Preoperative prediction of lymph node metastasis and deep stromal invasion in women with invasive cervical cancer: Prospective multicenter study using 2D and 3D ultrasound

K. Pálsdóttir, D. Fischerova, D. Franchi, A. Testa, A. Di Legge, E. Pstein

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To determine how various objective two-dimensional (2D) and three-dimensional (3D) ultrasound parameters allow prediction of deep stromal tumor invasion and lymph node involvement, in comparison to subjective ultrasound assessment, in women scheduled for surgery for cervical cancer. Methods: This was a prospective multicenter trial including 104 women with cervical cancer at FIGO Stages IA2-IIB, verified histologically. Patients scheduled for surgery underwent a preoperative ultrasound examination. The value of various 2D (size, color score) and 3D (volume, vascular indices) ultrasound parameters was compared to that of subjective assessment in the prediction of deep stromal tumor invasion and lymph node involvement. Histology obtained from radical hysterectomy or trachelectomy and pelvic lymphadenectomy was considered as the gold standard for assessment. Results: All women underwent pelvic lymphadenectomy, with 99 (95%) undergoing subsequent radical surgery; five underwent only pelvic lymphadenectomy because of the presence of a positive sentinel lymph node. Women with deep stromal invasion or lymph node involvement had significantly larger tumors (diameter and volume) but there was no correlation with vascular indices measured on 3D ultrasound. Subjective evaluation was superior (AUC, 0.93; sensitivity, 90.5%; specificity, 97.2%) in the prediction of deep stromal invasionwhen compared to any objective measurement technique, with maximal tumor diameter at 20.5-mm cut-off (AUC, 0.83; sensitivity, 90.5%; specificity, 61.1%) and 3D tumor volume at 9.1-mm3 cut-off (AUC, 0.85; sensitivity, 79.4%; specificity, 83.3%) providing the best performance among the objective parameters. Both subjective assessment and objective measurements were poorly predictive of lymph node involvement. Conclusions: In women with cervical cancer, subjective ultrasound evaluation allowed better prediction of deep stromal invasion than did objective measurements; however, neither subjective evaluation nor objective parameters were adequate to predict lymph node involvement. 3D vascular indices were ineffective in the prediction of advanced stages of the disease.

Original languageEnglish
Pages (from-to)470-475
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume45
Issue number4
DOIs
Publication statusPublished - Apr 1 2015

Keywords

  • Cervical cancer
  • Deep stromal invasion
  • Diagnostic accuracy
  • Lymph node
  • Power doppler
  • Three-dimensional ultrasound
  • Transvaginal ultrasound

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine

Fingerprint Dive into the research topics of 'Preoperative prediction of lymph node metastasis and deep stromal invasion in women with invasive cervical cancer: Prospective multicenter study using 2D and 3D ultrasound'. Together they form a unique fingerprint.

Cite this