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MR staging accuracy in cervical cancer - correlation with post-surgical pathology in stage IB1
Poster Title: MR staging accuracy in cervical cancer - correlation with post-surgical pathology in stage IB1
Submitted on 13 Sep 2018
Author(s): Dr Catriona Turbet, Dr Fiona Bryden, Dr David Millan
This poster was presented at BIR Annual Congress 2018
Poster Views: 271
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Poster Information
Abstract: Background
Accurate pre-operative staging of cervical carcinoma is crucial in determining appropriate management. Stage IB1 encompasses clinically visible tumours <4cm, confined to cervix. These tumours are amenable to radical surgical management.

• Determine local cervical cancer MR staging accuracy
• Explore possible reasons for overcall/undercall

Retrospective review of all patients diagnosed with Stage IB1 cervical carcinoma in NHS Greater Glasgow and Clyde over a 24 month period (Jan 2013–Dec 2014), n=38.
Data collected on pre-operative procedures/pathology, MR staging and final pathology.

Concordance 52%, MR overcall 21%, MR undercall 24%, staging correct but site discrepancy 3%.
Examining data subdivided by pathological subtype revealed the following:
• MR staging correct in 62.5% of squamous carcinomas but only 46% of adenocarcinomas
• Staging underestimated in 38% of adenocarcinomas, compared with 12.5% of squamous carcinomas
Sites of MR overcall included vaginal fornices and parametrium. 50% of MR overcalls were poorly differentiated. 25% of MR overcalls were in cases of no residual tumour on final pathology, despite being tumour present at LLETZ margins.
In cases of concordance between MR and pathology, 65% had IV contrast (no impact on overcall/undercall rates, however).

Overall concordance rate of 52%. Adenocarcinoma is difficult to accurately stage and is frequently undercalled. Poorly differentiated tumours are more likely to be overcalled, which may be attributable to a surrounding inflammatory flare and desmoplastic reaction(1). Vaginal fornix overcall is recognised but acceptable, as this region is better assessed clinically(2) and will not alter management. Contrast administration confers a higher concordance rate.
Summary: Please see abstractReferences: 1. Dr David Millan, Consultant Pathologist NHS GG&C.
2. Shue M-H, Chang C-Y, et al MR staging of clinical stage I and IIa cervical carcinoma : a reappraosal of efficacy and pitfalls Eur J Rad (2001) 38; 225-231
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