ABSTRACT Introduction: Magnetic resonance imaging (MRI) studies obtained during the initial staging of patients affected by uterine cervical cancer were compared to the final histological report after surgery. Methods: Data were retrieved from published papers. Results: MRI detection of lymph node metastases shows a sensitivity of 49.3% (1209 patients) and a specificity of 87.7% (1182 patients). Parametrial involvement detection has 66.2% sensitivity (1288 patients) and 83.6% specificity (1282 patients). MRI tumor size evaluation shows significant error. Even detection of over 1 cm diameter primary tumor can fail. MRI appears promising in the detection of myometrial and endometrial involvement. Conclusions: Primary uterine cervical cancer evaluation with routine MRI has a limited accuracy especially in the detection of lymph node involvement and parametrial invasion. It is not sensitive enough to replace histology of dissected nodes and parametria. Tumor size estimation is imprecise. Detection of myometrial and endometrial invasion using MRI might be possible. Awareness of MRI limitations is crucial in primary cervical cancer staging.
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G. Rigon, C. Vallone, A. Starita, M. Vismara, P. Ialongo, L. Putignani and F. Signore, "Diagnostic Accuracy of MRI in Primary Cervical Cancer," Open Journal of Radiology, Vol. 2 No. 1, 2012, pp. 14-21. doi: 10.4236/ojrad.2012.21003.
 A. Jemal, R. Siegel, E. Ward, T. Murray, J. Xu and M. J. Thun, “Cancer Statistics,” CA: A Cancer Journal of Clinicians, Vol. 57, No. 1, 2007, pp. 43-66.
 H. J. Choi, W. Ju, S. K, Myung and Y. Kim, “Diagnostic Performance of Computed 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 Science, Vol. 10, No. 6, 2010, pp. 1471-1479.
 H. H. Chung, S. B. Kang, J. Y. Cho, J. W. Kim, N. H. Park, Y. S. Song, S. H. Kim and H. P. Lee, “Can Preoperative MRI Accurately Evaluate Nodal and Parametrial Invasion in Early Stage Cervical Cancer?” Japanese Journal of Clinical Oncology, Vol. 37, No. 3, 2007, 370- 375. doi:10.1093/jjco/hym036
 K. Fujiwara, E. Yoden, T. Asakawa, M. Shimizu, M. Hirokawa, Y. Mikami, T. Oda, I. Joja, Y. Imajo and I. Kohno, “Negative MRI Findings with Invasive Cervical Biopsy May Indicate Stage IA Cervical Carcinoma,” Gynecoloy Oncology, Vol. 79, No. 3, 2000, pp. 451-456.
 W. W. M. Lam, N. M. C. So, W. T. Yang and C. Metreweli, “Detection of Parametrial Invasion in Cervical Carcinoma: Role of Short Tau Inversion Recovery Sequence,” Clinical Radiology, Vol. 55, No, 9, 2000, pp. 702-707. doi:10.1053/crad.2000.0506
 A. G. Rockall, S. Ghosh, F. Alexander-Sefre, S. Babar, M. T. Younis, S. Naz, I. J. Jacobs and R. H. Reznek, “Can MRI Rule Out Bladder and Rectal Invasion in Cervical Cancer to Help Select Patients for Limited EUA?” Gynecology Oncology, Vol. 101, No. 2, 2006, pp. 244-249.
 H. Hertel, C. K?hler, T. Elhawary, W. Michels, M. Possover and A. Schneider, “Laparoscopic Staging Compared with Imaging Techniques in the Staging of Advanced Cervical Cancer,” Gynecology Oncology, Vol. 87, No. 1, 2002, pp. 46-51. doi:10.1006/gyno.2002.6722
 S. Postema, P. T. M. Pattynama, A. Van den Berg- Huy- smans, P. W. Lex, G. Kenter and J. B. Trimbos, “Effect of MRI on Therapeutic Decisions in Invasive Cervical Carcinoma. Direct Comparison with the Pelvic Examination as a Preoperative Test,” Gynecology Oncology, Vol. 79, No. 3, 2000, pp. 485-489.
