Preoperative evaluation of uterine isthmus-cervical infiltration in patient with cervical cancer using nuclear magnetic resonance

Background: During the last three decades, fertility preservation has been established as a new treatment modality for young patients with early cervical cancer. In preservation of the uterine corpus in fertility sparing surgery one of the most important factors is evaluation of absence of internal uterine ostium or uterine corpus tumor infiltration. The aim was to evaluate the accuracy of nucler magnetic resonance (NMR) in detection of infiltration of uterine isthmuscervical part in cervical cancer patients without fertility preservation. Methods: In 60 patients with cervical cancer FIGO stage IA-2 - IVA, NMR was performed before the operation. Radical hysterectomy Piver class III was performed in 57 patients and pelvic exenteration in three patients with FIGO stage IVA. The histopathological material was examed at the Department of pathology and cytology and it was used as a gold standard. Results: The patient average age was 44.7, (range: 25-65 years). Squamous cervical cancer was diagnosed in 53 (88.3%), adenocarcinoma in 4 (6.7%), and adenosquamous carcinoma in 3 (5%) patients. According to NMR findings, 7 (11.7%) patients were with uterine isthmus-cervical infiltration when compared with histopathological examination, which established infiltration in 10 (16.7%) patients. Sensitivity of NMR was 60%, specificity 98%, positive predictive value 85.7%, and negative predictive value was 92.5% with overall accuracy 91.7%. Conclusion: Sensitivity of NMR was low compared with other studies but with high specificity and overall accuracy. The positive predictive value was relatively acceptable. Negative findings of NMR for corporal infiltration and precise evaluation of the depth of stromal infiltration and length of the proximal cervix without infiltration are important in preoperative diagnostic for fertility preservation surgery. nema