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. 2022 Nov 22;12(12):2904.
doi: 10.3390/diagnostics12122904.

Vaginosonography versus MRI in Pre-Treatment Evaluation of Early-Stage Cervical Cancer: An Old Tool for a New Precision Approach?

Ailyn M Vidal Urbinati  1   2 , Ida Pino  1 , Anna D Iacobone  1   2 , Davide Radice  3 , Giulia Azzalini  1   4 , Maria E Guerrieri  1 , Eleonora P Preti  1 , Silvia Martella  1 , Dorella Franchi  1
Affiliations

Vaginosonography versus MRI in Pre-Treatment Evaluation of Early-Stage Cervical Cancer: An Old Tool for a New Precision Approach?

Ailyn M Vidal Urbinati et al. Diagnostics (Basel). .

Abstract

This study aims to analyze the sensitivity of vaginosonography (VGS) and magnetic resonance imaging (MRI) in the preoperative local evaluation of early-stage cervical cancers and to assess their accuracy in the detection of tumors, size of the lesions and stromal invasion by comparing them with the final histopathology report. This single-center study included 56 consecutive patients with cervical cancer who underwent VGS and MRI from November 2012 to January 2021. VGS significantly overestimated the lesion size by 2.7 mm (p = 0.002), and MRI underestimated it by 1.9 mm (p = 0.11). Both MRI and VGS had a good concordance with the pathology report (Cohen’s kappa of 0.73 and 0.81, respectively). However, MRI had a false-negative rate (38.1%) that was greater than VGS (0%) in cases of cervical tumor size <2 cm. We found a good concordance between histology and VGS in the stromal infiltration assessment, with 89% sensitivity (95% CI 0.44−0.83) and 89% specificity (95% CI 0.52−0.86). VGS is a simple, inexpensive, widely available, and fast execution method that can complement ultrasound in particular cases and show a good correlation with MRI in the assessment of tumor dimensions, with a better performance in detecting small tumors (<2 cm).

Keywords: MRI and gynecological oncology diagnosis; cervical cancer; transvaginal ultrasound; vaginosonography.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Small tumor after conization. (A) Not detectable disease by MRI. (B) Detectable disease by TVUS, measuring 10.3 × 8.3 mm. (C) Lesion vascularization by power Doppler. (D) Disease detectable by VGS, measuring 13.3 × 6.9 mm.
Figure 2
Figure 2
Echogenicity by TVUS and VGS. (A) Small adenocarcinoma (arrows) at TVUS; (B) the same tumor at VGS, with better definitions of the margins and more hyperechoic echogenicity (arrows). (C) Squamous tumors (arrows) at TVUS; (D) the same tumor at VGS, with better definitions of the margins and more hypoechoic echogenicity (arrows).
Figure 3
Figure 3
Dimensions with both techniques compared with final histology. VGS image of IB2 N+ squamous tumor (A,B), MRI (C), and macroscopic appearance (D).
Figure 4
Figure 4
Detection of small tumors with VGS. (A,B) Small tumor not detectable at TVUS and MRI; (C,D) the same tumor detected by adding VGS and PD.
Figure 5
Figure 5
Bland–Altman plot of both methods compared with the gold standard.
Figure 5
Figure 5
Bland–Altman plot of both methods compared with the gold standard.
See this image and copyright information in PMC

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