 67. Perniola G, Tomao F, Graziano M, et al. The Role of 2D/3D Ultrasound to Assess the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer. Oncology. 98(11):807-813, 2020. |
Observational-Dx |
157 patients |
To evaluate the response to neoadjuvant chemotherapy (NACT) in LACC by 2D/3D ultrasound examination. |
From March 2010 to March 2019, 157 women were recruited. Among these patients, 12 of them were excluded: 6 for the presence of distant metastases, 4 for rare histology, and 2 for severe comorbidities not allowing the protocol treatment. Seventeen patients after NACT were excluded because they were not amenable to radical surgery. Thus, 128 were considered for the final analysis of whom 106 (83%) were considered responders to NACT by histology. The sensibility and specificity of ultrasound with regard to the response to chemotherapy compared to histological specimen were 94 and 82%, respectively, with an accuracy of 92%. The positive predictive value and negative predictive value were 96 and 75%, respectively. Finally, we found that nonetheless there was a trend towards a continuous response to chemotherapy among patients who were considered responders to NACT at pathological examination; the major volume and vascularization index (VI) reduction were observed during the first 2 cycles (74, 71% and 47, 63%, respectively). On the contrary, non-responders showed an initial reduction of the VI (4.86 consisting of 33%, 95% CI 0.79-8.92, p = 0.013), but no significant modification in tumour volume along NACT. |
3 |
| 68. Perniola G, Fischetti M, Tomao F, et al. Evaluation of Parametrial Status in Locally Advanced Cervical Cancer Patients after Neoadjuvant Chemotherapy: A Prospective Study on Diagnostic Accuracy of Three-Dimensional Transvaginal Ultrasound. Oncology. 98(9):603-611, 2020. |
Observational-Dx |
51 patients |
To analyze the diagnostic accuracy of two-dimensional (2D) and three-dimensional transvaginal ultrasound (3D TV-US) for evaluation of parametrial status in locally advanced cervical cancer patients after neoadjuvant chemotherapy (NACT), using histology as the gold standard. |
Before chemotherapy, clinical examination under anaesthesia identified parametrial involvement in 48 patients, ultrasonography in 46 patients, and MRI in 49 patients. The agreement between US and MRI was 94%. The sensitivity of US for parametrial status was 93.8%, with a positive predictive value of 97.8%, using MRI as the standard. The correlation between US and MRI was statistically significant (p = 0). After chemotherapy, histological examination of surgical specimens identified parametrial involvement in 3 patients. Ultrasonography correctly identified those cases with parametrial infiltration, recording a sensitivity of 100%, specificity of 90.9%, positive predictive value of 50%, and negative predictive value of 100%. The MRI had a sensitivity of 100%, specificity of 45.5%, positive predictive value of 14.3%, and negative predictive value of 100%, respectively. The concordance in the identification of the presence/absence of infiltration between US and MRI with histology was 90% (p = 0.001) and 61%, respectively, after chemotherapy treatment. Particularly, in defining the degree of infiltration, the agreement between US and MRI with histology was 90 and 58%, respectively. |
3 |
| 69. Testa AC, Ferrandina G, Moro F, et al. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. Ultrasound Obstet Gynecol. 51(5):684-695, 2018 May. |
Observational-Dx |
108 patients |
To analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single-institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery. |
There was a complete pathological response to neoadjuvant therapy in 40 (45.5%) patients and a partial response in 48 (54.5%). At baseline examination, tumor volume did not differ between the two groups. However, after 2 weeks of neoadjuvant treatment, the tumor volume was significantly greater in patients with partial response than it was in those with complete response (P = 0.019). Among the 3D vascular indices, the vascularization index (VI) was significantly lower in the partial-response compared with the complete-response group, both before and after 2 weeks of treatment (P = 0.037 and P = 0.024, respectively). At baseline examination in the contrast analysis, women with partial response had lower tumor peak enhancement (PE) as well as lower tumor wash-in rate (WiR) and longer tumor rise time (RT) compared with complete responders (P = 0.006, P = 0.003, P = 0.038, respectively). There was no difference in