Diagnostic value of routine endoscopic studies in staging locally advanced cervical cancer: a multicenter experience from a low and middle-income country

To evaluate the diagnostic value of routine cystoscopy and rectosigmoidoscopy in staging locally advanced cervical cancer (LACC) in a low - middle - income country (LMIC) setting.

A multicenter, retrospective cohort study of 233 patients with LACC (International Federation of Gynecology and Obstetrics 2018 stages IB3-IVB) in Venezuela. All patients underwent clinical examination, magnetic resonance imaging (MRI) and routine endoscopy. The primary outcome was the confirmation of mucosal invasion by endoscopy in patients without prior clinical or radiological suspicion.

Endoscopically confirmed bladder and rectal mucosal invasion occurred in 6.0% and 3.0% of patients, respectively. In 95% of all positive cases, suspicion was already present on MRI or clinical symptoms. MRI demonstrated high negative predictive values for bladder (95.9%, confidence interval (CI) 95% 92.5-98.1) and rectal (97.4% CI 95% 92.2-97.8) invasion. Notably, no treatment plan was modified solely based on endoscopic findings. Routine endoscopy was negative in 94% of cystoscopies and 97% of rectosigmoidoscopies.

Routine endoscopic staging in LACC showed a very low diagnostic yield and no impact on therapeutic decisions in this LMIC setting. A selective, imaging-guided approach is safe, resource-efficient and aligns with international guidelines, advocating for a change in local protocols. These findings strongly support discontinuing routine endoscopy in LMIC staging protocols.