 H. Nam, S. J. Huh, W. Park, D. S. Bae, B. G. Kim, J. H. Lee, C. K. Kim and B. K. Park, “Prognostic Significance of MRI-Detected Bladder Muscle and/or Serosal Invasion in Patients with Cervical Cancer Treated with Radiotherapy,” British Journal of Radiology, Vol. 83, No. 994, 2010, pp. 868-873. doi:10.1259/bjr/6646798
 S. Rajaram, H. Sharma, S. K. Bhargava, R. P. Tripathi, N. Goel and S. Mehta, “Mapping the Extent of Disease by Multislice Computed Tomography, Magnetic Resonance Imaging and Sentinel Node Evaluation in Stage I and II Cervical Carcinoma,” Journal of Cancer Research and Therapeutics, Vol. 6, No. 3, 2010, pp. 267-271.
 H. Hricak, C. Gatsonis, D. S. Chi, M. A. Amendola, K. Brandt, L. H. Schwartz, S. Koelliker, E. S. Siegelman, J. J. Brown, R. B. McGhee Jr., R. Iyer, K. M. Vitellas, B. Snyder, H. J. Long III, J. V. Fiorica and D. G. Mitchell, “Role of Imaging in Pretreatment Evaluation of Early Invasive Cervical Cancer: Results of the Intergroup Study American College of Radiology Imaging Network 6651- Gynecology Oncology Group 183,” Journal of Clinical Oncology, Vol. 23, No. 36, 2005, pp. 9329-9337.
 S. H. Choi, S. H. Kim, H. J. Choi, B. K, Park and H. J. Lee, “Preoperative Magnetic Resonance Imaging Staging of Uterine Cervical Carcinoma,” Journal of Computer Assisted Tomography, Vol. 28, No. 5, 2004, pp. 620-627.
 M. H. Sheu, C. Y, Chang, J. H. Wang and M. S. Yen, “Preoperative Staging of Cervical Carcinoma with MR Imaging: A Reappraisal of Diagnostic Accuracy and Pitfalls,” European Radiology, Vol. 11, No. 9, 2001, pp. 1828-1833. doi:10.1007/s003300000774
 M. H. Sheu, C. Y. Chang, J. H. Wang and M. S. Yen, “MR Staging of Clinical Stage I and IIa Cervical Carcinoma: A Reappraisal of Efficacy and Pitfalls,” European Journal of Radiology, Vol. 38, No. 3, 2001, pp. 225-231.
 A. Sahdev, S. A. Sohaib, A. E. T. Wenaden, J. H. Shepherd and R. H. Reznek “The Performance of Magnetic Resonance Imaging in Early Cervical Carcinoma: A Long Term Experience,” International Journal of Gynecological Cancer, Vol. 17, No. 3, 2007, pp. 629-636.
 L. J. Wang, Y. C. Wong, C. J. Chen, K. G. Huang and S. Hsueh, “Cervical Carcinoma: MR Imaging with Integrated Endorectal/Phased-Array Coils: A Pilot Study,” European Radiology, Vol. 11, No. 9, 2001, pp.1822-1827.
 S. C. Yoo, W. Y. Kim, J. H. Yoon, H. Y. Kim, E. J. Lee, S. J. Chang, K. H. Chang and H. S. Ryu, “Accuracy of Preoperative Magnetic Resonance Imaging in Assessing Lymph Node Metastasis and Myometrial Invasion in Patients with Uterine Cancer,” European Journal of Gynaecological Oncology, Vol. 30, No. 2, 2009, pp. 167- 170.
 D. Fischerova, D. Cibula, H. Stenhova, H. Vondrichova, P. Calda, M. Zikan, P. Freitag, J. Slama, P. Dundr and J. Belacek, “Transrectal Ultrasound and Magnetic Resonance Imaging in Staging of Early Cervical Cancer,” International Journal of Gynecological Cancer, Vol. 18, No. 4, 2008, pp. 766-772.
 K. Itoh, T. Shiozawa, S. Ohira, S. Shiohara and I. Konishi, “Correlation between MRI and Histopathologic Findings in Stage I Cervical Carcinomas: Influence of Stromal Desmoplastic Reaction,” International Journal of Gynecological Cancer, Vol. 16, No. 2, 2006, pp. 610-614.