terms of contrast parameters after 2 weeks of treatment. ROC-curve analysis of baseline parameters showed that the best cut-offs for predicting partial pathological response were 41.5% for VI (sensitivity, 63.6%; specificity, 66.7%); 16123.5 auxiliary units for tumor PE (sensitivity, 47.9%; specificity, 84.2%); 7.8 s for tumor RT (sensitivity, 68.8%; specificity, 57.9%); and 4902 for tumor WiR (sensitivity, 77.1%; specificity, 60.5%). ROC curves of parameters after 2 weeks of treatment showed that the best cut-off for predicting partial pathological response was 18.1 cm(3) for tumor volume (sensitivity, 70.8%; specificity 60.0%) and 39.5% for VI (sensitivity; 62.5%; specificity, 73.5%). |
3 |
| 70. Ding XP, Feng L, Ma L. Diagnosis of recurrent uterine cervical cancer: PET versus PET/CT: a systematic review and meta-analysis. [Review]. Arch Gynecol Obstet. 290(4):741-7, 2014 Oct. |
Meta-analysis |
18 studies |
To assess and compare the overall value of stand-alone FDG PET and PET/CT in diagnosing recurrent cervical cancer with a meta-analysis. |
A total of 18 studies were included in this meta-analysis, with a total of 762 subjects. Pooled sensitivity and specificity of PET and PET/CT were 0.91 (95 % CI 0.87-0.94) and 0.94 (95 % CI 0.89-0.97), and 0.92 (95 % CI 0.91-0.94) and 0.84 (95 % CI 0.74-0.91), respectively. The areas under the SROC curve (AUCs) of PET and PET/CT were 0.9610 and 0.9491, respectively. There was no statistical significance between the AUC of PET and PET/CT (P > 0.05). |
Good |
| 71. Chu Y, Zheng A, Wang F, et al. Diagnostic value of 18F-FDG-PET or PET-CT in recurrent cervical cancer: a systematic review and meta-analysis. [Review]. Nucl Med Commun. 35(2):144-50, 2014 Feb. |
Meta-analysis |
20 studies |
To assess the diagnostic value of PET or PET-computed tomography (PET-CT) using F-fluorodeoxyglucose (F-FDG) in recurrent cervical cancer using a meta-analysis. |
The meta-analysis showed that the pooled sensitivity and specificity of PET and PET-CT to detect distant metastasis in recurrent cervical cancer were 0.87 [95% confidence interval (CI): 0.80-0.92] and 0.97 (95% CI: 0.96-0.98), respectively. The pooled sensitivity and specificity for local regional recurrence were 0.82 (95% CI: 0.72-0.90) and 0.98 (95% CI: 0.96-0.99), respectively. |
Good |
| 72. Deng C, Ding D, Wang M. The predictive recurrence value of MTV-s as an 18F-FDG PET/CT index in patients with IIB-IVA cervical cancer. Postgrad Med. 133(4):436-443, 2021 May. |
Observational-Dx |
84 patients |
To explore the predictive recurrence value of the PET/CT index and some clinical features in patients with IIB-IVA cervical cancer. |
During the observation period, 26 patients had tumor recurrence (31.0%). Univariate analysis showed that lymph node metastasis, lymph node SUVmax (SUVmax-LN), MTV-C, MTV-LN, and MTV-s were associated with PFS. MTV-s > 27.36 cm(3) was an independent risk factor for PFS (P = 0.037). There were 41 patients with MTV-s > 27.36 cm(3), and 19 of them had tumor recurrence (46.3%). There were 43 patients with MTV-s </= 27.36 cm(3), 7 of whom had tumor recurrence (16.3%). |
3 |
| 73. Leray H, Gabiache E, Courbon F, et al. 18F-FDG PET/CT Identifies Predictors of Survival in Patients with Locally Advanced Cervical Carcinoma and Paraaortic Lymph Node Involvement to Allow Intensification of Treatment. J Nucl Med. 61(10):1442-1447, 2020 10. |
Observational-Dx |
68 patients |
To use (18)F-FDG PET/CT to identify a high-risk subgroup requiring therapeutic intensification among patients with locally advanced cervical cancer (LACC) and paraaortic lymph node (PALN) involvement. |
Three-year OS was 55.5% (95% confidence interval, 40.8-68.0). When adjusted for age, stage, and histology, pelvic lymph node TLG, PALN TLG, and PALN SUVmax were significantly associated with OS (P < 0.005). |
3 |
| 74. Shou H, Yasuo Y, Yuan S, Lou H, Ni J. Association of pretreatment SUVmax of cervix and SCC-antigen with FIGO2018 stage in Stage IIB-IVB squamous cervical cancer and relationship to prognosis. Int J Gynaecol Obstet. 152(1):112-117, 2021 Jan. |
Observational-Dx |
116 patients |
To evaluate the association of pretreatment maximum standardized (18) F-fluorodeoxyglucose uptake value (SUVmax ) of cervix and serum squamous cell carcinoma antigen (SCC-ag) with FIGO2018 stage and prognosis among women with Stage IIB-IVB squamous cervical cancer. |
