Comparison of Preoperative Magnetic Resonance Imaging Results with Postoperative Pathologic Results PowerPoint Presentation

Comparison of Preoperative Magnetic Resonance Imaging Results with Postoperative Pathologic Results PowerPoint Presentation

2019-02-04 3K 3 0 0

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Zehra Nihal Dolgun, Ahmet Salih . Altintas. , . Cihan . Inan. , Petek . Balkanli. Trakya University. ,. Faculty. of . Medicine. ,. . Department of Obstetrics and Gynecology, . Edirne. . Uterine. c. ID: 749997

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Slide1

Comparison of Preoperative Magnetic Resonance Imaging Results with Postoperative Pathologic Results in Early Stage Uterine Cervical Cancer

Zehra Nihal Dolgun, Ahmet Salih

Altintas

,

Cihan

Inan

, Petek

Balkanli

Trakya University

,

Faculty

of

Medicine

,

Department of Obstetrics and Gynecology,

Edirne

Slide2

Uterine cervical

cancer is the second most common cancer in women after breast cancer. Despite routine follow-up protocols, it is still the most fatal gynecologic cancer worldwide.American Cancer

Society

: Cancer Facts & Figures. Atlanta, Georgia, 2014Pecorelli S. Int J Gynaecol Obstet, 2009

The International Federation of Gynecology and Obstetrics (FIGO) describes cervical cancer staging clinically. Although imaging modalities may apply for detection of pelvic wall and

parametrium

invasion, they do not change the clinical staging .

Slide3

FIGO

Cervical Cancer

Staging

Slide4

Preoperative evaluations should include the level of tumor extension towards external os, the prediction of tumor size and tumoral stromal invasion to plan the appropriate treatment

.Pecorelli S, et al. Int J Gynaecol

Obstet

, 2009Pelvic examination, cervical biopsy and optical imaging (colposcopy, cystoscopy, intravenous

pyelogram

or

proctoscopy

,

e.g

.)

are

generally

used

before

treatment

.

Slide5

There are some limitations in FIGO clinical staging. Parametrial or sidewall invasions, metastases to pelvic and

paraaortic lymph nodes can be difficult to determine accurately.Lee SI, et al. J Nucl

Med

, 2015 For this reason, some additional imaging modalities such as abdominal/pelvic computed tomography (CT), positron emission tomography (PET), pelvic magnetic resonance imaging (MRI) are used in preoperative period.

Slide6

Aim

To compare the preoperative MRI findings of early stage cervical cancer patients with their postoperative hystopathologic results.

Material

and MethodsThis is a retrospective study of 30 women who were diagnosed, operated

and

had

preoperative

MRI

examinations

in

our

institution

.

Slide7

Medical charts of the patients were examined. Demographic data,

clinical FIGO staging of tumors, MRI examination results and postoperative pathologic results were recorded.Material

and

MethodsMR images were analyzed for presence of cervical tumor, tumor stage, tumor size in three dimensions, invasion depth within cervix, the presence of parametrial and vaginal infiltration,

lymph

node

involvement

,

vesical

and

rectal

invasion

.

Slide8

Material and Methods

The correlation of preoperative clinical FIGO and MRI stagings with postoperative histological staging, preoperative MRI examination accordances with pathological results and preoperative–postoperative

histopatologic

consistencies were evaluated.

Slide9

Results

 Pathological

staging

(n)Clinically correct staging (n)Correct staging by MRI (n)1a212

1b1

9

6

6

1b2

3

0

1

2a

5

0

4

2b

11

0

7

TOTAL

30

7

20

Correct

staging

of MRI

and

clinical

evaluation

according

to

pathological

staging

Slide10

Results

 

 

Histopathological

StagingTOTAL  1a

1b1

1b2

2a

2b

 

Clinically

FIGO

Staging

(n)

1a

1

3

0

0

0

4

1b1

1

6

335

18

1b2

0061072a0000002b000101 MRI Staging (n)1a2200041b10610291b20010122a0114172b000178 TOTAL29351130

Comparison

of

different

stagings

Slide11

Results

MRI Stages

Sensitivity

Specificity

PPVNPV1a10.930.50

0.92

1b1

0.66

0.84

0.33

0.87

1b2

0.33

0.96

0.50

0.93

2a

0.96

0.89

0.57

0.95

2b

0.63

0.95

0.870.85

Staging

accuracy of Magnetic resonance imaging

Slide12

Results

Tumor size <4cm

17

patients

MRI 8 patients Tumor size ≥ 4cm 13 patients

MRI 9

patients

MRI

sensitivity

in

correct

tumor

size

detection

0.68

Slide13

Results

 

MRI

Pathology  Tumoral characteristicsPresent on MRI

Present

in MRI

and

Pathology

Present

Absent

 

Cervical

ring

invasion

(n)

17

13

20

10

Parametrium invasion (n)87

11

19

Pelvic lymph node invasion (n)33921 Paraaortic lymph node invasion (n)00030Magnetic resonance imaging and pathology findings of tumor invasion

Slide14

Conclusions

MRI staged 20 out of 30 patients (66.6%) correctly Only 7

patients

(23.3%)

were staged correctly with clinical examination. MRI overstaged 10% and understaged 23% of the cases.MRI staging is superior

to

clinical

staging

even

in

early

stages

of

cervical

cancer

.

Slide15

Thank

you…


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