 N. M. de Souza, R. Dina, G. A. McIndoe and W. P. Soutter, “Cervical Cancer: Value of an Endovaginal Coil Magnetic Resonance Imaging Technique in Detecting Small Volume Disease and Assessing Parametrial Extension,” Gynecology Oncology, Vol. 102, No. 1, 2006, pp. 80-85. doi:10.1016/j.ygyno.2005.11.038
 W. Park, Y. J. Park, S. J. Huh, B. G. Kim, D. S. Bae, J. Lee, B. H. Kim, J. Y. Choi, Y. C. Ahn and D. H. Lim, “The Usefulness of MRI and PET Imaging for the Detection of Parametrial Involvement and Lymph Node Metastasis in Patients with Cervical Cancer,” Japanese Journal of Clinical Oncology, Vol. 35, No. 5, 2005, pp. 260-264.
 K. Hancke, V. Heilmann, P. Straka, R. Kreienberg and C. Kurzeder, “Pre-Treatment Staging of Cervical Cancer: Is Imaging Better Than Palpation? Role of CT and MRI in Preoperative Staging of Cervical Cancer: Single Institution Results of 255 Patients,” Annals of Surgical Oncology, Vol. 15, No. 10, 2008, pp. 2856-2861.
 A. G. Rockall, S. A. Sohaib, M. G. Harisinghani, S. A. Babar, N. Singh, A. R. Jeyarajah, D. H. Oram, I. J. Jacobs, J. H. Shepherd and R. H. Reznek, “Diagnostic Performance of Nanoparticle-Enhanced Magnetic Resonance Imaging in the Diagnosis of Lymph Node Metastases in Patients with Endometrial and Cervical Cancer,” Journal of Clinical Oncology, Vol. 23, No. 12, 2005, pp. 2813-2821.
 R. Manfredi, B. Gui, A. Giovanzana, S. Marini, M. Di Stefano, G. Zannoni, G. Scambia and L. Bonomo, “Localized Cervical Cancer (Stage < IIB): Accuracy of MR Imaging in Planning Less Extensive Surgery,” La Radiologia Medica, Vol. 114, No. 6, 2009, pp. 960-975.
 E. Sala, S. Wakely, E. Senior and D. Lomas, “MRI of Malignant Neoplasms of the Uterine Corpus and Cervix,” American Journal of Roentgenology, Vol. 188, No. 6, 2007, pp. 1577-1587. doi:10.2214/AJR.06.1196
 S. Bipat, R. A. van den Berg, J. van der Velden, J. Stoker and A. M. Spijkerboer, “The Role of Magnetic Resonance Imaging in Determining the Proximal Extension of Early Stage Cervical Cancer to the Internal OS,” European Journal of Radiology, Vol. 78, No. 1, 2009, pp. 60-64.
 H. J. Choi, S. H. Kim, S. S. Seo, S. Kang, S. Lee, J. Y. Kim, Y. H. Kim, J. S. Lee, H. H. Chung, J. H. Lee and S. Y. Park, “MRI for Pretreatment Lymph Node Staging in Uterine Cervical Cancer,” American Journal of Roentgenology, Vol. 187, No. 5, 2006, pp. 538-543.
 K. Narayan, R. J. Hicks, T. Jobling, D. Bernshaw and A. F. Mckenzie, “A Comparison of MRI and PET Scanning in Surgically Staged Loco-Regionally Advanced Cervical Cancer: Potential Impact on Treatment,” International Journal of Gynecological Cancer, Vol. 11, No. 4, 2001, pp. 263-271. doi:10.1046/j.1525-1438.2001.011004263.x
 M. J. Reinhardt, C. Ehritt-Braun, D. Vogelgesang, C. Ihling, S. H?gerle, M. Mix, E. Moser and T. M. Krause, “Metastatic Lymph Nodes in Patients with Cervical Cancer: Detection with MR Imaging and FDG PET,” Radiology, Vol. 218, No. 3, 2001, pp. 776-782.
 K. S. Hong, W. Ju, H. J. Choi, J. K. Kim, M. H. Kim and K. S. Cho, “Differential Diagnostic Performance of Magnetic Resonance Imaging in the Detection of Lymph Node Metastases According to the Tumor Size in Early- Stage Cervical Cancer Patients,” International Journal of Gynecological Cancer, Vol. 20, No. 5, 2010, pp. 841-846.