Women were stratified by mean SUVmax and mean SCC-ag. There was a significant difference between low (<12.9) and high (>/=12.9) SUVmax groups in menopause (P = 0.004), FIGO2018 stage (P = 0.015), and survival rate (P < 0.001). The low group had better overall and progress-free survival by Kaplan-Meier evaluation (both P = 0.022). High SCC-ag (>/=14.6 ng/mL) was associated with FIGO2018 stage (P = 0.038) and distant metastasis (P = 0.011). There was a significant correlation between SUVmax and serum SCC-ag (P = 0.026). In multivariate Cox regression analyses, FIGO2018 stage (P = 0.019) and SUVmax of cervix (P = 0.015) were independent predictors of poor outcome in squamous cervical cancer. |
3 |
| 75. Brandmaier P, Purz S, Bremicker K, et al. Simultaneous [18F]FDG-PET/MRI: Correlation of Apparent Diffusion Coefficient (ADC) and Standardized Uptake Value (SUV) in Primary and Recurrent Cervical Cancer. PLoS ONE. 10(11):e0141684, 2015. |
Observational-Dx |
31 patients |
To investigate correlations in patients with primary and recurrent tumors using a simultaneous PET/MRI system which could lead to a better understanding of tumor biology and might play a role in early response assessment. |
92 lesions were detected. We found a significant inverse correlation between SUVmax and ADCmin (r = -0.532, p = 0.05) in primary tumors as well as in primary metastases (r = -0.362, p = 0.05) and between SUVmean and ADCmin (r = -0.403, p = 0.03). In recurrent local tumors we found correlations for SUVmax and ADCmin (r = -0.747, p = 0.002) and SUVmean and ADCmin (r = -0.773, p = 0.001). Associations for recurrent metastases were not significant (p>0.05). |
3 |
| 76. Grueneisen J, Beiderwellen K, Heusch P, et al. Correlation of standardized uptake value and apparent diffusion coefficient in integrated whole-body PET/MRI of primary and recurrent cervical cancer. PLoS ONE. 9(5):e96751, 2014. |
Observational-Dx |
19 patients |
To evaluate a potential correlation of the maximum standard uptake value (SUVmax) and the minimum apparent diffusion coefficient (ADCmin) in primary and recurrent cervical cancer based on integrated PET/MRI examinations. |
In 15 out of 19 patients cervical cancer lesions (n = 12) or lymph node metastases (n = 42) were detected. Mean SUVmax (12.5 +/- 6.5) and ADCmin (644.5 +/- 179.7 x 10(-5) mm2/s) values for all assessed tumor lesions showed a significant but weak inverse correlation (R = -0.342, p < 0.05). When subdivided in primary and recurrent tumors, primary tumors and associated primary lymph node metastases revealed a significant and strong inverse correlation between SUVmax and ADCmin (R = -0.692, p < 0.001), whereas recurrent cancer lesions did not show a significant correlation. |
2 |
| 77. Watanabe Y, Nakamura S, Ichikawa Y, et al. Early alteration in apparent diffusion coefficient and tumor volume in cervical cancer treated with chemoradiotherapy or radiotherapy: Incremental prognostic value over pretreatment assessments. Radiother Oncol. 155:3-9, 2021 02. |
Observational-Dx |
103 patients |
To evaluate a prognostic value of early changes in apparent diffusion coefficients (ADC) and tumor volume during treatment in patients with cervical cancer treated with chemoradiotherapy or radiotherapy, and to assess whether the early changes provided an incremental value to pre-treatment ADC and tumor volume in predicting disease recurrences. |
During a median follow-up of 2.7 years, 42 (41%) patients had disease recurrences. Univariate Cox regression analysis revealed that pre-treatment ADC (Hazard ratio [HR] = 2.8; p = 0.002), %ADC increase (HR = 6.8; p < 0.001), and %Volume reduction (HR = 2.7; p = 0.003) were significant predictors for disease recurrences. On multivariate analysis, %ADC increase was the only independent predictor (adjusted HR = 5.2; p < 0.001) for disease recurrences when adjusted for %Volume reduction and pre-treatment ADC. Global chi-square analysis demonstrated that %ADC increase and %Volume reduction had an additional prognostic value over pre-treatment ADC and tumor volume (p < 0.05). Kaplan-Meier curve analysis showed that both smaller %ADC increase and %Volume reduction were associated with worse prognosis in disease-free survival (log-rank, p < 0.001 and p = 0.002, respectively). |
3 |
| 78. Gu KW, Kim CK, Choi CH, Yoon YC, Park W. Prognostic value of ADC quantification for clinical outcome in uterine cervical cancer treated with concurrent chemoradiotherapy. Eur Radiol. 29(11):6236-6244, 2019 Nov. |
Observational-Dx |
124 patients |
To investigate the prognostic value of diffusion-weighted imaging (DWI) in predicting clinical outcome in patients with cervical cancer after concurrent chemoradiotherapy (CCRT). |
