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

OBJECTIVES: Our aim was to compare magnetic resonance imaging (MRI) with the current standard clinical practice (pelvic examination including general anesthesia in selected patients) with regard to treatment planning in invasive cervical carcinoma. It was of particular interest to compare the accuracy 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 cervical carcinoma underwent both MRI at 1.5 T and pelvic examination. The gold standard for comparing treatment decisions was based on the surgico-pathologic 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 examination made correct treatment decisions in 89% of patients. However, the sensitivity 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; observer 2, 63/91). CONCLUSION: Treatment decisions based on the pelvic examination were correct in 89%, with MRI not bringing improvement. MRI, however, is better in diagnosing extracervical spread, but at the cost of more false positives