STAGING, VOLUME ESTIMATION AND ASSESSMENT OF NODAL STATUS IN CARCINOMA OF THE CERVIX - COMPARISON OF MAGNETIC-RESONANCE-IMAGING WITH SURGICAL FINDINGS

Pre-operative magnetic resonance imaging (MRI) was carried out in 50 w omen scheduled for operative treatment of invasive carcinoma of the ce rvix. The extent of the primary tumour (stage), its dimensions and the presence of lymph node enlargement were assessed and compared with fi ndings at surgery and/or histopathological examination of the resected uterus. In 45 patients undergoing radical hysterectomy, accuracy of M RI staging of the primary tumour was 84.4%. In the group as a whole, i ncluding four patients with inoperable disease, staging accuracy was 8 4%. Most errors were due to difficulty in identifying early vaginal or parametrial invasion by tumour. There was close correlation between t he volume of tumour measured from pre-operative MRI scans and measurem ents made on the hysterectomy specimen (r=0.95). MRI had a sensitivity of 75% and a specificity of 88% in predicting metastatic lymphadenopa thy, based solely on the criterion of enlargement of any pelvic or par a-aortic nodes to 1.5 cm or greater. However, retrospective analysis o f the presence or absence of metastases by site in 49 patients undergo ing lymphadenectomy or lymph node sampling at laparotomy showed the tr ue sensitivity to be 57.1% and the specificity 96.8%. Differentiation between malignant and reactive lymphadenopathy was not reliably achiev ed on MRI, and in several patients, metastases were present in normal- sized lymph nodes.