In multivariate analysis, DeltaADCmean was the only independent predictor of PFS (hazard ratio [HR] = 0.2379, p = 0.005), CSS (HR = 0.310, p = 0.024), and OS (HR = 0.217, p = 0.002). Squamous cell carcinoma antigen, histology, and pretreatment tumor size were significantly independent predictors of PFS. Tumor size response was significantly independent predictor of CSS and OS. Using the cutoff values of DeltaADCmean, the PFS was significantly lower for DeltaADCmean < 27.8% (p = 0.001). The CSS and OS were significantly lower for DeltaADCmean < 16.1% (p = 0.002 and p < 0.001, respectively). |
4 |
| 79. Lee SW, Lee SH, Kim J, et al. Magnetic resonance imaging during definitive chemoradiotherapy can predict tumor recurrence and patient survival in locally advanced cervical cancer: A multi-institutional retrospective analysis of KROG 16-01. Gynecol Oncol. 147(2):334-339, 2017 11. |
Observational-Dx |
225 patients |
To assess the association between tumor response in MRI using FIGO classification and clinical outcomes. |
112 (49.7%) of the 225 patients showed a positive response in post-CRT MRI and were named the responsive arm. After a median follow-up time of 36.2months, the responsive arm had significantly lower para-aortic recurrence (7.5% vs. 12.4%; p=0.04) and distant metastasis (13.2% vs. 27.6%; p=0.03) rates than did the non-responsive arm. The responsive arm had significantly higher 3-year cause-specific survival rate (94.6% vs. 81.1%, p<0.01) than did the non-responsive arm. In the multivariate analysis, tumor size (hazard ratio, 1.91 and 95% confidence interval, 1.07-3.43; p=0.028) and positive MR response (hazard ratio, 1.75 and 95% confidence interval, 1.06-2.27; p=0.045) were significant factors for recurrence-free survival |
3 |
| 80. Park SH, Hahm MH, Bae BK, et al. Magnetic resonance imaging features of tumor and lymph node to predict clinical outcome in node-positive cervical cancer: a retrospective analysis. Radiat. oncol.. 15(1):86, 2020 Apr 20. |
Observational-Dx |
93 patients |
To investigate pretreatment magnetic resonance (MR) imaging features of primary tumor and involved lymph node for predicting clinical outcome in cervical cancer patients. |
For predicting LC, models generated from primary tumor imaging features showed better predictive performance (C-index, 0.72) than those from lymph node features (C-index, 0.62). In contrast, models from lymph nodes showed superior performance for predicting RC, DMFS, and OS compared to models of the primary tumor. According to the 3-year time-dependent receiver operating characteristic analysis of LC, RC, DMFS, and OS prediction, the respective area under the curve values for the predicted risk of the models generated from the training dataset were 0.634, 0.796, 0.733, and 0.749 in the validation dataset. |
3 |
| 81. Wang YT, Li YC, Yin LL, Pu H. Can Diffusion-weighted Magnetic Resonance Imaging Predict Survival in Patients with Cervical Cancer? A Meta-Analysis. [Review]. Eur J Radiol. 85(12):2174-2181, 2016 Dec. |
Meta-analysis |
9 studies |
To systematically evaluate whether DWI can serve as a reliable prognostic predictor in patients with cervical cancer. |
Methodological quality was relatively high. Eight of the nine studies employed apparent diffusion coefficient (ADC) as an indicator of DWI results. Using disease-free survival (DFS) as an outcome measure, nine studies yielded a combined HR of 1.55 (95% confidence interval (CI): 1.23-1.95), and seven studies that employed pretreatment DWI yielded a combined HR of 1.50 (95% CI: 1.03-2.19), which indicated that unfavorable DWI results were associated with an approximately 1.50-1.55-fold higher risk of tumor recurrence. The two studies investigating the impact of DWI results on overall survival (OS) reported HRs of 7.20 and 2.17, respectively. |
Good |
| 82. Meads C, Davenport C, Malysiak S, et al. Evaluating PET-CT in the detection and management of recurrent cervical cancer: systematic reviews of diagnostic accuracy and subjective elicitation. [Review]. BJOG. 121(4):398-407, 2014 Mar. |
Meta-analysis |
15 studies |
To evaluate diagnostic accuracy of additional whole body PET-CT compared with CT/magnetic resonance imaging (MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance. |
We identified 15 relevant studies; none directly compared additional PET-CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET-CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET-CT were less than elicited increases required to justify the use in PET-CT for surveillance. |
Good |
| 83. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
