Objective: To assess the value of delayed Gadolinium-enhanced magnetic resonance imaging (MRI) to standard T2-and diffusion-weighted (T2/diffusion-weighted) MRI for evaluating residual locoregional tumour in International Federation of Gynaecology and Obstetrics (FIGO) stage-2009 IB2-IIB cervical cancer treated with neoadjuvant chemotherapy.Methods: This retrospective study included patients diagnosed with FIGO-2009 stage IB2-IIB cervical cancer between 2016 and 2020, treated with neoadjuvant chemotherapy and radical hysterectomy with pelvic lymphadenectomy and staged with pelvic T2-, diffusion-weighted and delayed Gadolinium-enhanced MRI after neoadjuvant chemotherapy.Diagnostic accuracies of T2/diffusion-weighted MRI and delayed Gadolinium-enhanced MRI, assessed by a subspecialty-(reader 1) and general radiologist (reader 2), were compared for identification of residual tumour, parametrial, vaginal invasion and detection of lymph node metastases.Interobserver agreement was calculated.Additionally, Bland-Altman plots were used to compare the residual tumour size measured by T2/diffusion-weighted MRI and delayed Gadolinium-enhanced MRI.Histopathology after surgery was the standard reference.Results: Forty-two patients were eligible for study analysis.Delayed Gadolinium-enhanced (reader 1/reader2) enabled identification of all 4 complete responders, while T2/diffusionweighted MRI only identified 2. Delayed Gadolinium-enhanced MRI (reader 1/reader 2) significantly improved diagnostic accuracy for detecting lymph node metastases (84.5%/82.2%versus 72.6%/70.2%;p-value <0.0001) compared to T2/diffusion-weighted MRI.Addition of delayed Gadolinium-enhanced MRI improved accuracy for detecting parametrial invasion (97.6%/88.1% versus 85.7%/78.6%)and vaginal invasion (92.9%/88.1% versus 80.9%/76.2%;p-value =0.063).Delayed Gadolinium-enhanced MRI showed better interobserver agreement than T2/diffusion-weighted MRI for assessment of vaginal invasion ( = 0.86 versus 0.33), parametrial invasion ( = 0.63 versus 0.44), and nodal status ( = 0.90 versus 0.79). Conclusions: Addition of delayed Gadolinium-enhanced MRI substantially improvedpreoperative identification of extra-uterine primary tumour extent, significantly improved the detection of metastatic lymph nodes and allowed better assessment of residual tumour size over J o u r n a l P r e -p r o o f
Vandecaveye et al. (Sun,) studied this question.
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