cancers
Article
Utility of 3T MRI in Women with IB1 Cervical Cancer in
Determining the Necessity of Less Invasive Surgery
Soo Young Jeong 1 , Byung Kwan Park 2, * , Chel Hun Choi 3, *, Yoo-Young Lee 3 , Tae-Joong Kim 3 ,
Jeong-Won Lee 3 and Byoungi-Gie Kim 3
1
2
3
*
Hallym University Medical Center, Department of Obstetrics & Gynecology, Kangnam Sacred-Heart Hospital,
Hallym University College of Medicine, Seoul 07441, Korea; ohora_87@naver.com
Samsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine,
Seoul 06351, Korea
Samsung Medical Center, Department of Obstetrics & Gynecology, School of Medicine,
Sungkyunkwan University, Seoul 06351, Korea; yyl.lee@samsung.com (Y.-Y.L.);
tj28.kim@samsung.com (T.-J.K.); garden.lee@samsung.com (J.-W.L.); bksong.kim@samsung.com (B.-G.K.)
Correspondence: rapark@skku.edu (B.K.P.); chelhun.choi@samsung.com (C.H.C.);
Tel.: +82-2-3410-6457 (B.K.P.); +82-2-3410-5151 (C.H.C.)
Simple Summary: 3T MRI can estimate more precisely the tumor volume of early cervical cancer
than physical examination. Women with IB1 cervical cancer, which is invisible on 3T MRI, have
no parametrial invasion so that parametrectomy can be skipped or minimized. Vagina invasion or
lymph node metastasis is rare in these women so that vaginectomy or lymph node dissection can be
performed less aggressively. Therefore, less invasive surgery can be one of the treatment options if
IB1 cervical cancer is invisible on 3T MRI.
Citation: Jeong, S.Y.; Park, B.K.;
Choi, C.H.; Lee, Y.-Y.; Kim, T.-J.;
Lee, J.-W.; Kim, B.-G. Utility of 3T
MRI in Women with IB1 Cervical
Cancer in Determining the Necessity
of Less Invasive Surgery. Cancers
2022, 14, 224. https://doi.org/
10.3390/cancers14010224
Academic Editor: Daniela
M. Dinulescu
Received: 23 November 2021
Accepted: 17 December 2021
Published: 4 January 2022
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
Abstract: Purpose: Cervical cancer that is invisible on magnetic resonance imaging (MRI) may
suggest lower tumor burden than physical examination. Recently, 3 tesla (3T) MRI has been widely
used prior to surgery because of its higher resolution than 1.5T MRI. The aim was to retrospectively
evaluate the utility of 3T MRI in women with early cervical cancer in determining the necessity of
less invasive surgery. Materials and methods: Between January 2010 and December 2015, a total of
342 women with FIGO stage IB1 cervical cancer underwent 3T MRI prior to radical hysterectomy,
vaginectomy, and lymph node dissection. These patients were classified into cancer-invisible (n = 105)
and cancer-visible (n = 237) groups based on the 3T MRI findings. These groups were compared
regarding pathologic parameters and long-term survival rates. Results: The cancer sizes of the cancerinvisible versus cancer-visible groups were 11.5 ± 12.2 mm versus 30.1 ± 16.2 mm, respectively
(p < 0.001). The depths of stromal invasion in these groups were 20.5 ± 23.6% versus 63.5 ± 31.2%,
respectively (p < 0.001). Parametrial invasion was 0% (0/105) in the cancer-invisible group and
21.5% (51/237) in the cancer-visible group (odds ratio = 58.3, p < 0.001). Lymph node metastasis
and lymphovascular space invasion were 5.9% (6/105) versus 26.6% (63/237) (5.8, p < 0.001) and
11.7% (12/105) versus 40.1% (95/237) (5.1, p < 0.001), respectively. Recurrence-free and overall 5-year
survival rates were 99.0% (104/105) versus 76.8% (182/237) (p < 0.001) and 98.1% (103/105) versus
87.8% (208/237) (p = 0.003), respectively. Conclusions: 3T MRI can play a great role in determining
the necessity of parametrectomy in women with IB1 cervical cancer. Therefore, invisible cervical
cancer on 3T MRI will be a good indicator for less invasive surgery.
