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Fischerova D, Smet C, Scovazzi U, Sousa DN, Hundarova K, Haldorsen IS. Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements. Int J Gynecol Cancer 2024; 34:363-378. [PMID: 38438175 PMCID: PMC10958454 DOI: 10.1136/ijgc-2023-004609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/05/2024] [Indexed: 03/06/2024] Open
Abstract
In recent years the role of diagnostic imaging by pelvic ultrasound in the diagnosis and staging of gynecological cancers has been growing exponentially. Evidence from recent prospective multicenter studies has demonstrated high accuracy for pre-operative locoregional ultrasound staging in gynecological cancers. Therefore, in many leading gynecologic oncology units, ultrasound is implemented next to pelvic MRI as the first-line imaging modality for gynecological cancer. The work herein is a consensus statement on the role of pre-operative imaging by ultrasound and other imaging modalities in gynecological cancer, following European Society guidelines.
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Affiliation(s)
- Daniela Fischerova
- Gynecologic Oncology Center, Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carolina Smet
- Department of Obstetrics and Gynecology, São Francisco de Xavier Hospital in Lisbon, Lisbon, Portugal
| | - Umberto Scovazzi
- Department of Gynecology and Obstetrics, Ospedale Policlinico San Martino and University of Genoa, Genoa, Italy
| | | | - Kristina Hundarova
- Department of Gynecology and Obstetrics A, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Ingfrid Salvesen Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology and Department of Clinical Medicine, Haukeland University Hospital and the University of Bergen, Bergen, Norway
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Xin Z, Yan W, Feng Y, Yunzhi L, Zhang Y, Wang D, Chen W, Peng J, Guo C, Chen Z, Wang X, Zhu J, Lei J. An MRI-based machine learning radiomics can predict short-term response to neoadjuvant chemotherapy in patients with cervical squamous cell carcinoma: A multicenter study. Cancer Med 2023; 12:19383-19393. [PMID: 37772478 PMCID: PMC10587964 DOI: 10.1002/cam4.6525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Neoadjuvant chemotherapy (NACT) has become an essential component of the comprehensive treatment of cervical squamous cell carcinoma (CSCC). However, not all patients respond to chemotherapy due to individual differences in sensitivity and tolerance to chemotherapy drugs. Therefore, accurately predicting the sensitivity of CSCC patients to NACT was vital for individual chemotherapy. This study aims to construct a machine learning radiomics model based on magnetic resonance imaging (MRI) to assess its efficacy in predicting NACT susceptibility among CSCC patients. METHODS This study included 234 patients with CSCC from two hospitals, who were divided into a training set (n = 180), a testing set (n = 20), and an external validation set (n = 34). Manual radiomic features were extracted from transverse section MRI images, and feature selection was performed using the recursive feature elimination (RFE) method. A prediction model was then generated using three machine learning algorithms, namely logistic regression, random forest, and support vector machines (SVM), for predicting NACT susceptibility. The model's performance was assessed based on the area under the receiver operating characteristic curve (AUC), accuracy, and sensitivity. RESULTS The SVM approach achieves the highest scores on both the testing set and the external validation set. In the testing set and external validation set, the AUC of the model was 0.88 and 0.764, and the accuracy was 0.90 and 0.853, the sensitivity was 0.93 and 0.962, respectively. CONCLUSIONS Machine learning radiomics models based on MRI images have achieved satisfactory performance in predicting the sensitivity of NACT in CSCC patients with high accuracy and robustness, which has great significance for the treatment and personalized medicine of CSCC patients.
