Differential diagnostic performance of magnetic resonance imaging in the detection of lymph node metastases according to the tumor size in early-stage cervical cancer patients

Objectives: The objective of this study was to evaluate the diagnostic performance in managing early-stage cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO) stage or tumor size. Methods/Materials: We performed a retrospective review of patients with FIGO stages IB1 to IIA cervical carcinoma who underwent magnetic resonance imaging (MRI) before lymphadenectomy. Lymphadenectomy involved all visible lymph nodes in the surgical fields. We compared the accuracy of MRI for detecting metastatic lymph nodes in the FIGO IB and IIA groups and in the nonbulky (≤4 cm) and bulky (>4) tumor groups. x² analysis was used to compare the accuracy of MRI for detecting metastatic lymph nodes. P ≤ 0.05 was considered statistically significant. Results: Three hundred five patients were included. Lymph node metastases were present in 49 (16.1%) of these patients. The sensitivity, specificity, and positive and negative predictive values were 7%, 99.3%, 31.3%, and 95.8% in the nonbulky tumor group and 43.8%, 97.1%, 70%, and 91.8% in the bulky tumor group (P = 0.001, P = 0.0097, P = 0.0479, and P = 0.0142, respectively). Conclusions: For predicting lymph node metastasis with MRI in early-stage cervical cancer patients, MRI showed a higher diagnostic performance in the bulky tumor group compared with that in the nonbulky tumor group and had a low value in the nonbulky tumor group, even when accounting for FIGO stage.