Affiliations: [a] Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| [b] Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China
| [c] Department of Radiology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Suzhou, China
Correspondence:
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Corresponding authors. Hong-yan Wang, Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, qianjin road 91, Kunshan, Jiangsu, China. Tel.: +18013281626; Fax: +512 57501112; E-mail: anne5214@163.com and Jun-kang Shen, Department of Radiology, The Second Affiliated Hospital of Soochow University, Institute of Radiotherapy & Oncology, Soochow University, Sanxiang Road 1055, Suzhou, Jiangsu, China. Tel.: +13962174116; Fax: +512 68284303; E-mail: sdfeysjk@163.com.
Abstract: OBJECTIVE: The purpose of this study was to evaluate the clinical value of transvaginal elastography (TVES) combined with high-resolution transvaginal ultrasound (TVS) in the detection of parametrial invasion in cervical cancer and to compare the diagnostic performance with magnetic resonance imaging (MRI). MATERIALS AND METHODS: 52 women with histologically confirmed cervical cancer over a 2-year period were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and TVES combined with TVS according to a standardized protocol before treatment. When assessing parametrial involvement with TVS, MRI, and combination of TVES and TVS, the findings were recorded and compared with histopathological results after surgery in early-stage disease (stage⩽IIa). Sensitivity, specificity accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method independently; subsequently, a matched-sample analysis was performed by using McNemar’s test or chi-square test. RESULTS: Of 52 patients, 39 were early-stage disease (stage⩽IIa), and 13 were advanced-stage disease (stage⩾IIb) according to conventional FIGO staging. For the detection of parametrial infiltration, both the diagnostic sensitivity of MRI and the combination of TVS and TVES were statistically higher than alone TVS in early-stage of cervical cancer (P = 0.03 < 0.05). Both MRI and the combination of TVS and TVES had a sensitivity of 72.73%; specificity rates of 82.14% for MRI and 78.57% for the combination of TVES and TVS; and the diagnostic accuracy rates of 79.49% for MRI and 76.92% for the combination of TVES and TVS. A matched sample analysis revealed no statistically significant difference between the diagnostic performance of MRI and the combination of TVES and TVS in the assessment of parametrial invasion (all P values > 0.05). CONCLUSION: TVES combined with TVS performed by a dedicated gynecologic radiologist should be considered a promising and economic method for pre-operative work-up for cervical cancer.
