RESULTS OF A PROSPECTIVE-STUDY WITH COMPARISON OF CLINICAL, ENDOSONOGRAPHIC, COMPUTED-TOMOGRAPHY, MAGNETIC-RESONANCE-IMAGING AND PATHOLOGICAL STAGING OF ADVANCED GYNECOLOGIC CARCINOMA AND RECURRENCE

Between january 1988 and April 1991, 57 patients with advanced gynecol ogic carcinoma were preoperatively evaluated by gynecologic examinatio n and endosonography (ESG) using general anesthesia. Abdominopelvic co mputed tomography (CT) was performed in 49 patients and magnetic reson ance imaging (MRI) in 21 patients. There were 34 primary tumors and 23 instances of recurrence. Causes of gynecologic carcinoma were 38 carc inomas of die cervix uten (26 primary and 12 recurrences), eight carci nomas of die ovary (four primary and four recurrences), three recurren ces of carcinoma of the endometrium, five sarcomas of the uterus (one primary and four recurrences) and three carcinomas of the vagina. All of the patients were operated upon. This perspective study compares di e data from clinical and imaging examinations to the data obtained fro m histologic examination of surgical sections. According to anterior o r posterior tumor extension, die accuracy of dinical evaluation and pr eoperative imaging were studied for the posterior vesical wall and the vesicovaginal septum and the anterior rectal wall and the rectovagina l septum. Histologic examination revealed vesical involvement in 17 pa tients and of the involvement of vesicovaginal septum in 21 patients. The accuracy of the clinical examination, ESG, cystoscopy, Ct and MRI was 83, 88, 87, 75 and 81 percent, respectively, for vesical extension . Cystoscopy was not taken into account for evaluation of extension to the vesicovaginal septum- accuracy was 80, 90, 67 and 86 percent for dinical examination, ESG, CT and MRI. Histologic examination showed in volvement in the rectum in 14 patients and involvement in the rectovag inal septum in 19 patients. Rectoscopy was performed 13 times. The acc uracy of dinical examination, ESG, CT and MRI was 91, 98, 89 and 71 pe rcent, respectively, for extension to the anterior rectal wall. Rectos copy was not taken into account for evaluation of extension to the sep tum-accuracy was 80, 96, 75 and 57 percent for dinical examination, ES G, CT and MRI. Endosonography would seem to be useful to complete exam inations for regional extension of advanced gynecologic carcinomas. It s accuracy is superior to that of other examinations. Because it is pe rformed using general anesthesia, there is no discomfort for the patie nt during this low cost procedure.