Role of X-ray computed tomography in the evaluation of prognosis of cervical carcinoma

In 129 patients with cervical cancer, CT findings before treatment were analysed on the basis of the outcome during a 5 year follow-up period (75 survivals, and 54 deaths). 1) The incidence of each CT finding in the two groups was; (1) enlargement of the uterine cervix: 40.0% in survivals, 64.8% in deaths, (2) low density area in the cervix: 18.7%, 37.0%, (3) necrotic cavity: 4.0%, 33.3%, (4) pyometra: 8.0%, 31.5%, (5) irregular and indistinct margin of the cervix: 2.7%, 51.9%, (6) abnormal image of parametrium: 25.3%, 87.0%, (7) extension to the vagina: 2.7%, 37.0%, (8) extension toward the bladder: 8.0%, 57.4%, and (9) enlarged lymph node: 0%, 27.8%. 2) CT scores obtained by multivariate analysis for prognostic discrimination of cervical cancer were (1) + 1, (2) - 1, (3) + 1, (4) - 3, (5) + 25, (6) type B + 29, C + 25, D + 10, (7) + 2, (8) grade I + 12, II + 7, III + 20, and (9) + 18, respectively. The discrimination ratio for the prognosis of cervical cancer was 82.9%. 3) The score obtained by multivariate analysis showed significant increases according with the stage. Even in the same stage, there were significant differences between the scores for survivals and deaths (stage II: p less than 0.01, stage III: p less than 0.05). The survival period in the poor prognosis group was correlated with the score, especially in the cases treated with radiotherapy (r = -0.54, p less than 0.01).     

The value of computed tomography in staging cervical carcinoma

The purpose of our study was to determine the value of computed tomography (CT) in relation to the local extension of cervical carcinoma and the possible spread in the peritoneal and the retroperitoneal space. Sixty-five patients treated for cervical carcinoma during the period 1980-1986 were included in the study. Histologic diagnosis of the disease was done by punch cervical biopsy and diagnostic curettage. The investigation of all patients included intravenous pyelography, barium enema, bone and liver scanning and CT. Our results demonstrate a correlation between CT and pathologic data in 75-78.5% depending on stage. CT may be considered as a dependable method for staging of cervical carcinoma.     

Role of computed axial tomography of the chest in staging patients with nonmetastatic gestational trophoblastic disease

Thirty-nine women with nonmetastatic gestational trophoblastic disease as determined by conventional staging studies were prospectively evaluated with computed axial tomography (CAT) of the lungs. Sixteen patients (41%) had pulmonary micrometastases detected by CAT, which were not detected by routine chest x-ray. Eight patients (20.5%) had indeterminate scans, and only 15 patients (38%) had negative scans. Eight of 16 patients (50%) with pulmonary micrometastases failed initial therapy with methotrexate-folinic acid rescue while one of eight (12.5%) patients in the indeterminate group and one of 15 (6.7%) patients in the true nonmetastatic group failed initial therapy (P less than .006). All patients who failed methotrexate-folinic acid rescue ultimately achieved prolonged remission with actinomycin D. Time to remission was significantly decreased in patients without evidence of pulmonary micrometastases (P = .03), but the total number of courses of chemotherapy was not significantly different (P = .06). No life-threatening toxicity occurred. Pulmonary micrometastases detected by CAT but not chest x-ray are predictive of an increased risk of methotrexate-folinic acid therapy failure. Computed axial tomography of the lungs identifies a group of patients at high risk for failure of methotrexate-folinic acid rescue, and, therefore, may be indicated for routine staging of patients with otherwise nonmetastatic gestational trophoblastic disease.     

A prospective trial of computed tomography in the staging of ovarian malignancy

Thirty patients, thought clinically to have ovarian tumours, were studied prospectively by pre-operative computed tomographic (CT) scans of the abdomen and pelvis. In six patients (20%) small metastases in mesentery, omentum and on subdiaphragmatic peritoneum were not detected by the scans. CT did not improve the accuracy of staging or assist the surgeons by drawing their attention to disease which they might otherwise have missed. Although CT gives an elegant demonstration of anatomy, it is not an alternative to extended laparotomy in patients with ovarian tumours.     

