Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability

Hedvig Hricak, Constantine Gatsonis, Fergus Coakley, Bradley Snyder, Caroline Reinhold, Lawrence H. Schwartz, Paula J. Woodward, Harpreet K. Pannu, Marco Amendola, Donald G. Mitchell

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Abstract

Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage ≥ IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P ≤ .05 considered to indicate a significant difference). Descriptive statistics for staging and κ statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard. Results: For CT and MR imaging, respectively, multirater κ values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (≥IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P <.001) and detection of parametrial invasion (P = .047). Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.

Original languageEnglish (US)
Pages (from-to)491-498
Number of pages8
JournalRadiology
Volume245
Issue number2
DOIs
StatePublished - Nov 2007
Externally publishedYes

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Observer Variation
Uterine Cervical Neoplasms
Tomography
Magnetic Resonance Imaging
Neoplasms
Health Insurance Portability and Accountability Act
Research Ethics Committees
Informed Consent
Radiology
ROC Curve
Magnetic Resonance Spectroscopy
Biopsy

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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Early invasive cervical cancer : CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability. / Hricak, Hedvig; Gatsonis, Constantine; Coakley, Fergus; Snyder, Bradley; Reinhold, Caroline; Schwartz, Lawrence H.; Woodward, Paula J.; Pannu, Harpreet K.; Amendola, Marco; Mitchell, Donald G.

In: Radiology, Vol. 245, No. 2, 11.2007, p. 491-498.

Research output: Contribution to journalArticle

Hricak, H, Gatsonis, C, Coakley, F, Snyder, B, Reinhold, C, Schwartz, LH, Woodward, PJ, Pannu, HK, Amendola, M & Mitchell, DG 2007, 'Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability', Radiology, vol. 245, no. 2, pp. 491-498. https://doi.org/10.1148/radiol.2452061983
Hricak, Hedvig ; Gatsonis, Constantine ; Coakley, Fergus ; Snyder, Bradley ; Reinhold, Caroline ; Schwartz, Lawrence H. ; Woodward, Paula J. ; Pannu, Harpreet K. ; Amendola, Marco ; Mitchell, Donald G. / Early invasive cervical cancer : CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability. In: Radiology. 2007 ; Vol. 245, No. 2. pp. 491-498.
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abstract = "Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage ≥ IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P ≤ .05 considered to indicate a significant difference). Descriptive statistics for staging and κ statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard. Results: For CT and MR imaging, respectively, multirater κ values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (≥IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P <.001) and detection of parametrial invasion (P = .047). Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.",
author = "Hedvig Hricak and Constantine Gatsonis and Fergus Coakley and Bradley Snyder and Caroline Reinhold and Schwartz, {Lawrence H.} and Woodward, {Paula J.} and Pannu, {Harpreet K.} and Marco Amendola and Mitchell, {Donald G.}",
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T2 - CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability

AU - Hricak, Hedvig

AU - Gatsonis, Constantine

AU - Coakley, Fergus

AU - Snyder, Bradley

AU - Reinhold, Caroline

AU - Schwartz, Lawrence H.

AU - Woodward, Paula J.

AU - Pannu, Harpreet K.

AU - Amendola, Marco

AU - Mitchell, Donald G.

PY - 2007/11

Y1 - 2007/11

N2 - Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage ≥ IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P ≤ .05 considered to indicate a significant difference). Descriptive statistics for staging and κ statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard. Results: For CT and MR imaging, respectively, multirater κ values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (≥IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P <.001) and detection of parametrial invasion (P = .047). Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.

AB - Purpose: To retrospectively compare diagnostic performance and interobserver variability for computed tomography (CT) and magnetic resonance (MR) imaging in the pretreatment evaluation of early invasive cervical cancer, with surgical pathologic findings as the reference standard. Materials and Methods: This HIPAA-compliant study had institutional review board approval and informed consent for evaluation of preoperative CT (n = 146) and/or MR imaging (n = 152) studies in 156 women (median age, 43 years; range, 22-81 years) from a previous prospective multicenter American College of Radiology Imaging Network and Gynecologic Oncology Group study of 172 women with biopsy-proved cervical cancer (clinical stage ≥ IB). Four radiologists (experience, 7-15 years) interpreted the CT scans, and four radiologists (experience, 12-20 years) interpreted the MR studies retrospectively. Tumor visualization and detection of parametrial invasion were assessed with receiver operating characteristic curves (with P ≤ .05 considered to indicate a significant difference). Descriptive statistics for staging and κ statistics for reader agreement were calculated. Surgical pathologic findings were the reference standard. Results: For CT and MR imaging, respectively, multirater κ values were 0.26 and 0.44 for staging, 0.16 and 0.32 for tumor visualization, and -0.04 and 0.11 for detection of parametrial invasion; for advanced stage cancer (≥IIB), sensitivities were 0.14-0.38 and 0.40-0.57, positive predictive values (PPVs) were 0.38-1.00 and 0.32-0.39, specificities were 0.84-1.00 and 0.77-0.80, and negative predictive values (NPVs) were 0.81-0.84 and 0.83-0.87. MR imaging was significantly better than CT for tumor visualization (P <.001) and detection of parametrial invasion (P = .047). Conclusion: Reader agreement was higher for MR imaging than for CT but was low for both. MR imaging was significantly better than CT for tumor visualization and detection of parametrial invasion. The modalities were similar for staging, sharing low sensitivity and PPV but relatively high NPV and specificity.

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