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Objective: To evaluate interobserver agreement for the assessment of local tumor extension in women with cervical cancer, among experienced and less experienced observers, using transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI).Methods: The TVS observers were all gynecologists and consultant ultrasound specialists, six with and seven without previous experience in cervical cancer imaging. The MRI observers were five radiologists experienced in pelvic MRI and four less experienced radiology residents without previous experience in MRI of the pelvis. The less experienced TVS observers and all MRI observers underwent a short basic training session in the assessment of cervical tumor extension, while the experienced TVS observers received only a written directive. All observers were assigned the same images from cervical cancer patients at all stages (n = 60) and performed offline evaluation to answer the following three questions: (1) Is there a visible primary tumor? (2) Does the tumor infiltrate > ⅓ of the cervical stroma? and (3) Is there parametrial invasion? Interobserver agreement within the four groups of observers was assessed using Fleiss kappa (κ) with 95% CI.Results: Experienced and less experienced TVS observers, respectively, had moderate interobserver agreement with respect to tumor detection (κ (95% CI), 0.46 (0.40-0.53) and 0.46 (0.41-0.52)), stromal invasion > ⅓ (κ (95% CI), 0.45 (0.38-0.51) and 0.53 (0.40-0.58)) and parametrial invasion (κ (95% CI), 0.57 (0.51-0.64) and 0.44 (0.39-0.50)). Experienced MRI observers had good interobserver agreement with respect to tumor detection (κ (95% CI), 0.70 (0.62-0.78)), while less experienced MRI observers had moderate agreement (κ (95% CI), 0.51 (0.41-0.62)), and both experienced and less experienced MRI observers, respectively, had good interobserver agreement regarding stromal invasion (κ (95% CI), 0.80 (0.72-0.88) and 0.71 (0.61-0.81)) and parametrial invasion (κ (95% CI), 0.69 (0.61-0.77) and 0.71 (0.61-0.81)).Conclusions: We found interobserver agreement for the assessment of local tumor extension in patients with cervical cancer to be moderate for TVS and moderate-to-good for MRI. The level of interobserver agreement was associated with experience among TVS observers only for parametrial invasion. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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 invasion when 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. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To assess the accuracy of magnetic resonance imaging ( MRI) and transrectal ultrasound ( TRUS) in the evaluation of tumor size and in the detection of residual tumor following neoadjuvant chemotherapy ( NACT) in patients with cervical cancer. Methods This was a prospective study involving 42 women with locally advanced histologically confirmed cervical cancer referred for NACT. Clinical examination, TRUS and MRI were performed before and after NACT. The tumor volume was calculated using three standardized diameters (anteroposterior, laterolateral and craniocaudal) that were measured using both TRUS and MRI. Thereafter patients underwent surgical treatment and the same tumor measurements were taken by a pathologist using a fixed surgical specimen. Tumor volumes were calculated from tumor dimensions using the ellipsoid formula, and data obtained from both imaging methods were compared with pathological results as the gold standard. Results Twelve cases were excluded from the study owing to disease progression (these patients were referred for primary radiotherapy) or inability to perform MRI, leaving data from 30 patients for the final analysis. On average, tumor volume decreased after NACT by 84.6 and 87.1% as measured by MRI and TRUS, respectively. The agreement between measurements obtained by MRI and histology did not reach significance (intraclass correlation coefficient, 0.344 (95% CI, -0.013 to 0.610), P = 0.059), while agreement between TRUS and histology was statistically significant (intraclass correlation coefficient, 0.795 (95% CI, 0.569-0.902), P < 0.001). The accuracy of residual tumor detection (for non-microscopic tumors > 5 mm3 in volume) reached 77% for both MRI and TRUS. The sensitivity of TRUS was, however, lower than that of MRI (83 vs 96%). The positive predictive values were similar for the two methods. Conclusions TRUS should be considered as an accurate diagnostic method in the evaluation of tumor volume after NACT in patients with cervical cancer and may constitute a reliable alternative imaging method to MRI. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

