MRI-defined parametrial venous invasion in locally advanced cervical cancer: association with pathological venous invasion, pretreatment lymph node metastasis, and survival outcomes.

PURPOSE: To evaluate MRI-defined parametrial venous invasion (mrPMVI) for detecting pathological parametrial venous invasion (pPMVI) and its associations with pretreatment lymph node metastasis (LNM) and survival outcomes in locally advanced cervical cancer.

MATERIALS AND

METHODS

This retrospective study included 42 patients with cervical cancer with parametrial invasion on MRI or histopathology, corresponding to International Federation of Gynecology and Obstetrics 2018 stage IIB or higher disease. Fifteen patients underwent surgery without preoperative therapy and were included in the pathological validation analysis. Image interpretation was primarily based on T2-weighted and diffusion-weighted imaging. Two radiologists independently assessed mrPMVI using a five-point scoring system. Scores ≥ 3 were predefined as mrPMVI-positive. Diagnostic performance for pPMVI and interobserver agreement were evaluated. Univariable logistic and Cox regression analyses were performed for pretreatment LNM and survival outcomes, respectively.

RESULTS

pPMVI was present in 10 of 15 patients. The five-point mrPMVI score showed an area under the receiver operating characteristic curve of 0.87 (95% confidence interval [CI], 0.60-0.98) for detecting pPMVI. The predefined threshold (≥ 3) yielded 30.0% sensitivity and 100% specificity. Interobserver agreement for the five-point mrPMVI score was substantial (linearly weighted κ = 0.75). mrPMVI positivity was associated with pretreatment LNM (odds ratio = 4.00, 95% CI: 1.05-15.26, p = 0.042). During a median follow-up of 24.0 months, 16 patients experienced disease progression and 10 died. mrPMVI positivity was associated with shorter progression-free survival (hazard ratio = 34.25, 95% CI: 4.35-269.91; p < 0.001) and overall survival (hazard ratio = 10.16; 95% CI: 1.28-80.61, p = 0.028).

CONCLUSION

The mrPMVI score showed potential for identifying pPMVI, although the predefined threshold was highly specific but insensitive. mrPMVI positivity was associated with pretreatment LNM and survival outcomes, suggesting potential complementary value for risk characterization in locally advanced cervical cancer.