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Preoperative tumour size assessment in patients with early-stage cervical cancer: Final results of the SENTIX study
M. Borčinová, C. Köhler, K. Němejcová, I. Zapardiel, J. Klát, F. Frühauf, V. Kalist, W. Szatkowski, D. Wydra, R. Kocián, R. Laky, R. Tóth, M. Misiek, M. Redecha, I. Martin, F. Kridelka, A. Burgetová, FJ. Santiago Garcia, T. Van Gorp, G. Szewczyk,...
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Sentinel Lymph Node Biopsy methods MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Uterine Cervical Neoplasms * pathology surgery diagnostic imaging MeSH
- Preoperative Care methods MeSH
- Prospective Studies MeSH
- Aged MeSH
- Neoplasm Staging MeSH
- Tumor Burden MeSH
- Ultrasonography MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND: Preoperative tumour size is a key prognostic marker in tailoring surgical treatment in early-stage cervical cancer. This post-hoc analysis assessed the accuracy of preoperative tumour size evaluation via imaging, utilizing data from the prospective, international, multicentre SENTIX study that evaluated safety of sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. METHODS: Between 05/2016-09/2020, forty-seven sites across 18 countries enrolled cervical cancer patients (FIGO2018 stages 1A1/lymphovascular-space-invasion-positive to 1B2). Preoperative staging included pelvic MRI or ultrasound as mandatory imaging modalities. All patients underwent primary surgical treatment. Pathological assessment of surgical specimens served as reference standard for evaluating the accuracy of preoperative assessments. RESULTS: Among the 680 included patients, although the mean tumour size discrepancy between preoperative/pathological assessments was only 1.24 ± 8.891 mm, postoperative pT stage was upgraded in 187 (27.5 %) and downgraded in 74 (10.9 %) patients. Discrepancy of ≥10 mm was observed among 155 (22.8 %) patients across all stages, with underestimation in 105 (15.4 %), overestimation in 50 (7.4 %), and a positive correlation (P < 0.0001) between the pathological tumour size and the discrepancy in size assessment. If a maximum 2 cm tumour size threshold were applied to guide the decision between simple and radical hysterectomy, underestimation would result in inadequate surgical management for 9.0 % of patients, whereas overestimation would lead to unnecessarily radical procedures in 5.1 % of cases. CONCLUSIONS: The study highlights, that even with the use of modern imaging in preoperative staging, inaccuracies in tumour size assessment remain a common cause of up-/down-staging after surgery resulting in potential inappropriate planning of surgery, and thus in procedure that is either excessively or insufficiently radical. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02494063.
Asklepios Klinik Altona Department of Radiology Germany
Cliniques universitaires Saint Luc Institut Roi Albert 2 Avenue Hippocrate Brussel Belgium
Department of Biophysics Physiology and Pathophysiology Medical University of Warsaw Poland
Department of Gynaecogy and Obstetrics Bory Hospital Bratislava Slovakia
Department of Gynecology and Obstetrics University Hospital of Liège CHU Liège Liège Belgium
Department of Gynecology Asklepios Clinic Hamburg Altona
Department of Gynecology DRK Klinik Berlin Westend Berlin Germany
Department of Gynecology Obstetrics Medical University of Gdansk Poland
Department of Obstetrics and Gynecology Cantonal Hospital of Lucerne Lucerne Switzerland
Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Hungary
Department of Obstetrics and Gynecology Medical University of Graz Graz Austria
Department of Radiology 1st Faculty of Medicine Charles University 121 08 Prague Czech Republic
Fundación Instituto Valenciano de Oncología Valencia Spain
Gynecologic Oncology Unit La Paz University Hospital Madrid Spain
Holy Cross Cancer Center Kielce Poland
Hospital Clinico San Carlos IdISSC School of Medicine University Complutense Madrid Spain
MD Anderson Cancer Center Madrid Spain
References provided by Crossref.org
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- $a BACKGROUND: Preoperative tumour size is a key prognostic marker in tailoring surgical treatment in early-stage cervical cancer. This post-hoc analysis assessed the accuracy of preoperative tumour size evaluation via imaging, utilizing data from the prospective, international, multicentre SENTIX study that evaluated safety of sentinel lymph node (SLN) biopsy without pelvic lymph node dissection in patients with early-stage cervical cancer. METHODS: Between 05/2016-09/2020, forty-seven sites across 18 countries enrolled cervical cancer patients (FIGO2018 stages 1A1/lymphovascular-space-invasion-positive to 1B2). Preoperative staging included pelvic MRI or ultrasound as mandatory imaging modalities. All patients underwent primary surgical treatment. Pathological assessment of surgical specimens served as reference standard for evaluating the accuracy of preoperative assessments. RESULTS: Among the 680 included patients, although the mean tumour size discrepancy between preoperative/pathological assessments was only 1.24 ± 8.891 mm, postoperative pT stage was upgraded in 187 (27.5 %) and downgraded in 74 (10.9 %) patients. Discrepancy of ≥10 mm was observed among 155 (22.8 %) patients across all stages, with underestimation in 105 (15.4 %), overestimation in 50 (7.4 %), and a positive correlation (P < 0.0001) between the pathological tumour size and the discrepancy in size assessment. If a maximum 2 cm tumour size threshold were applied to guide the decision between simple and radical hysterectomy, underestimation would result in inadequate surgical management for 9.0 % of patients, whereas overestimation would lead to unnecessarily radical procedures in 5.1 % of cases. CONCLUSIONS: The study highlights, that even with the use of modern imaging in preoperative staging, inaccuracies in tumour size assessment remain a common cause of up-/down-staging after surgery resulting in potential inappropriate planning of surgery, and thus in procedure that is either excessively or insufficiently radical. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02494063.
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