A prospective trial of computed tomography in the staging of ovarian malignancy

Summary. Thirty patients, thought clinically to have ovarian tumours, were studied prospectively by pre-operative computed tomographic (CT) scans of the abdomen and pelvis. In six patients (20%) small metastases in mesentery, omentum and on subdiaphragmatic peritoneum were not detected by the scans. CT did not improve the accuracy of staging or assist the surgeons by drawing their attention to disease which they might otherwise have missed. Although CT gives an elegant demonstration of anatomy, it is not an alternative to extended laparotomy in patients with ovarian tumours.     

Abdominopelvic computed tomography in the preoperative evaluation of early cervical cancer

The efficacy of abdorainopelvic computed tomography (CT) in determining the extent of disease in the patient with early cervical cancer was evaluated in 24 patients (FIGO Stage Ia-1, Ib-18, IIa-5). The CT stage was compared to both the clinical and surgical pathological staging, CT was accurate only in 58% of the cases in determining parametrial extension. It was unable to detect any of the 6 cases of histologically documented lymph node metastases. CT appears to have limited use in the patient with early cervical carcinoma because with parametrial thickening it lacks sufficient specificity to differentiate between malignant and nonmalignant tissues and there is not sufficient sensitivity to detect early nodal involvement.     

MRI评估宫颈癌病变范围的临床分析

目的评价磁共振成像对宫颈癌分期的价值。方法对33例宫颈癌患者在手术前进行磁共振成像(MRI)检查,依临床分期制定治疗计划。以术后病理诊断为金标准,将临床、磁共振成像分期结果中癌浸润的部位和范围、淋巴结转移,尤其对宫旁浸润采用患者自身对照法与手术病理所见进行对比,评价宫颈癌分期。结果MRI对宫旁浸润判断的准确度为94%,特异度为96%,敏感度为90%。MRI对宫颈癌总的分期预测的准确性为75.7%。在局限性和宫旁浸润的区分中MRI有着94%的准确性。结论MRI在宫颈癌中对区分局限性和浸润性病灶有着较高的准确性。引入MRI技术于临床,有利于治疗计划的制定,应成为宫颈癌术前常规的影像检查方法。     

Discrepancies between clinical and surgical--pathologic staging of cervical carcinoma

OBJECTIVES: Cervical cancer is the only gynecological tumor staged clinically. The aim of this study was comparison of clinical staging to surgical specimen evaluation in cervical cancer patients. DESIGN: Clinical staging of cervical cancer was compared to histopathological outcome in prospective study. MATERIALS AND METHODS: One hundred patients with cervical cancer treated with radical hysterectomy combined with pelvic lymphadenectomy were included in the study. RESULTS: Discrepancies between clinical and surgico-pathological staging occurred in 62% of cases. The tendency towards overdiagnosis was found to be increasing with local advancement of neoplasm. CONCLUSIONS: Accuracy of preliminary cervical cancer staging needs further improvement.     

Role of radiotherapy in the management of cervical carcinoma

Different therapy schemes related with the stage of tumours are reported, after general considerations on the topic. We have evaluated various criteria for the choice of methods, pointing out the complications of therapy. Lithium-carbonate action during radiation therapy has been studied, valuing the positive effect on leukopoiesis and the consequent better clinical conditions of the patients in course of treatment. In this study we report our experience with regard to 21 patients affected by cervical neoplasia, histologically diagnosed. The stages of neoplasia in the 21 patients were so distributed: 10 at stage I B, 8 at stage II A, 3 at stage II B. Treatment consisted of three therapeutical techniques: 1) application of radium in the cervical canal and in the vaginal fornices; 2) surgical procedure; 3) application of radium against the vaginal vault. In agreement with other author's results, the histological exam of the surgical specimen confirmed in different cases the complete absence of neoplastic aspects following the pre-operative radiotherapy. Although our experience is limited, we hold that radio-surgical "sandwich" treatment of cervical carcinoma may represent an excellent therapy in young women and in patients with associated systemic diseases. The follow-up of the 21 patients has excluded up to this day any neoplasia. In this program pre-operative intracavitary radiotherapy is a primary step allowing, in the majority of the cases, the reduction of surgical radicality. In so doing, effective therapeutical results associated with a better quality of life are obtained.     

