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

AZ Turnhout Turnhout Belgium

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 Obstetrics Gynecology and Gynecological Oncology Mazovian Voivodship Hospital Siedlce 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 and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

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 Obstetrics and Gynecology University Hospital Ostrava and Faculty of Medicine University of Ostrava Czech Republic

Department of Pathology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University 121 08 Prague Czech Republic

Division of Gynaecological Oncologiy University Hospital Leuven and KU Leuven Leuven Cancer Institute BGOG Leuven Belgium

Fundación Instituto Valenciano de Oncología Valencia Spain

Gyneacologic Oncology Department Maria Sklodowska Curie National Research Institute of Oncology Krakow Poland

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

Oncology Institute of East Slovakia Košice Slovakia

Thomas Bata Hospital Zlín Czechia

Citace poskytuje Crossref.org

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ClinicalTrials.gov
NCT02494063