Ultrasound detection of residual cervical cancer after conization, in a retrospective monocentric analysis: the URECA...

To assess the accuracy of ultrasound in identifying residual cervical tumors following conization, using histology as the gold standard.

This retrospective, single-center study included patients with early-stage cervical cancer (International Federation of Gynecology and Obstetrics IA1-IB1 and early IB2) who underwent conization followed by secondary surgical treatment (re-conization, hysterectomy, or trachelectomy). Patients with locally advanced disease were excluded. All patients underwent trans-vaginal or trans-rectal ultrasound after conization and before definitive surgery between January 2015 and May 2025. Ultrasound findings were classified as follows: a) absence of residual tumor, b) presence of residual tumor, or c) uncertain (suggestive of either residual disease or post-conization artifacts). For statistical analysis, uncertain cases were conservatively considered positive for residual disease. Additionally, a secondary analysis was performed in which "uncertain" cases were classified as negative. Ultrasound results were compared with final histopathology, and diagnostic performance metrics with 95% confidence intervals were calculated.

A total of 166 patients were included (mean age, 44.4 ± 9.2 years). Residual tumor was found at final histology in 75 patients (45.2%), while 91 (54.8%) had no residual disease. The median tumor diameter at conization was 9.8 ± 6.2 mm, and the mean interval between conization and ultrasound was 61.2 ± 45.5 days. Ultrasound correctly identified residual tumor in 40/75 cases (53.3%), while false-positive findings occurred in 16/91 patients (17.6%). Uncertain ultrasound findings were reported in 43 cases (25.9%), of which 16 (37.2%) had residual disease at histology. Residual tumors were predominantly hypoechoic and showed moderate (45.0%) or rich (35.0%) vascularization on color Doppler imaging. Ultrasound demonstrated a sensitivity of 74.7% (95% confidence interval 64.8 to 84.5), specificity of 52.7% (95% confidence interval 42.5 to 63.0), and overall accuracy of 62.7% (95% confidence interval 53.1 to 72.2).

This study shows that ultrasound has sub-optimal performance in detecting residual tumor after conization for cervical cancer, indicating that optimal timing and accurate assessment of residual disease remain clinically relevant challenges.