J. Slama, P. Freitag, P. Dundr, J. Duskova, D. Fischerova, M. Zikan, I. Pinkavova and D. Cibula Outcomes of pregnant patients with Pap smears classified as atypical glandular cells Objectives: The incidence of cervical cancers increases with age. Due to the trend of increasing age of first pregnancy, abnormal Pap smears including those classified as atypical glandular cells (AGC) are being found more often in early pregnancy. Once invasive cancer is excluded, conservative management of squamous intraepithelial lesions (SIL) in pregnancy is considered safe; however, optimal management of AGC is not well established. The aim of our study was to evaluate the outcome of patients with AGC diagnosed from smears during pregnancy. Methods: The study included 17 patients referred to us in early pregnancy with Pap smears reported as AGC: 11 not otherwise specified (AGC-NOS), five favour neoplasia (AGC-FN) and one adenocarcinoma in situ (AIS). Thirty-one with high-grade SIL (HSIL) Pap smears confirmed on punch biopsy in early pregnancy comprised a control group. Human papillomavirus (HPV) positivity was found in seven patients with persistent AGC-NOS (including all four who had CIN3 postpartum). All the women were initially examined by expert colposcopy and those with AGC-FN or AIS smears also by transrectal ultrasound to exclude invasive endocervical cancer. Follow-up controls were carried out every 8-12 weeks and, if there were no signs of progression, revaluation was scheduled 6-8 weeks after delivery. Results: The mean age of the women was 31.4 years. Conization in one patient in the study group was performed in the 16th week of pregnancy due to colposcopic signs of microinvasive squamous cell cancer confirmed on histology. Progression to invasive cancer was not found in any of the other 16 patients in the study group or in the control group. Cervical intraepithelial neoplasia or AIS was confirmed postpartum by conization or punch biopsy in 47.1% (8/17) of patients in the study group and, in 77.4% (24/31) of patients in the control group. Conclusions: Conservative management of women with AGC in pregnancy is safe where invasive cancer is excluded. As histological verification of glandular pre-cancerous lesions by punch biopsy is not reliable and the postpartum regression rate cannot be determined precisely, conization should be performed in all cases with AGC-FN or AIS. Triage of persistent AGC-NOS with HPV testing is useful in distinguishing significant underlying lesions. [ABSTRACT FROM AUTHOR]

This Review documents examination techniques, sonographic features and clinical considerations in ultrasound assessment of gynecological tumors. The methodology of gynecological cancer staging, including assessment of local tumor extent, lymph nodes and distant metastases, is described. With increased technical quality, sonography has become an accurate staging method for early and advanced gynecological tumors. Other complementary imaging techniques, such as computed tomography and magnetic resonance imaging, can be used as an adjunct to ultrasound in specific cases, but are not essential to tumor staging if sonography is performed by a specialist in gynecological oncology. Ultrasound is established as the method of choice for evaluating local extent of endometrial cancer and is the most important imaging method for the differential diagnosis of benign and malignant ovarian tumors. Ultrasound can be used to detect early as well as locally advanced cancers that extend from the vagina, cervix or other locations to the paracolpium, parametria, rectum and sigmoid colon, urinary bladder and other adjacent organs or structures. In cases of ureteric involvement, ultrasound is also helpful in locating the site of obstruction. Furthermore, it is specific for the detection of extrapelvic tumor spread to the abdominal cavity in the form of parietal or visceral carcinomatosis, omental and/or mesenteric infiltration. Ultrasound can be used to assess changes in infiltrated lymph nodes, including demonstration of characteristic sonomorphologic and vascular patterns. Vascular patterns are particularly well visualized in peripheral nodes using high resolution linear array probes or in the pelvis using high-frequency probes. The presence of peripheral or mixed vascularity or displacement of vessels seems to be the sole criterion in the diagnosis of metastatic or lymphomatous nodes. In the investigation of distant metastases, if a normal visceral organ or characteristic diffuse or focal lesions (such as a simple cyst, hepatic hemangioma, renal angiomyolipoma, fatty liver (steatosis)) are identified on ultrasound, additional examinations using complementary imaging methods are not required. If, however, less characteristic findings are encountered, especially when the examination result radically affects subsequent therapeutic management, an additional examination using a complementary imaging method (e.g. contrast-enhanced ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography) is indicated. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to assess the detection rate, false-negative rate and sensitivity of SLN in LN staging in tumors over 2 cm on a large cohort of patients. Methods Data from patients with stages pT1a – pT2 cervical cancer who underwent surgical treatment, including SLN biopsy followed by systematic pelvic lymphadenectomy, were retrospectively analyzed. A combined technique with blue dye and radiocolloid was modified in larger tumors to inject the tracer into the residual cervical stroma. Results The study included 350 patients with stages pT1a - pT2. Macrometastases, micrometastases, and isolated tumor cells were found in 10%, 8%, and 4% of cases. Bilateral detection rate was similar in subgroups with tumors < 2 cm, 2–3.9 cm, and ≥ 4 cm (79%, 83%, 76%) (P = 0.460). There were only two cases with false-negative SLN ultrastaging for pelvic LN status among those with bilateral SLN detection. The false negative rate was very low in all three subgroups of different tumor sizes (0.9%, 0.9%, and 0.0%; P = 0.999). Sensitivity reached 96% in the whole group and was high in all three groups (93%, 93%, 100%; P = 0.510). Conclusions If the tracer application technique is adjusted in larger tumors, SLN biopsy can be equally reliable in pelvic LN staging in tumors smaller and larger than 2 cm. The bilateral detection rate and false negative rate did not differ in subgroups of patients with tumors < 2 cm, 2–3.9 cm, and ≥ 4 cm. [ABSTRACT FROM AUTHOR]

An abstract of the article "The role of ultrasound in planning fertility sparing surgery and individual treatment in early stage cervical cancer," by D. Fischerova, M. Zikan, I. Pinkavova, F. Frühauf, P. Dundr, K. Nemejcova, A. Burgetova, and D. Cibula is presented.

An abstract of the article "Intra-operative ultrasound in fertility sparing procedures for cervical cancer," by D. Fischerova, M. Zikan, I. Pinkavova, F. Frühauf, P. Dundr, K. Nemejcova, A. Burgetova, and D. Cibula is presented.