Incisional recurrence of squamous cell cervical carcinoma following operative staging

A patient with FIGO Stage IIB cervical carcinoma underwent an extraperitoneal lymphadenectomy with exploratory laparotomy and washings for surgical staging. Intraperitoneal tumor was found. Seven months later, the tumor recurred as a subcutaneous nodule in the surgical incision. The implications of this recurrence are discussed.     

Pre-operative staging of cervical cancer: comparison of magnetic resonance imaging (MRI) and computed tomography (CT) with histologic results

Thirty-two patients with histologically confirmed cervical carcinoma were preoperatively investigated using MRI; in addition, a CAT-scan was performed on 15 of these patients. The diagnostic results using both modalities were compared with the histological findings (after hysterectomy according to Wertheim-Meigs, including lymph node dissection in the pelvic and, in part, in para-aortal regions). Determination of tumour volume was possible with high accuracy using MRI. Accuracy in assessing the parametria was 86%, vagina 90%, bladder and rectum 97%. The shortcoming of MRI is still the detection of infiltrated lymph nodes. The accuracy of 69% achieved for lymph nodes is equal to results with computed tomography. The general accuracy for our patients in staging was 81% for MRI versus 47% for CT. MRI-based diagnosis enables us to determine a correct tumour staging preoperatively, and is therefore very helpful in planning an adequate therapy. If MRI were used more widely it would contribute to simplification and shortening of the preoperative diagnostic procedure in patients with cervical carcinoma.     

Can computed tomography substitute for second-look operation in ovarian carcinoma?

The increasing use of computerized tomography as a noninvasive means of evaluating pelvic and abdominal malignancy was investigated as an adjunct to a second-look operation in patients with ovarian carcinoma. In order to fully evaluate the abdominal and pelvic contents enhanced CT examinations were done in 18 patients. There were 3 “true positives” and 12 “true negatives.” The 3 “false negative” CT scans demonstrated multiple small implants at operation. It appears that the use of the CT scan in evaluating ovarian carincoma is restricted because of the diffuse nature and small implants associated with ovarian cancer. The absence of disease by CT scan evaluation was not an adequate reason to defer the second-look operation.     

Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma

BACKGROUND: Although cervical cancer is clinically staged, surgery has long been considered the best means to assess extrapelvic disease and remains the gold standard for the detection of both intraperitoneal spread and small volume nodal metastases. The objective of this study was to determine short- and long-term outcomes for patients with locally advanced cervical cancer who underwent pretherapeutic laparoscopic staging. METHODS: From 1997 to 2004, 184 patients with stages IB2-IVA cervical cancer underwent pretherapeutic laparoscopic staging procedure including transperitoneal abdomino-pelvic exploration and extraperitoneal bilateral infrarenal paraaortic lymph node dissection. Patients were then treated with definitive radiotherapy tailored according to the staging results. RESULTS: The median age and BMI were respectively 45.8 years old and 27.1 kg/m2. Most lesions were squamous (n=172) and clinical stage was evenly distributed. Median operative time was 155 min with an average of 20.8 lymph nodes removed. Postoperative hospital stay averaged 1.4 days. Major complications included 1 intraoperative ureteral injury and 1 postoperative bowel obstruction from an umbilical trocar site hernia. The final pathology revealed that 44 patients (24.3%) had metastatic disease within paraaortic lymph nodes. With a median follow-up of 26.8 months (average 32.9), 67 patients (36.4%) had recurrent disease. Overall 5-year survival rate was 58.3%. Successful resection of positive lymph node correlated with a survival advantage. CONCLUSIONS: Pretherapeutic laparoscopic assessment of patients with locally advanced cervical cancer offers valuable information for individualized treatment planning with minimal morbidity. This appears to be a therapeutic effect with resection of positive nodes followed by a tailored chemoradiation therapy.