Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study 2: the role of ultrasound after chemoradiation to assess residual tumor

5 years ago

Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study 2: the role of ultrasound after chemoradiation to assess residual tumor

Tina Pasciuto, Angela Collarino, Gian Franco Zannoni, Antonia Carla Testa, Vittoria Rufini, Maura Miccò, Giovanni Scambia, Benedetta Gui, Gabriella Ferrandina, Antonietta Gambacorta, Francesca Moro, Gilda Fuoco, Maria Cristina Moruzzi, Alessia Di Legge, Rosa Autorino

Objective To determine the diagnostic performance of two-dimensional ultrasound parameters, three-dimensional power Doppler and intravenous 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, 108 women with histologically documented cervical cancer and FIGO stage IB2-IVA were screened and 88 of them were included in the final analysis. Ultrasound parameters, 3D power Doppler, and contrast ultrasound indices were obtained five weeks after the end of treatment. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial, including both microscopic and macroscopic residual tumor at pathological examination. Comparisons between the two groups were performed with Mann–Whitney-test and χ2-test, as appropriate. Receiver operating characteristic curves were generated to determine the best cut-off value of ultrasound tumor diameter to predict residual disease. Histology was considered as a reference. Results Complete and partial pathological responses to chemoradiation therapy were documented in 40 (45.5%) and 48 (54.5%) patients, respectively. Ultrasound examination detected the presence of residual pathological disease with sensitivity of 64.6% and specificity of 65%. Color Doppler examination performed on the visualized lesions detected the presence of residual pathological disease with sensitivity of 87.1% and specificity of 21.4%. The best area under the curve (0.817) was observed for the detection of pathological residual disease of at least 6 mm using a cut-off value of 12 mm for the largest tumor diameter assessed on ultrasound (sensitivity 95%, specificity 70.6%). Neither 3D vascular indices nor contrast ultrasound parameters performed on the suspicious lesions at ultrasound examination after chemoradiation significantly differed between patients with histological complete versus partial response. Conclusions Our results showed that gray-scale and color Doppler examinations have a low level of diagnostic performance in detecting any residual disease after chemoradiation in patients with locally advanced cervical cancer. A good predictive performance can be achieved in detecting a macroscopic pathological residual disease (≥6 mm).

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18953