Keywords: high tesla magnetic resonance imaging; early cervical cancer; less invasive surgery
Copyright: © 2022 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
1. Introduction
conditions of the Creative Commons
Radical hysterectomy, vaginectomy, and lymph node (LN) dissection have been considered as the standard treatment in treating International Federation of Gynecology and
Obstetrics (FIGO) stage IB1 cervical carcinoma. Many investigations have demonstrated
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Cancers 2022, 14, 224. https://doi.org/10.3390/cancers14010224
https://www.mdpi.com/journal/cancers
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that these surgical procedures provide good long-term survival rates in women with this
early cervical cancer [1–4].
However, these surgical procedures also may induce various complications. Bladder
anatomy is gradually deformed, and the bladder function becomes poor because radical
hysterectomy is associated with parametrectomy, leading to autonomic nerve injury [2–4].
Furthermore, this nerve injury may cause anorectal motility disorder and sexual dissatisfaction [5–7]. If the vaginectomy becomes excessive, women with early cervical cancer cannot
feel sexual satisfaction postoperatively. Lymph node dissection may lead to lymphedema
in women with IB1 cervical cancer [8–10]. Higher availability of screening examination
helps to detect early cervical cancer in relatively young women. Subsequently, they have to
face the poor quality of life resulting from life-long postoperative morbidities.
Magnetic resonance imaging (MRI) is more precise in estimating tumor volume than
is physical examination because MRI enables accurate measurement of three-dimensional
tumor axes [11–13]. Only a few investigations have reported on the usefulness of such
MRI findings, showing that early cervical or endometrial cancer can be treated with less
invasive surgery if the tumor is invisible on MRI [14–16]. However, these studies did not
deal with the role of 3 tesla (3T) MRI in evaluating early cervical cancer. 3T MRI provides
a higher image resolution or shorter scan time compared to 1.5T MRI [17–19]. Therefore,
we hypothesized that 3T MRI can provide useful imaging findings to determine whether
less invasive surgery is necessary.
The aim of this study was to retrospectively evaluate the utility of 3T MRI in women
with early cervical cancer in determining the necessity of less invasive surgery.
2. Materials and Methods
This study (File No.: 2018-06-114) was approved by our institutional review board in
Samsung Medical Center and informed consent was waived due to the retrospective design.
2.1. Patients
Between January 2010 and December 2015, a total of 427 patients with FIGO IB1
cervical cancer underwent MRI prior to radical hysterectomy (Figure 1). Among them,
85 patients were excluded due to MRI examinations that were scanned using a 1.5T scanner
or were done in a local hospital. Finally, 342 patients were included in the study population
when they underwent 3.0T MRI at a single institute. Of them, 105 women (cancer-invisible
group) had a cancer that was invisible on MRI. The remaining 237 women (cancer-visible
group) had a cancer that was visible on MR images. The medical records of the cancerinvisible group (age range, 27–81 years; mean ± standard deviation, 48.1 ± 11.4 years) and
cancer-visible group (25–81 years; 50.1 ± 11.5 years) were reviewed. Colposcopic biopsy
and conization were performed in 70.8% (242/342) and 29.2% (100/342), respectively.
Figure 1. Flow diagram of selecting the study population.
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Bimanual pelvic and rectovaginal examinations were done to identify the disease
extent. Laboratory tests, chest radiography, cystoscopy, and sigmoidoscopy were routinely
performed for the clinical FIGO staging [1]. The time interval between MRI and hysterectomy ranged from 1 to 115 days (15.4 ± 12.8 days) in the cancer-invisible group and from
0 to 79 days (14.3 ± 9.3 days) in the cancer-visible group.
The MR images were preoperatively interpreted by one of two radiologists who
had approximately 5 years of experience in gynecologic imaging and were additionally
reviewed by one radiologist who had approximately 19 years of experience in gynecologic
imaging. The MRI diagnoses of only three cases were changed from the cancer-invisible
group to cancer-visible group.