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Affiliation(s)
- Zhonghong Xin
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Wanying Yan
- Infervision Medical Technology Co., LtdBeijingChina
| | - Yibo Feng
- Infervision Medical Technology Co., LtdBeijingChina
| | - Li Yunzhi
- Department of RadiologyGansu Provincial Maternity and Child‐care HospitalLanzhouChina
| | - Yaping Zhang
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Dawei Wang
- Infervision Medical Technology Co., LtdBeijingChina
| | - Weidao Chen
- Infervision Medical Technology Co., LtdBeijingChina
| | - Jianhong Peng
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Cheng Guo
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Zixian Chen
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Xiaohui Wang
- Department of Gynecology and ObstetricsThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Jun Zhu
- Department of PathologyThe First Hospital of Lanzhou UniversityLanzhouChina
| | - Junqiang Lei
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouChina
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Pasciuto T, Moro F, Collarino A, Gambacorta MA, Zannoni GF, Oradei M, Ferrandina MG, Gui B, Testa AC, Rufini V. The Role of Multimodal Imaging in Pathological Response Prediction of Locally Advanced Cervical Cancer Patients Treated by Chemoradiation Therapy Followed by Radical Surgery. Cancers (Basel) 2023; 15:3071. [PMID: 37370682 DOI: 10.3390/cancers15123071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE This study aimed to develop predictive models for pathological residual disease after neoadjuvant chemoradiation (CRT) in locally advanced cervical cancer (LACC) by integrating parameters derived from transvaginal ultrasound, MRI and PET/CT imaging at different time points and time intervals. METHODS Patients with histologically proven LACC, stage IB2-IVA, were prospectively enrolled. For each patient, the three examinations were performed before, 2 and 5 weeks after treatment ("baseline", "early" and "final", respectively). Multivariable logistic regression models to predict complete vs. partial pathological response (pR) were developed and a cost analysis was performed. RESULTS Between October 2010 and June 2014, 88 patients were included. Complete or partial pR was found in 45.5% and 54.5% of patients, respectively. The two most clinically useful models in pR prediction were (1) using percentage variation of SUVmax retrieved at PET/CT "baseline" and "final" examination, and (2) including high DWI signal intensity (SI) plus, ADC, and SUVmax collected at "final" evaluation (area under the curve (95% Confidence Interval): 0.80 (0.71-0.90) and 0.81 (0.72-0.90), respectively). CONCLUSION The percentage variation in SUVmax in the time interval before and after completing neoadjuvant CRT, as well as DWI SI plus ADC and SUVmax obtained after completing neoadjuvant CRT, could be used to predict residual cervical cancer in LACC patients. From a cost point of view, the use of MRI and PET/CT is preferable.
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Affiliation(s)
- Tina Pasciuto
- Data Collection G-STeP Research Core Facility, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Francesca Moro
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Maria Antonietta Gambacorta
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Radiology, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gian Franco Zannoni
- Gynecopathology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Pathology, Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Marco Oradei
- ALTEMS (Graduate School of Health Economics and Management), Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Maria Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Benedetta Gui
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
| | - Antonia Carla Testa
- Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Obstetrics and Gynecology, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Ye Y, Li Z, Kang S, Zhan X, Zhang Y, Xu Y, Li W, Lang J, Liu P, Chen C. Impact of different postoperative adjuvant therapies on the survival of early-stage cervical cancer patients with one intermediate-risk factor: A multicenter study of 14 years. J Obstet Gynaecol Res 2023. [PMID: 36916196 DOI: 10.1111/jog.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To compare survival outcomes of different postoperative adjuvant therapies (PATs) for early-stage cervical cancer (ECC) patients with one intermediate-risk pathological factor (IPF). METHODS A total of 2889 patients with stage IA1 to IIA2 cervical cancer were included in this study. Three PAT groups were identified, namely a no adjuvant therapy (NAT) group (n = 773), an adjuvant radiotherapy/chemoradiotherapy (ART) group (n = 1648) and an adjuvant chemotherapy (ACT) group (n = 468). Kaplan-Meier analysis and COX regression analysis were used to compare the overall survival (OS) and disease-free survival (DFS) among the three groups, before and after propensity score matching (PSM). RESULTS The recurrence and mortality rate rates in the NAT, ART and ACT groups were 9.2%, 8.6%, and 7.9%, respectively (p = 0.737). Kaplan-Meier analysis demonstrated no significant differences in the NAT, ART, and ACT groups in 5-year OS rates (92.8% vs. 93.6% vs. 94.7%, p = 0.594) and DFS rates (88.7% vs. 89.6% vs. 90.5%, p = 0.772). Post-hoc tests yielded similar results, with no differences in 5-year OS and DFS (NAT vs. ART, before and after matching, p > 0.05); (NAT vs. ACT, before and after matching, p > 0.05); and (ACT vs. ART, before and after matching, p > 0.05). CONCLUSION Postoperative adjuvant radiotherapy, chemoradiotherapy, and chemotherapy are not associated with survival outcomes of ECC patients with one IPF. Considering the side effects and impact on patients' quality of life, the PATs should be carefully considered.