An abstract of the conference paper "Role of ultrasound in the referral of young patients with cervical cancer for fertility sparing surgery," by D. Fischerova and colleagues is presented.

An abstract of the conference paper "Transrectal ultrasound in the evaluation of locally advanced cervical cancer after neoadjuvant chemotherapy," by I. Pinkavova and colleagues is presented.

An abstract of the conference paper "Role of ultrasound in guiding of surgery radicality in cervical cancer management," by D. Fischerova and colleagues is presented.

Abstract: Objectives. Neoadjuvant chemotherapy (NAC) is used in locally advanced cervical cancers with the aim to decrease the size of the tumor and to allow for less radical surgery. Despite of the fact that the high response rate of the tumor has been well established, the impact of NAC on sentinel lymph node (SN) detection and status has not been explored to date. Methods. Our study included 82 patients with locally advanced cervical cancers (FIGO IB1 >3cm, IB2, IIA2 and selected IIB) out of which 51 patients were referred to SN biopsy prior to NAC and 31 patients to radical surgical procedure including SN biopsy after three courses of “dose density” NAC. In both groups, the prevalence of macrometastases, micrometastases and isolated tumor cells (ITC) in SN was compared. Results. The total of 179 SNs was evaluated. SN detection rate in the whole cohort reached 87.8% per patient and 60.9% bilaterally, without significant difference between both groups. In the group with upfront SN biopsy prior to NAC the prevalence of macrometastases, micrometastases and ITC amounted to 43.1% (22/51), 7.8% (4/51) and 7.8% (4/51) respectively. In the group with SN biopsy after previous NAC, macrometastases were detected in 22.6 (7/31) of patients in SN, whereas there was only one micrometastasis and no ITC detected in that group. Conclusions. Neoadjuvant chemotherapy did not influence the detection rate of SNs, yet it was associated with significantly reduced prevalence of metastatic involvement of SNs, especially almost completely eliminating low volume disease. [Copyright &y& Elsevier]

Abstract: Objectives: Nerve-sparing (NS) modification of radical hysterectomy (RH) has been developed with the main purpose of improving the quality of life after radical surgical treatment of early-stage cervical cancer. Although the procedure has been discussed for almost 30 years, there are only limited data available on late morbidity. The aim of the study was to prospectively evaluate the morbidity of patients before and 6 months after NS RH and compare that with the morbidity in patients following different types of parametrectomy without nerve sparing. Methods: Multiple parameters were assessed prospectively using 20-item self-reported questionnaire, focusing on three main areas of morbidity: bladder, sexual, and anorectal functions. Excluded were patients treated with adjuvant radiotherapy. Results: Enrolled were women following NS RH (N =32), type C RH (N =19), and type D RH (N =21). Nine parameters significantly deteriorate in the whole group after the treatment: defecation straining (p =0.03), defecation regularity (p =0.0006), defecation frequency (p =0.02), need to use laxatives (p <0.001), flatulence incontinence (p <0.001), urinary incontinence (p <0.001), nocturia (p =0.002), loss of bladder sensation (p =0.04), and straining to void (p <0.001). There were significant differences (p <0.05) between groups following NS and type C or D RH in changes of following parameters: defecation regularity, receptivity to sexual activity, urinary incontinence, nocturia, and straining to void, while no differences were found between type C and D RH. Minimal changes were observed in any of 10 parameters of sexual functions. Conclusions: Our results confirmed a significant negative impact of RH on bladder and anorectal functions. Autonomic nerve preservation significantly improved morbidity 6 months after treatment. [Copyright &y& Elsevier]

Abstract: Objectives: Sentinel lymph node (SLN) biopsy can significantly contribute to the management of locally advanced cervical cancers with high risk of lymph node (LN) positivity. However, low detection rate and sensitivity were reported in larger tumors, albeit on a small number of cases. It was the aim of our study to verify the SLN reliability in large tumors, with modified dye application technique and a careful identification of side-specific lymphatic drainage. Methods: The study involved 44 patients with tumors 3 cm in diameter or larger, stages IB1 to IIA, or selected IIB. In cases where SLN could not be detected, systematic pelvic lymphadenectomy was performed on the respective side. Systematic pelvic lymphadenectomy was performed during the second step radical procedure if not already done. Results: Detection rate in the whole cohort reached 77% per patient and 59% bilaterally. No significant difference was found whether a blue dye or a combined method was used (75% vs 80%, and 55% vs 67%). Systematic pelvic lymphadenectomy was performed in cases with undetected SLN unilaterally in 8 and bilaterally in 10 women. A systematic pelvic lymphadenectomy was included in the second step radical procedure in 19 cases and no positive LN were found. There was no case of false-negative SLN result in patients who underwent surgical treatment. Conclusion: Detection rate in locally advanced cervical cancer could be improved by a careful dye application technique. Low false-negative SLN rate could be achieved if pelvic lymphatic drainage is evaluated on a side-specific principle by performing systematic lymphadenectomy if SLN is not detected. [Copyright &y& Elsevier]