Clinical Significance of Diagnostic Images in the Evaluation of Cervical Cancer

Background. The problems of diagnostics and treatment of cervical cancer (CC) currently remain relevant due to the increase in morbidity and high mortality from this disease, including patients of reproductive age. The “gold standard” for visualization of cervical tumors is pelvic magnetic resonance imaging (MRI). Data on the efficiency of the method in diagnostics of parametrial invasion are contradictory. At the same time, the successes of modern ultrasound sonography in oncogynecology allowed us to look at the problem of diagnostics of locally advanced СС from a more optimistic standpoint. Objective: evaluation of the capabilities of ultrasound and MRI in the diagnosis of locally advanced СС and dynamic monitoring of structural changes in the cervix during comprehensive treatment. Material and methods. The single-center, retrospective, selective study was carried out. The results of complex ultrasound and MRI were analyzed in 23 patients with CC, including 7 patients of reproductive age. According to the histological structure, squamous cell carcinoma was determined in 20 (87%) cases, endocervical adenocarcinoma in 3 (13%) cases. During comprehensive treatment, 18 patients (78.3%) underwent surgery, 5 (21.7%) patients had only chemoradiation therapy. Surgical treatment (extirpation of the uterus with appendages and pelvic lymphadenectomy) was performed at the first stage in 3/23 (13%) patients with stage IB1, the remaining 20/23 (87%) underwent neoadjuvant polychemotherapy (NAPCT), which was supplemented in 7/20 (35%) cases with uterine artery chemoembolization (UACE). Ultrasound examinations were performed in 23 patients on the eSaote Pro device using high-tech methods according to generally accepted technique: B-mode, Dopplerography in energy mode, 3D reconstruction in angio mode, ultrasound tomography. Pelvic contrast-enhanced MRI was carried out in 21/23 (91%) patients on tomographs with a magnetic field strength of 1.5 T (Canon Vantage Atlas, Siemens Magnetom Aero). Results. During UACE and/or NAPCT, all patients (20/20) showed a decrease in cervical volume, neovascularization loci, and blood flow velocity in most cases. The inclusion of the surgical stage of treatment is possible in the absence of paracervical, parametrial infiltration data based on clinical, magnetic resonance and ultrasound data, taking into account the absence of the ultrasound sign “paracervical vessel +”. The absence of this sign and, accordingly, parametrial invasion, correlated with MRI results. The diagnostic informativeness indicators of ultrasound in detecting parametrial invasion were: sensitivity 89.4%, specificity 91.3%, positive predictive value (PPV) 89.4%, negative predictive value (NPV) 55.2%. Sensitivity, specificity, PPV and NPV of MRI in detecting parametrial invasion were 76.9%, 75.0%, 83.3%, 66.7% for researcher 1 (2 years of experience) and 91.7%, 87.5%, 84.6%, 77.8% for researcher 2 (8 years of experience), respectively. Conclusion. The use of high-tech diagnostic methods (ultrasound and MRI) allows for high diagnostic performance in visualizing parametric invasion in CC.

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