Pre-operative imaging in clinical International Federation of Gynecology and Obstetrics stage IB2 or less cervical carcinoma
To assess clinical utility of pre-operative imaging in cervical cancer beyond pelvic magnetic resonance imaging (MRI) in patients with pre-operative International Federation of Gynecology and Obstetrics (FIGO) stage IB2 or less. We retrospectively identified patients who underwent evaluation or received consultation for newly diagnosed cervical squamous cell carcinoma, adenocarcinoma, or adeno-squamous carcinoma at our institution from January 2006 until February 2024. Patients with stage ≤IB2 disease on examination and a pre-operative pelvic MRI demonstrating a tumor ≤4 cm were included. Cases with evidence of gross pelvic nodal involvement or unequivocal parametrial/vaginal extension on MRI were excluded. All patients then underwent surgical treatment. Patients were included if they also underwent chest, abdominal, and pelvic computed tomography with/without positron emission tomography. Additional imaging was performed prior to consultation at our institution or at the treating physician's discretion. We sought to assess the findings of additional imaging in identifying extra-pelvic gross nodal or extra-nodal abdominal and/or chest disease. We did not seek to identify the role of imaging in identifying microscopic disease in normal-sized lymph nodes and such cases were included. Among 183 patients, the median age at diagnosis was 36 years (range; 18-81); 100 (54.6%) had adenocarcinoma, 78 (42.6%) squamous cell carcinoma, and 5 (2.7%) adeno-squamous carcinoma. The final pathologic FIGO 2018 stages included IA1 (n = 34, 18.6%), IA2 (n = 18, 9.8%), IB1 (n = 96, 52.5%), IB2 (n = 14, 7.7%), IB3 (n = 1, 0.5%), and IIIC1 (n = 20, 10.9%). The median tumor size was 0 mm (range; 0-38) on imaging and 8 mm (range; 0-41) on final pathology. Twenty-eight patients (15.3%) had non-specific/borderline enlarged pelvic lymph nodes on MRI, 6 (21.4%) of whom had final pathologic lymph node involvement. Thirty-four patients (18.6%) had "extra-pelvic" findings on computed tomography with/without positron emission tomography; 21 (61.8%) had non-specific findings, and 13 (38.2%) underwent further diagnostic intervention but none had cervical cancer metastases. There were no cervical cancer-related findings on additional imaging beyond MRI of the pelvis. Additionally, no extra-pelvic disease was encountered intra-operatively. The false-positive rate for imaging to detect extra-pelvic intra-abdominal metastasis of cervical carcinoma was 100% (13 of 13, 95% confidence interval [CI] 75.3% to 100%), with no false negatives (0%, 95% CI 0% to 1.7%). For patients with cervical carcinoma ≤4 cm and confined to the cervix on pre-operative MRI, additional imaging appears to be of limited utility, leading to unnecessary interventions.