TRANSRECTAL ULTRASOUND IN THE EVALUATION OF CERVICAL-CARCINOMA AND COMPARISON WITH SPIRAL COMPUTED-TOMOGRAPHY AND MAGNETIC-RESONANCE-IMAGING

38 women with biopsy proven untreated cervical carcinoma were prospect ively studied with transrectal ultrasound (TRUS), spiral computed tomo graphy (SCT) and magnetic resonance imaging (MRI). 20 women had radica l hysterectomy and pelvic lympbadenectomy with detailed histological e valuation of the parametra. The echographic features of cervical carci noma on TRUS area hypoechoic (60%) or isoechoic (40%) (relative to nor mal uterine muscle/cervical stroma), poorly defined mass lesion with i ndistinct margins in an enlarged cervix. This relatively high percenta ge of isoechoic tumours and relative lack of contrast resolution may p ose a problem in the identification of some tumours, and to our knowle dge has not been previously reported. Further limitations of TRUS are in the evaluation of advanced cervical cancer, due to bulky tumours re ndering poor access to the parametrium and pelvic sidewall. The overal l accuracy in staging of early cervical cancer (less than stage 2b) ma s 85% for examination under anaesthesia (EUA), 75% for TRUS, 65% for M RI and 50% for SCT. The positive predictive value in evaluating the pa rametra in this group of patients was also lower for SCT (14%) and MRI (33%) compared with TRUS (100%). In the evaluation of advanced cervic al cancer (stage 2b or higher), there was poor correlation between TRU S and EUA, with MRI showing the best correlation with EUA. We conclude that SCT is inferior to both TRUS and MRI in the staging of early sta ge cervical cancer.