 M. Bellomi, G. Bonomo, F. Landoni, G. Villa, M. E. Leon, L. Bocciolone, A. Maggioni and G. Viale, “Accuracy of Computed Tomography and Magnetic Resonance Imag- ing in the Detection of Lymph Node Involvement in Cervix Carcinoma,” European Radiology, Vol. 15, No. 12, 2005, pp. 2469-2474. doi:10.1007/s00330-005-2847-1
 A. Jena, R. Oberoi, S. Rawal, S. K. Das and K. K. Pandey, “Parametrial Invasion in Carcinoma of Cervix: Role of MRI Measured Tumour Volume,” British Journal of Radiology, Vol. 78, No. 936, 2005, pp. 1075-1077.
 A. C. Testa, M. Ludovisi, R. Manfredi, G. Zannoni, B. Gui, D. Basso, A. Di Legge, A. Licameli, R. Di Bidino, G. Scambia and G. Ferrandina “Transvaginal Ultrasonography and Magnetic Resonance Imaging for Assessment of preseNce, Size and Extent of Invasive Cervical Cancer,” Ultrasound in Obstetrics and Gynecology, Vol. 34, No. 3, 2009, pp. 335-344. doi:10.1002/uog.7325
 Conference Report, “The Contribution of New Imaging Techniques in Staging Cervical Cancer,” Gynecology Oncology, Vol. 107, Suppl. 1, 2007, pp. S10-S12.
 T. J. Selman, C. Mann, J. Zamora, T. L. Appleyard and K. Khan, “Diagnostic Accuracy of Test for Lymph-Node Status in Primary Cervical Cancer: A Systematic Review and Meta-Analysis,” Canadian Medical Association Journal, Vol. 25, No. 7, 2008, pp. 855-862.
 D. L. Morton, J. F. Thompson, R. Essner, R. Elashoff, S. L. Stern, O. E. Nieweg, D. F. Roses, C. P. Karakousis, N. Mozzillo, D. Reintgen, H. J. Wang, E. C. Glass and A. J. Cochran, “Validation of the Accuracy of Intraoperative Lymphatic Mapping and Sentinel Lymphadenectomy for Early-Stage Melanoma: A Multicenter Trial. Multicenter Selective Lymphadenectomy Trial Group,” Annals of Surgery, Vol. 230, No. 4, 1999, pp. 453-463.
 K. M. McMasters, S. L. Wong, C. Chao, C. Woo, T. M. Tuttle, R. D. Noyes, D. J. Carlson, A. L. Laidley, T. Q. McGlothin, P. B. Ley, C. M. Brown, R. L. Glaser, R. E. Pennington, P. S. Turk, D. Simpson, M. J. Edwards and University of Louisville Breast Cancer Study Group, “Defining the Optimal Surgeon Experience for Breast Cancer Sentinel Lymph Node Biopsy: A Model for Implementation of New Surgical Techniques,” Annals of Surgery, Vol. 234, No. 3, 2001, pp. 292-299.
 C. Levenback, T. W. Burke, D. M. Gershenson, M. Morris, A. Malpica and M. I. Ross, “Intraoperative Lymphatic Mapping for Vulvar Cancer,” Obstetrics and Gynecology, Vol. 84, No. 2, 1994, pp. 163-167.
 M. J. Liptay, G. A. Masters, D. J. Winchester, B. L. Edelman, B. J. Garrido, T. R. Hirschtritt, R. M. Perlman and W. A. Fry, “Intraoperative Radioisotope Sentinel Lymph Node Mapping in Non-Small Cell Lung Cancer,” The Annals of thoracic surgery, Vol. 70, No. 2, 2000, pp. 384-389. doi:10.1016/S0003-4975(00)01643-X
 W. P. Soutter, J. Hanoch, T. D’Arcy, R. Dina, G. A. Mc- Indoe and N. M. DeSouza, “Pretreatment Tumour Volume Measurement on High-Resolution Magnetic Resonance Imaging as a Predictor of Survival in Cervical Cancer,” British Journal of Obstetrics and Gynaecology, Vol. 111, No. 7, 2004, pp. 741-747.
 H. J. Choi, J. W. Roh, S. S. Seo, S. Lee, J. Y. Kim, S. K. Kim, K. W. Kang, J. S. Lee, J. Y. Jeong and S. Y. Park, “Comparison of the Accuracy of Magnetic Resonance Imaging and Positron Emission Tomography/Computed Tomography in the Presurgical Detection of Lymph Node Metastases in Patients with Uterine Cervical Carcinoma,” Cancer, Vol. 106, 4, 2006, pp. 914-922.