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Objective <p>To assess the accuracy of MRI in detecting residual disease after conization in patients with early-stage cervical cancer (CC) and to evaluate the impact of MRI on FIGO staging and surgical management.</p> Materials and methods <p>Between January 2018 and December 2023, a consecutive series of patients with early-stage invasive CC undergoing conization, pre-operative pelvic MRI, and surgery were included in this retrospective study. Two experienced radiologists reviewed the MRI scans for the presence of residual tumor, assessed on T2-weighted, diffusion-weighted, and contrast-enhanced sequences, if available. MRI findings were compared with surgical pathology to evaluate diagnostic performance and clinical impact.</p> Results <p>A total of 108 patients were included in the study. MRI detected residual disease with an accuracy of 78.7% (95% CI 71.0–86.4), sensitivity of 66%, specificity of 90.9%, positive predictive value of 87.5%, and negative predictive value of 73.5%. The use of contrast agent showed no significant difference in overall accuracy, with an accuracy of 74.5% for contrast-enhanced MRI (CE-MRI) and 83% for non-CE-MRI (<i>p</i> = 0.28), respectively. MRI correctly staged 73.8% of cases, suggested the correct extent of radicality in 79.7% of cases following the 2018 ESGO guidelines, and the appropriate type of hysterectomy (simple vs. radical) in 90.9% of cases following the SHAPE study.</p> Conclusion <p>Non-CE MRI is a reliable and sufficient tool for detecting residual tumor after conization in early-stage CC, as contrast administration offers no additional diagnostic value. Accurate pre-operative identification of residual disease may refine FIGO staging and assist in tailoring surgical strategies.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>MRI evaluation of residual tumor after cervical conization in early-stage cervical cancer is critical to optimize surgical planning noninvasively and avoid overtreatment.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>MRI correctly identified residual disease with high specificity (90.9%) and moderate sensitivity (66%); contrast enhancement did not significantly improve diagnostic accuracy.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>MRI, particularly non-contrast protocols, reliably excludes post-conization residual disease and aids in selecting appropriate surgical treatment, reducing overtreatment in early-stage cervical cancer.</i></p> Graphical Abstract <p></p>

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Accuracy and clinical impact of MRI in early-stage cervical cancer after cervical conization, a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月18日

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  • M. Dolciami,
  • M. Criscione,
  • N. Bizzarri,
  • A. Amerighi,
  • A. Napoletano,
  • L. Russo,
  • G. Scaglione,
  • D. Giannarelli,
  • M. Petrillo,
  • E. Sala,
  • F. Fanfani,
  • B. Gui

摘要

Objective

To assess the accuracy of MRI in detecting residual disease after conization in patients with early-stage cervical cancer (CC) and to evaluate the impact of MRI on FIGO staging and surgical management.

Materials and methods

Between January 2018 and December 2023, a consecutive series of patients with early-stage invasive CC undergoing conization, pre-operative pelvic MRI, and surgery were included in this retrospective study. Two experienced radiologists reviewed the MRI scans for the presence of residual tumor, assessed on T2-weighted, diffusion-weighted, and contrast-enhanced sequences, if available. MRI findings were compared with surgical pathology to evaluate diagnostic performance and clinical impact.

Results

A total of 108 patients were included in the study. MRI detected residual disease with an accuracy of 78.7% (95% CI 71.0–86.4), sensitivity of 66%, specificity of 90.9%, positive predictive value of 87.5%, and negative predictive value of 73.5%. The use of contrast agent showed no significant difference in overall accuracy, with an accuracy of 74.5% for contrast-enhanced MRI (CE-MRI) and 83% for non-CE-MRI (p = 0.28), respectively. MRI correctly staged 73.8% of cases, suggested the correct extent of radicality in 79.7% of cases following the 2018 ESGO guidelines, and the appropriate type of hysterectomy (simple vs. radical) in 90.9% of cases following the SHAPE study.

Conclusion

Non-CE MRI is a reliable and sufficient tool for detecting residual tumor after conization in early-stage CC, as contrast administration offers no additional diagnostic value. Accurate pre-operative identification of residual disease may refine FIGO staging and assist in tailoring surgical strategies.

Key Points

Question MRI evaluation of residual tumor after cervical conization in early-stage cervical cancer is critical to optimize surgical planning noninvasively and avoid overtreatment.

Findings MRI correctly identified residual disease with high specificity (90.9%) and moderate sensitivity (66%); contrast enhancement did not significantly improve diagnostic accuracy.

Clinical relevance MRI, particularly non-contrast protocols, reliably excludes post-conization residual disease and aids in selecting appropriate surgical treatment, reducing overtreatment in early-stage cervical cancer.

Graphical Abstract