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Affiliation(s)
- Yanna Ye
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China
| | - Zhiqiang Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Kang
- Department of Gynecology, Fourth Hospital, Hebei Medical University, Shijiazhuang, China
| | - Xuemei Zhan
- Department of Obstetrics and Gynecology, Affiliated Jiangmen Hospital of SUN YAT-SEN University, Jiangmen, China
| | - Yi Zhang
- Department of Gynecology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Xu
- Department of Obstetrics and Gynecology, Pan Yu Central Hospital, Guangzhou, China
| | - Weili Li
- Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China
| | - Jinghe Lang
- Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ping Liu
- Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China
| | - Chunlin Chen
- Department of Midwifery, Faculty of Health, Dongguan Polytechnic, Dongguan, China
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Tomalczyk A, Tomasik B, Fijuth J, Moszynska-Zielinska M, Gottwald L. Assessment of cervical vascularization density in patients with locally advanced squamous cell cervical carcinoma evaluated in colour Doppler and power Doppler functions. Arch Gynecol Obstet 2021; 305:955-961. [PMID: 34586470 PMCID: PMC8969035 DOI: 10.1007/s00404-021-06161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
Purpose The aim of the prospective study was to assess changes during treatment and prognostic significance of cervical vascularization density in patients with cervical squamous cell carcinoma (SCC) staged II B and III B and to find relationship of cervical vascularization density with tumour diameter, grading, staging and age of patients. Methods The study group included 50 patients who underwent transvaginal Doppler ultrasonography prior to chemoradiotherapy, after external beam radiation therapy (EBRT) and 6 weeks after HDR brachytherapy. The colour Doppler (CD) vascularity index (CDVI) and the power Doppler (PD) vascularity index (PDVI) in cervical tumour were examined. Results CDVI and PDVI values decreased significantly during radiotherapy (0.13 (95% CI 0.09–0.16); 0.09 (95% CI 0.07–0.11) and 0.05 (95% CI 0.03–0.06) for CDVI (p < 0.001) and 0.26 (95% CI 0.22–0.31); 0.18 (95% CI 0.14–0.22) and 0.08 (95% CI 0.06–0.11) for PDVI (p < 0.001)). No statistically significant associations of CDVI and PDVI with tumour diameter, grading, staging and age of patients were found. The higher (above median) CDVI values before EBRT were associated with better OS (p = 0.041). The higher (above median) PDVI values before EBRT were associated with superior DFS (p = 0.011) and OS (p < 0.001). DFS and OS did not differ significantly regarding CDVI and PDVI values after EBRT and after the treatment. Conclusions In the study group, cervical vascularization density evaluated in CD and PD functions did not depend on tumour diameter, grading, staging and age of patients and decreased during radiotherapy. The prognosis for our patients with CDVI and PDVI before the treatment above the median value was better than compared to patients with these parameters below the median value.
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Affiliation(s)
- Adam Tomalczyk
- Department of Radiology, Copernicus Memorial Hospital, Pabianicka 62, 93-513, Lodz, Poland
| | - Bartłomiej Tomasik
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Jacek Fijuth
- Department of Radiotherapy, Medical University of Lodz, ul. Paderewskiego 4, 93-509, Lodz, Poland.,Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Lodz, Lodz, Poland
| | | | - Leszek Gottwald
- Department of Radiotherapy, Medical University of Lodz, ul. Paderewskiego 4, 93-509, Lodz, Poland. .,Department of Teleradiotherapy, Regional Cancer Centre, Copernicus Memorial Hospital of Lodz, Lodz, Poland.
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Perniola G, Tomao F, Graziano M, Palaia I, Fischetti M, Lecce F, Casorelli A, Di Donato V, Giancotti A, Battaglia FA, Muzii L, Benedetti Panici P. The Role of 2D/3D Ultrasound to Assess the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer. Oncology 2020; 98:807-813. [PMID: 32892198 DOI: 10.1159/000505426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Different imaging techniques were introduced to improve preoperative clinical staging of locally advanced cervical cancer (LACC) with transvaginal ultrasound (TV-US) or transrectal ultrasound (TR-US) representing a promising staging technique in the evaluation of the local extension of the disease for invasive tumors. The aim of this study was to evaluate the response to neoadjuvant chemotherapy (NACT) in LACC by 2D/3D ultrasound examination. MATERIALS AND METHODS We prospectively enrolled patients affected by histologically and clinically confirmed LACC. All patients were scheduled for 3 cycles of platinum-based NACT followed by radical surgery. The ultrasound examination was performed at every cycle and within 10 days before surgery. The parameters evaluated were: the volume (automatically computed by the VOCAL software) and the mass vascularization. RESULTS From March 2010 to March 2019, 157 women were recruited. Among these patients, 12 of them were excluded: 6 for the presence of distant metastases, 4 for rare histology, and 2 for severe comorbidities not allowing the protocol treatment. Seventeen patients after NACT were excluded because they were not amenable to radical surgery. Thus, 128 were considered for the final analysis of whom 106 (83%) were considered responders to NACT by histology. The sensibility and specificity of ultrasound with regard to the response to chemotherapy compared to histological specimen were 94 and 82%, respectively, with an accuracy of 92%. The positive predictive value and negative predictive value were 96 and 75%, respectively. Finally, we found that nonetheless there was a trend towards a continuous response to chemotherapy among patients who were considered responders to NACT at pathological examination; the major volume and vascularization index (VI) reduction were observed during the first 2 cycles (74, 71% and 47, 63%, respectively). On the contrary, non-responders showed an initial reduction of the VI (4.86 consisting of 33%, 95% CI 0.79-8.92, p = 0.013), but no significant modification in tumour volume along NACT. CONCLUSION 2D/3D ultrasound is useful in assessing early response to NACT in patients with LACC.
