Added value of radiological staging to clinical examination in different histopathological subtypes of uterine cervical cancer: A retrospective study

Abstract

Objective: Accurate staging of uterine cervical cancer (UCC) is crucial for treatment guidance and prognostic predictions. This study investigated the added value of conventional diagnostic imaging for different histopathological subtypes of UCC by comparing clinical staging according to International Federation of Gynaecology and Obstetrics staging system (cFIGO) and radiological staging (rFIGO) with histopathological staging (pFIGO) as reference.

Methods: 26 consecutive patients with UCC from the retrospective part of the PRODIGYN study (ethical approval number 2022-04207-01; NCT05855941) were included in the present study. Data from study participants was collected from radiological and histopathological records 2016-2022 at the University hospital of Umeå. Staging was assessed according to the FIGO 2018 staging system. Statistical analysis included descriptive statistics and Cohen's weighted kappa coefficient (κ) for calculation of agreement between cFIGO and rFIGO, and between rFIGO and pFIGO.

Results: With rFIGO staging, more advanced disease stages were found in 67 % (8/12 patients with known cFIGO). Poor agreement was found between cFIGO and rFIGO (κ =0.057) and between rFIGO and pFIGO (κ= 0169). Among the patients with squamous cell carcinoma (SCC) positive for human papilloma virus (HPV+), 67 % (4/6) were assigned a higher stage by rFIGO compared to cFIGO. For the single patients with HPV-negative SCC and HPV status unknown SCC, both were upstaged by rFIGO. In the case of adenocarcinomas, 67 % (2/3) of the patients were assigned a higher stage with rFIGO.

Conclusions: In primary staging of UCC, rFIGO leads to substantial up-staging compared to cFIGO, without obvious differences in subtypes.

Keywords: Adenocarcinoma; Computed Tomography; Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Squamous Cell Neoplasms; Uterine cervical neoplasms.

Graphical abstract

Fig. 1

STARD Diagram of Patient Selection.

Fig. 2

Distribution of Histopathological Subtypes for uterine cervical cancer (UCC) Patients: HPV-positive squamous cell carcinoma (HPV+ SCC), HPV-negative squamous cell carcinoma (HPV- SCC), HPV status unknown squamous cell carcinoma (HPV status unknown SCC), adenocarcinoma, and carcinosarcoma.

Fig. 3

Comparison of clinical (cFIGO), radiological (rFIGO) and patholgoical (pFIGO) FIGO Staging. This bar graph compares the number of UCC patients categorized by each clinical (cFIGO – pink bars), radiological (rFIGO – blue bars) and pathological (pFIGO – green bars) FIGO stage. This graph highlights discrepancies and similarities between the three staging methods, showing variations in patient counts for each stage.

Fig. 4

Cervical Carcinoma, MRI and PET/CT imaging. The orange arrow in Picture A (T1W TFE, coronal MRI) shows invasion of the tumour into the posterior wall of the bladder, with the orange arrow in Picture B (Gd T1W TFE, coronal MRI) pointing towards the contrast enhancement of the cervical carcinoma. The arrows in Picture C (ADC, coronal MRI) and D (DWI b=1000, coronal MRI) show restricted diffusion of the cervical carcinoma as well as the posterior wall of the urinary bladder with a low ADC value 0,58 × 10–3 mm2/s of the tumor. Picture E shows a coronal PET/CT with the green arrows pointing towards paraaortic and left iliac lymph node metastases with FDG accumulation. The orange arrow in picture E shows the FDG accumulation of the cervical carcinoma.