Effect of MRI on therapeutic decisions in invasive cervical carcinoma - Direct comparison with the pelvic examination as a preoperative test

Objectives. Our aim was to compare magnetic resonance imaging (MRI) with th e current standard clinical practice (pelvic examination including general anesthesia in selected patients) with regard to treatment planning in invas ive cervical carcinoma. It was of particular interest to compare the accura cy of both methods for allocating the patients to the appropriate treatment modality: surgery versus primary radiotherapy. Methods. One hundred and three consecutive patients with primary invasive c ervical carcinoma underwent both MRI at 1.5 T and pelvic examination. The g old standard for comparing treatment decisions was based on the surgico-pat hologic data: tumor confined to the cervix (treatment decision for surgery) or extracervical tumor spread (treatment decision for primary radiotherapy ). Results. A gold standard was available in 91 patients. The pelvic examinati on made correct treatment decisions in 89% of patients. However, the sensit ivity for extracervical spread was only 44% (8/18 patients). MRI was better at identifying extracervical tumor spread: 67 and 89% for observers 1 and 2, respectively. MRI, however, had more false positive results and correct treatment decisions were made in 69-84% of patients (observer 1, 76/91; obs erver 2, 63/91). Conclusion. Treatment decisions based on the pelvic examination were correc t in 89%, with MRI not bringing improvement. MRI, however, is better in dia gnosing extracervical spread, but at the cost of more false positives. (C) 2000 Academic Press.