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Affiliation(s)
- Giorgia Perniola
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Federica Tomao
- Dipartimento di Ginecologia Oncologica, European Institute of Oncology, IRCCS, Milan, Italy,
| | | | - Innocenza Palaia
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Margherita Fischetti
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Francesca Lecce
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Assunta Casorelli
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Violante Di Donato
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Antonella Giancotti
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | | | - Ludovico Muzii
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
| | - Pierluigi Benedetti Panici
- Dipartimento Universitario Materno-infantile e Scienze Urologiche, Università di Roma "Sapienza'', Rome, Italy
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Discriminating Performance of Early Uterine and Cervical Artery Pulsatility and Resistivity In Pre-Invasive Cervical Lesions. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:206-211. [PMID: 32595400 PMCID: PMC7315096 DOI: 10.14744/semb.2018.07769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 11/20/2022]
Abstract
Objectives: The aim of the present study was to investigate the diagnostic effectiveness of uterine and cervical vascularity alone or in combination with human papillomavirus (HPV) DNA testing and with cytology. Methods: Data were prospectively collected from 129 patients in an outpatient clinic of a secondary setting. Routine liquid-based cervical cytology and HPV-DNA testing were obtained. An abnormal result of any of these high-risk types was viewed as positive. Pulsatility (PI) and resistance (RI) indices of uterine (UA) and cervical (CA) arteries were assessed by Doppler sonography. Pathological diagnosis was considered as the gold standard for assessment. Diagnostic efficiency of alone and joint screening of the three indices for discriminating cervical intraepithelial neoplasia (CIN-I) or above from below was assessed. Results: UA-RI and CA-RI were significantly lower in the HPV (+) group than in the controls (p=0.02 and p=0.03, respectively). In subsequent sub-analysis among patients with positive HPV-DNA, UA-PI was significantly higher in the HPV-16 (+) group than in the HPV-18 (+) group (p=0.04). High-risk HPV (Hr-HPV) testing had the highest sensitivity compared with Doppler and cytology (76.5%, 64.7%, and 58.5%, respectively). Combining CA-RI with cytology or Hr-HPV significantly reduced the sensitivity (23.5% and 29.4, respectively) but improved the specificity from 54.4% to 69.8% and 40.9% to 70.7%, respectively. Combining UA-PI with Hr-HPV slightly increased the positive predictivity when compared with testing Hr-HPV alone (36.1% vs. 33.3%). Conclusion: The potential of the Doppler indices of UA and CA was doubtful in discriminating CIN-I or above lesions in the early period. In addition, RI of UA and CA differed with regard to the presence of HPV infection, whereas CA-RI differed in high-risk HPV cases.
