Stage IB cervical carcinoma: comparison of clinical, MR, and pathologic staging

In patients with stage IB cervical carcinoma (carcinoma confined to the cervix), accurate staging is essential in order to determine the best treatment strategy--that is, whether to use surgery alone or surgery in combination with pre- or postsurgical radiation therapy. Currently, decisions regarding the management of patients are made on the basis of clinical staging that has an error rate of 34-39% (when surgical staging is used as the standard). To investigate the value of MR in staging patients with IB cervical cancer, we performed prospective MR examinations in 27 patients who had cervical carcinoma. Of these, 10 were clinically staged as having IB cervical carcinoma and underwent radical hysterectomy, providing specimens for pathologic correlation. In six of these 10 patients, the extent of disease had been underestimated during clinical examination under anesthesia. These six patients would have received radiation therapy before surgery had the MR information been used at the treatment-planning stage. MR imaging correlated better with surgical pathology than did clinical examination under anesthesia in determining the location and extent of tumor. MR imaging should be used in conjunction with clinical staging to determine appropriate therapy in patients with stage IB cervical carcinoma.