PREDICTIVE VALUE OF CLINICAL EXAMINATION, TRANSRECTAL ULTRASOUND AND MAGNETIC-RESONANCE-IMAGING PRIOR TO RADIOTHERAPY IN CARCINOMA OF THE CERVIX

The objectives of this study were to compare tumour staging and volume assessment by examination under anaesthesia (EUA), transrectal ultras ound (TRU) and magnetic resonance imaging (MRI) in patients with invas ive carcinoma of the cervix, and to correlate findings with long-term outcome following treatment by radiotherapy. Tumour staging was perfor med on 60 patients immediately before starting radiotherapy. Clinician s and radiologists performing EUA, TRU or MRI were blinded to the resu lts of other investigations. Tumour stage and dimensions were recorded prospectively for each technique, and analysed for concordance. The r elationship between pre-treatment stage, size of tumour and patient ou tcome after radiotherapy was assessed, using clinical status 5 years a fter treatment as the truth measure. EUA, TRU and MRI assigned the sam e tumour stage in only 30% of patients and EUA and MRI agreed tumour s tage in a further 27%. In cases of disagreement, the MRI stage correla ted better with outcome than the TRU or EUA stage. There was a signifi cant difference between tumour volume obtained from measurements made on MRI and those from TRU. 62% of patients with enlarged lymph nodes o n pre-treatment MRI either died, or developed tumour recurrence or met astases. The ability of MRI to assess the full extent of bulky tumours and the presence of lymph node enlargement was an advantage over both EUA and TRU in identifying patients with a poor prognosis.