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Testa AC, Moro F, Pasciuto T, Moruzzi MC, Di Legge A, Fuoco G, Autorino R, Collarino A, Gui B, Zannoni GF, Gambacorta A, Miccò M, Rufini V, Scambia G, Ferrandina G. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:110-118. [PMID: 29119649 DOI: 10.1002/uog.18953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. METHODS Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. RESULTS Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. CONCLUSIONS Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A C Testa
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Pasciuto
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M C Moruzzi
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Di Legge
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Fuoco
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Autorino
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - A Collarino
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Gui
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - G F Zannoni
- Department of Histopathology, Catholic University of the Sacred Heart, Rome, Italy
| | - A Gambacorta
- Radiation Oncology Department, Catholic University of the Sacred Heart, Rome, Italy
| | - M Miccò
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - V Rufini
- Nuclear Medicine Section, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Scambia
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ferrandina
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Health Science and Medicine, University of Molise, Campobasso, Italy
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He Y, Zhao Q, Geng YN, Yang SL, Li XM, Finas D, Yin CH, Wu YM. Analysis of short-term efficacy as defined by RECIST and pathological response of neoadjuvant chemotherapy comprised paclitaxel and cisplatin followed by radical surgery in patients with locally advanced cervical cancer: A prospective observational study. Medicine (Baltimore) 2018; 97:e10913. [PMID: 29851821 PMCID: PMC6392635 DOI: 10.1097/md.0000000000010913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study is to investigate short-term efficacy as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) and pathological response of neoadjuvant chemotherapy (NACT) comprised of paclitaxel and cisplatin (TP) followed by radical surgery in patients with locally advanced cervical cancer (LACC).This is a prospective study involving 61 women with histologically confirmed LACC referred for NACT following radical surgery at Beijing Obstetrics and Gynecology Hospital between April 2013 and January 2015.The efficacy of NACT was evaluated by the RECIST. The total short-term efficacy of NACT was 91.8% (complete remission and partial remission). The cervical invasion ≤1/2 was 82.4% in the complete remission (CR) group, 46.2% in the partial remission (PR) group, and 20% in the stable disease (SD) group. The difference between groups was statistically significant (P = .012). The slides of all surgical specimens were reviewed and classified according to the Tumor Regression Grade (TRG). The good response was defined by good short-term efficacy (RECIST) and the difference between groups was statistically significant (P = .042). The route of administration of NACT is a factor predicting response to NACT. A significant higher response rate (P = .011) and lower chemotherapy-related adverse events (P < .05) were observed in the artery intervention (AI) group compared to those received NACT via intravenous (IV) route. All patients were followed-up to the last day of 2015 with the median follow-up time of 21.5 months for NACT. For the 61 patients referred for NACT in LACC, 2 patients had relapsed and 1 patient died from the disease.The study showed that the NACT comprised TP for LACC treatment had a significant local effect. It could reduce tumor myometrial invasion and regress tumor. The route of administrating NACT is a predicting factor to the NACT response; 2 cycles of NACT of AI treatment to LACC patients would obtain a desired response with low chemotherapy adverse events.
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Affiliation(s)
- Yue He
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
| | - Qun Zhao
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
| | - Yu-Ning Geng
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
| | - Shu-Li Yang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
| | | | - Dominique Finas
- Department of Obstetrics and Gynecology, Magdeburg Clinic gGmbH, Birkenallee, Magdeburg, Germany
| | - Cheng-Hong Yin
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
| | - Yu-Mei Wu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital
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Xu Y, Zhu L, Ru T, Wang H, He J, Zhou Z, Yang X. Three-dimensional power Doppler ultrasound in the early assessment of response to concurrent chemo-radiotherapy for advanced cervical cancer. Acta Radiol 2017; 58:1147-1154. [PMID: 28068824 DOI: 10.1177/0284185116684677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Three-dimensional power Doppler ultrasound (3D-PDU) imaging has been widely applied to the differentiation of benign and malignant cervical lesions; however, its potential value for predicting response to chemo-radiotherapy has not been fully explored. Purpose To investigate the feasibility of 3D-PDU imaging in predicting treatment response in patients receiving concurrent chemo-radiotherapy (CCRT) for advanced cervical cancer. Material and Methods Fifty-two patients with advanced cervical cancer who received CCRT underwent 3D-PDU examinations at four timepoints: pre-therapy (baseline), 1 week and 2 weeks during, as well as immediately post CCRT. Final tumor response was determined by change in tumor size using magnetic resonance imaging (MRI). Cervical tumor volumes and vascular indices were calculated and compared with the clinical outcome. Results Of the 52 patients, 32 patients who completed all four examinations were included in the analyses: 21 were classified as complete response (CR) and 11 as partial response (PR). During the treatment, the CR group showed that 3D vascular indices (VI and VFI) significantly increased at 1 week ( P = 0.028, P = 0.017, respectively) then decreased at 2 weeks and obviously decreased at therapy completion (both P < 0.001), whereas tumors significantly decreased in volume at 2 weeks after therapy initiation ( P < 0.05). However, no significant differences in 3D vascular indices values were seen in the PR group during the treatment course (all P > 0.05). Conclusion Prospective longitudinal 3D-PDU imaging may have potentials in monitoring early therapeutic response to CCRT in patients with cervical cancer.