Radical hysterectomy, vaginectomy, and LN dissection were performed in all women.
Additional surgical procedures depended on the clinical stage and the surgeons’ decision.
When pelvic lymph nodes were suspicious for metastasis at frozen sectioning, para-aortic
LNs were dissected.
Two pathologists examined radical hysterectomy, vaginectomy, and LN specimens.
They recorded the size of the cervical cancer, histologic type, depth of stromal invasion,
lymphovascular space (LVS) invasion, parametrial invasion, vaginal invasion, resection
tumor margin, and LN metastasis.
After primary treatment, all patients received adequate follow-up procedures. During
this period, patients underwent physical examination, Pap smear, and tumor marker every
3 months for the first 2 years, and every 6 months for the next 3 years. Imaging studies,
such as abdomiopelvic CT or pelvis MRI, were conducted every 6–12 months for the first
2 years and then annually for the next 3 years.
2.2. MR Imaging
The pelvis was scanned with a 3T MRI scanner (Intera Achiva 3T; Philips Medical
System, Best, The Netherlands). The upper abdomen was scanned with a 3T MRI or CT.
MRI sequences of the pelvis included T2-weighted images, T1-weighted images, diffusionweighted images, and dynamic contrast-enhanced images. T2-weighted images were
obtained into axial, sagittal, and coronal planes. The other sequences were obtained in
the axial planes. The upper abdomen was scanned from lower lung to aortic bifurcation.
T2-weighted and T1-weighted axial images were obtained using a fast spin echo sequence.
We used the same MR parameters as those that Park et al. used [2].
2.3. Data Analysis
Invisible cancer was defined when the cervical tumor was not seen on either the
T2-weighted images, diffusion-weighted images, or contrast-enhanced T1-weighted images
(Figure 2) [3]. Visible cancer was defined when the cervical cancer is hyperintense on T2weighted images and hyperintense on diffusion-weighted images, hypointense on apparent
diffusion coefficient map images, and poorly enhanced on contrast-enhanced T1-weighted
images, as compared to neighboring cervical tissue (Figure 3) [3]. Post-biopsy inflammation
was differentiated from cervical cancer with the following findings: it was hyperintense on
T2-weighted images. However, it had no diffusion restriction and showed iso- or higher
enhancement compared to neighboring cervical tissue on post-contrast MR images [3].
Cancer-invisible and cancer-visible groups were compared regarding patient age,
biopsy type, histologic type, and squamous cell carcinoma (SCC) antigen. These groups
were also compared in terms of residual tumor size, depth of stromal invasion, LVS invasion,
parametrial invasion, vaginal invasion, and LN metastasis. Post-biopsy tumor sizes on MR
images were correlated with those on radical hysterectomy.
Recurrent tumor was assessed on the follow-up CT or MR images. Recurrence-free
and overall 5-year survival rates were calculated. Cancer-invisible and cancer-visible
groups were compared regarding the recurrent rate and recurrence-free or overall 5-year
survival rate.
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Figure 2. A 41-year-old woman with invisible IB1 cervical cancer on 3T MRI. (A,B). T2-weighted and
delayed contrast-enhanced sagittal MR images do not show residual cancer but a conization defect
(white arrow). The radical hysterectomy specimen demonstrated a 2.0 mm residual SCC and 22.2%
invasion depth. There was no invasion or metastasis into the parametrium, vagina, LVS, and LN.
(C,D). The diffusion-weighted axial MR image shows a hyperintense cervix (black arrow). However,
it does not show a low ADC value (black arrow) on the apparent diffusion coefficient map image.
Therefore, cervical cancer is not visible on the MR images.
Figure 3. A 40-year-old woman with visible IB1 cervical cancer on 3T MRI. (A,B). T2-weighted sagittal
MR image following colposcopic biopsy show a slightly hyperintense cervical cancer. This tumor
shows poor enhancement on delayed contrast-enhanced sagittal MR image. (C,D). The diffusionweighted axial MR image shows a hyperintense cervical mass (white arrow), suggesting strong
diffusion restriction. The tumor (white arrow) is hypointense on an apparent diffusion coefficient
axial MR image. The radical hysterectomy specimen showed a 20 mm residual cancer (Glassy cell
carcinoma) and 40.0% invasion depth. Four metastatic lymph nodes were detected even though there
was no invasion into the parametrium, vagina, and LVS.
