International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2026
Pre-operative assessment in International Federation of Gynaecology and Obstetrics-2009 stage IB2 to IIB cervical cancer: role of delayed gadolinium-enhanced magnetic resonance imaging after neoadjuvant chemotherapy.
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Vandecaveye Vincent, Walgraeve Marie-Sofie, De Keyzer Frederik, Vergote Ignace, Han Sileny, Van Nieuwenhuysen Els, Van Gorp Toon, Vanmarcke Cedric, Dresen Raphaëla C, Baert Thaïs
Аннотация
OBJECTIVE: To assess the value of delayed gadolinium-enhanced magnetic resonance imaging (MRI) in addition to standard T2- and diffusion-weighted (T2/diffusion-weighted) MRI for evaluating residual locoregional tumor in patients with International Federation of Gynaecology and Obstetrics (FIGO) stage-2009 IB2 to IIB cervical cancer treated with neoadjuvant chemotherapy.
METHODS: This retrospective study included patients diagnosed with FIGO-2009 stage IB2 to IIB cervical cancer between 2016 and 2020, who were treated with neoadjuvant chemotherapy and radical hysterectomy with pelvic lymphadenectomy, and staged with pelvic T2-, diffusion-weighted, and delayed gadolinium-enhanced MRI after neoadjuvant chemotherapy. Diagnostic accuracies of T2/diffusion-weighted MRI and delayed gadolinium-enhanced MRI, assessed by a sub-specialty radiologist (reader 1) and a general radiologist (reader 2), were compared for identification of residual tumor, parametrial, vaginal invasion, and detection of lymph node metastases. Inter-observer agreement was calculated. Additionally, Bland-Altman plots were used to compare the residual tumor size measured by T2/diffusion-weighted MRI and delayed gadolinium-enhanced MRI. Histopathology after surgery was the standard reference.
RESULTS: Forty-two patients were eligible for study analysis. Delayed gadolinium-enhanced (reader 1/reader2) enabled identification of all 4 complete responders, while T2/diffusion-weighted MRI identified only 2. Delayed gadolinium-enhanced MRI (reader 1/reader 2) significantly improved diagnostic accuracy for detecting lymph node metastases (84.5%/82.2% vs 72.6%/70.2%, p <.0001) compared to T2/diffusion-weighted MRI. The addition of delayed gadolinium-enhanced MRI improved accuracy for detecting parametrial invasion (97.6%/88.1% vs 85.7%/78.6%) and vaginal invasion (92.9%/88.1% vs 80.9%/76.2%, p =.063). Delayed gadolinium-enhanced MRI showed better inter-observer agreement than T2/diffusion-weighted MRI for assessment of vaginal invasion (κ, 0.86 vs 0.33), parametrial invasion (κ, 0.63 vs 0.44), and nodal status (κ, 0.90 vs 0.79).
CONCLUSIONS: Addition of delayed gadolinium-enhanced MRI substantially improved pre-operative identification of extra-uterine primary tumor extent, significantly improved detection of metastatic lymph nodes, and allowed better assessment of residual tumor size compared with T2/diffusion-weighted MRI alone in patients with FIGO-2009 stage IB to IIB cervical cancer treated with neoadjuvant chemotherapy.
METHODS: This retrospective study included patients diagnosed with FIGO-2009 stage IB2 to IIB cervical cancer between 2016 and 2020, who were treated with neoadjuvant chemotherapy and radical hysterectomy with pelvic lymphadenectomy, and staged with pelvic T2-, diffusion-weighted, and delayed gadolinium-enhanced MRI after neoadjuvant chemotherapy. Diagnostic accuracies of T2/diffusion-weighted MRI and delayed gadolinium-enhanced MRI, assessed by a sub-specialty radiologist (reader 1) and a general radiologist (reader 2), were compared for identification of residual tumor, parametrial, vaginal invasion, and detection of lymph node metastases. Inter-observer agreement was calculated. Additionally, Bland-Altman plots were used to compare the residual tumor size measured by T2/diffusion-weighted MRI and delayed gadolinium-enhanced MRI. Histopathology after surgery was the standard reference.
RESULTS: Forty-two patients were eligible for study analysis. Delayed gadolinium-enhanced (reader 1/reader2) enabled identification of all 4 complete responders, while T2/diffusion-weighted MRI identified only 2. Delayed gadolinium-enhanced MRI (reader 1/reader 2) significantly improved diagnostic accuracy for detecting lymph node metastases (84.5%/82.2% vs 72.6%/70.2%, p <.0001) compared to T2/diffusion-weighted MRI. The addition of delayed gadolinium-enhanced MRI improved accuracy for detecting parametrial invasion (97.6%/88.1% vs 85.7%/78.6%) and vaginal invasion (92.9%/88.1% vs 80.9%/76.2%, p =.063). Delayed gadolinium-enhanced MRI showed better inter-observer agreement than T2/diffusion-weighted MRI for assessment of vaginal invasion (κ, 0.86 vs 0.33), parametrial invasion (κ, 0.63 vs 0.44), and nodal status (κ, 0.90 vs 0.79).
CONCLUSIONS: Addition of delayed gadolinium-enhanced MRI substantially improved pre-operative identification of extra-uterine primary tumor extent, significantly improved detection of metastatic lymph nodes, and allowed better assessment of residual tumor size compared with T2/diffusion-weighted MRI alone in patients with FIGO-2009 stage IB to IIB cervical cancer treated with neoadjuvant chemotherapy.
Предметные рубрики MeSH
HumansFemaleUterine Cervical NeoplasmsNeoadjuvant TherapyRetrospective StudiesMiddle AgedNeoplasm StagingAdultMagnetic Resonance ImagingContrast MediaAgedDynamic Contrast Enhanced Magnetic Resonance ImagingHysterectomyDiffusion Magnetic Resonance ImagingGadoliniumChemotherapy, AdjuvantNeoplasm, ResidualPreoperative Care