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Affiliation(s)
- Yan Xu
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Lijing Zhu
- Department of the Comprehensive Cancer Centre, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Tong Ru
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Huanhuan Wang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, PR China
| | - Xiaofeng Yang
- Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Chiappa V, Di Legge A, Valentini AL, Gui B, Miccò M, Ludovisi M, Giansiracusa C, Testa AC, Valentin L. Agreement of two-dimensional and three-dimensional transvaginal ultrasound with magnetic resonance imaging in assessment of parametrial infiltration in cervical cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:459-469. [PMID: 25091827 DOI: 10.1002/uog.14637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/25/2014] [Accepted: 07/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound with magnetic resonance imaging (MRI) as the gold standard in assessment of parametrial infiltration of cervical cancer and to determine if all parts of the cervix are equally assessable with ultrasound. METHODS Patients with macroscopically evident and histologically confirmed cervical cancer were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and 2D and 3D ultrasound examination before treatment. When assessing parametrial infiltration with 3D ultrasound and MRI, the cervix was (virtually) divided into three cylinders (cranial, middle and caudal) of equal size and each cylinder was then divided into six sectors in a clockwise manner following a consensus between radiologists and ultrasound examiners. The presence and the extent of parametrial invasion were recorded for each sector. Results of 2D ultrasound, 3D ultrasound and MRI were compared and reported in terms of percentage agreement and kappa value. RESULTS A total of 29 consecutive patients were included in the study. The percentage agreement between 2D ultrasound and MRI in assessing parametrial infiltration (yes or no) was 76% (kappa, 0.459) and that between 3D ultrasound and MRI was 79% (kappa, 0.508). The results of 2D ultrasound showed the following agreement with those of MRI: 90% for the ventral parametrium (kappa, 0.720), 72% for the right lateral parametrium (kappa, 0.494), 69% for the left lateral parametrium (kappa, 0.412) and 58.5% for the dorsal parametrium (kappa, 0.017). The results of 3D ultrasound showed the following agreement with those of MRI: 62.5% for the ventral parametrium (kappa, 0.176), 81% for the right lateral parametrium (kappa, 0.595), 70% for the left lateral parametrium (kappa, 0.326) and 52% for the dorsal parametrium (kappa, 0.132). The best agreement between 3D ultrasound and MRI was for the middle cervical cylinder (76%; kappa, 0.438) and the poorest agreement was for the caudal cylinder (42%; kappa, 0.125). CONCLUSION The results of 2D and 3D ultrasound showed similar moderate agreement with MRI; 2D and 3D ultrasound examinations are less costly and more readily available than MRI and should be considered in the preoperative work-up for cervical cancer.
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Affiliation(s)
- V Chiappa
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
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12
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Belitsos P, Papoutsis D, Rodolakis A, Mesogitis S, Antsaklis A. Three-dimensional power Doppler ultrasound for the study of cervical cancer and precancerous lesions. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:576-581. [PMID: 22323111 DOI: 10.1002/uog.11134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the blood flow characteristics of the cervix in normal women and in women with cervical precancerous lesions or cervical cancer. METHODS We studied 165 women with three-dimensional power Doppler ultrasound (3D-PDU), of whom 71 had cervical cancer, 61 had precancerous lesions and 33 were healthy controls. The cervix was manually traced in the stored volumes using 15° rotation steps and the following 3D-PDU indices were calculated: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). These indices were compared among the study groups and were also correlated with features of the precancerous lesions group and cancer group. RESULTS The three indices were all statistically significantly higher in the cervical cancer group and precancerous lesions group than in controls (P < 0.001). In addition, significantly higher values of all indices were found in the cervical cancer group than in the precancerous lesions group (P < 0.001). Further analysis according to patient characteristics in the cancer group showed that VI, FI and VFI were not significantly different in relation to grade, histology, presence of positive lymph nodes or lymphovascular space involvement (P > 0.05). However, VI was significantly higher in patients with Stages IIIB-IV cancer than in patients with less advanced disease (P = 0.045). In the cervical cancer group there was a significant positive correlation between 3D-PDU indices and cervical volume. CONCLUSION 3D-PDU assessment of the cervix reveals significant differences in all indices studied between women with cervical precancerous lesions or cancer and healthy women. In women with cervical cancer, an advanced stage is associated with higher VI, but 3D-PDU indices are not related to other pathological characteristics.
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Affiliation(s)
- P Belitsos
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece.
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