REVIEW OF MAGNETIC RESONANCE IMAGING FOR STAGING EVALUATION OF CARCINOMA CERVIX

Introduction:Cervical carcinoma is one of the most common cancer in women worldwide. Cervical carcinoma most often affects women between 45 to 55 years of age. Squamous cell carcinoma comprises approximately 69% of all cervical carcinomas. It is clinically staged using International Federation of Gynaecology and Obstetrics (FIGO) classication system, which is based on ndings at clinical examination and radiological examination.Without cross-sectional imaging, there is poor evaluation of nodal metastasis and parametrial invasion. MRI helps in assessing these features and hence MRI is now widely accepted as optimal for staging evaluation as well as selection of therapeutic strategy. The aim of the study is to determine the efciency of MRI in staging of cervical carcinoma and to compare MRI staging of cervical carcinoma with FIGO clinical staging. Materials and methods: All such patients with biopsy proven cervical carcinoma referred to the department of Radio diagnosis, GSL Medical College & Hospital were subjected for the study. Upon investigations with MRI Pelvis , a multi-planar, multi-sequence images with slice thickness of 5 mm were acquired.MRI interpretation of tumour size, signal intensity, vaginal invasion, parametrial invasion, pelvic wall invasion, bladder and rectum invasion, lymph node status will be done. Then the MRI staging was correlated with the FIGO clinical staging. All statistical analysis was performed by SPSS software version 20.0, MEDCALC software and MS EXCEL-2007.For all statistical analysis p<0.05 was considered as statistically signicant. Results: In FIGO staging, the maximum number of patients belonged to Stage IIB followed by stage IIIB. On MRI staging IIIC1 and IIB are the most common presentation. On correlation of staging from FIGO clinical stage with MRI staging, only 32% patients had same stage with 51% patients upstaged after MRI evaluation. It can also be observed that approximately 17% of patients had at least 1 node with 56.6% had no nodes at all on MRI evaluation. On multivariate analysis of various parameters, it was found that MRI tumor size showed strong association with the MRI staging (P value, <0.0001), FIGO staging (P value, 0.002), no. of nodes (P value, 0.002), and parametrial invasion (P value, 0.003). Conclusion: There is change of FIGO clinical stage in signicant number of patients on MRI evaluation. Most of our patients diagnosed are at the higher stages of the disease and so, assessing the above mentioned parameters are of utmost importance as it may change the clinical course as well as prognosis of such patients. Hence we conclude that MRI evaluation must be a part of imaging work up in cervical carcinoma patients