Pretreatment staging of cervical cancer: Is imaging better than palpation?

Background: Cervical carcinoma is clinically staged according to the criteria of the International Federation of Gynecology and Obstetrics (FIGO). Computed tomography (CT) and magnetic resonance imaging (MRI) can also be used in pretreatment evaluation of tumor extension and size; however, the diagnostic value and the impact on clinical decisions of cross-sectional imaging have been questioned. Methods: The files of 255 patients with biopsy-proven cervical carcinoma receiving primary surgical treatment at the Department of Obstetrics and Gynaecology of Ulm University between 1992 and 2003 were analyzed retrospectively. All patients had a clinical pelvic examination; additionally, 164 underwent CT, 101 had an MRI, and 90 had both CT and MRI. Surgicopathologic findings were used as the standard of reference. Results: To evaluate detection of parametrial involvement, patients were divided into those with stage IIA or less disease (n = 171; 67%) and those with stage IIB or more disease (n = 84; 33%). The accuracy, sensitivity, and specificity were 75%, 66%, and 81% for clinical staging, 59%, 43%, and 71% for CT, and 58%, 52%, and 63% for MRI, respectively. After stratification for palpation, the results with CT and MRI were no better than with palpation (accuracy: CT 61% and 54%, MRI 61% and 56%, respectively). The sensitivity of CT and MRI for detecting lymph node metastasis was also poor (36% and 35%, respectively). Conclusion: Clinical examination was better than CT and MRI for pretreatment evaluation of early invasive cervical cancer.