2.4. Statistical Analysis
Patient age, tumor size, SCC antigen, and invasion depth were compared with a
Mann–Whitney test because these data had a non-Gaussian distribution.
Proportions of biopsy types, cancer histology, LVS invasion, parametrial invasion,
vaginal invasion, LN metastasis, and recurrent rate were compared with Fisher’s exact test.
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Odds ratios and 95% confidence intervals were calculated using the approximation of
Woolf. When a value was zero, 0.5 was added to each to make the calculation possible.
Recurrence-free and overall 5-year survival rates were compared with Kaplan–Meier
survival curves.
Commercially available software SPSS 24.0 for Windows (SPSS Inc., Chicago, IL, USA)
was used for statistical analyses. A p-value of <0.05 was considered statistically significant.
3. Results
The cancer-invisible group underwent conization in 59.0% (62/105) and coloposcopic
biopsy in 41.0% (43/105), while the cancer-visible group did conization in 16.0% (38/237)
and colposcopic biopsy in 84.0% (199/237), respectively (p < 0.001) (Table 1). There
was a significant difference between the groups in terms of histologic types (p = 0.046).
The cancer-invisible group had a lower proportion of SCC (p = 0.039) and a higher proportion of adenocarcinoma than the cancer-visible group (p = 0.015) (Table 1). The cancerinvisible group had a higher level of SCC antigen than the cancer-visible group.
Table 1. Comparison of patient demographics between the groups.
Demographics
Age (years)
Conization
Colposcopic biopsy
SCC
Adenocarcinoma
Other cancers
SCC antigen (ng/mL)
Patients (n = 342) with FIGO Stage IB1 Cervical Cancer: Cancer Visibility on 3T MRI
Cancer-Invisible Group (n = 105)
Cancer-Visible Group (n = 237)
48.1 ± 11.4 (27–81)
62 (59.0%)
43 (41.0%)
58 (55.2%)
40 (38.1%)
7 (6.7%)
1.4 ± 3.0 (0.2–21.4)
50.1 ± 11.0 (25–81)
38 (16.0%)
199 (84.0%)
159 (67.1%)
59 (24.9%)
19 (8.0%)
4.6 ± 12.2 (0.1–91.7)
Note—SCC, squamous cell carcinoma.
deviation (range).
p Value
0.073
<0.001
<0.001
0.039
0.015
0.326
<0.001
Age and SCC antigen are shown as the median ± standard
The median residual tumor size was 11.5 mm (0–55.0 mm) in the cancer-invisible group
and 30.1 mm (0–95.0 mm) in the cancer-visible group (p < 0.001) (Table 2). The median
depth of stromal invasion was 20.5% (0–100%) in the cancer-invisible group and 63.5%
(0–100%) in the cancer-visible group (p < 0.001). Residual tumors of these groups were
detected in 67.6% (71/105) and in 97.0% (230/237) (p < 0.001), respectively. Accordingly,
the cancer-invisible group had no residual tumor more frequently than the cancer-visible
group (p < 0.001). Parametrial invasion in the cancer-invisible and cancer-visible groups
was detected in 0% (0/105) and 21.5% (51/237), respectively (p < 0.001). LVS invasion was
11.7% (12/105) in the cancer-invisible group and 40.1% (95/237) in the cancer-visible group,
respectively (p < 0.001). LN metastasis of these groups was detected in 5.9% (6/105) and
26.6% (63/237), respectively (p < 0.001). However, vaginal invasion of these groups was
detected in 1.9% (2/105) and 5.5% (13/237), respectively (p = 0.163).
The tumor recurrent rate was 1.0% (1/105) in the cancer-invisible group and 23.2%
(55/237) in the cancer-visible group on follow-up CT or MR images (p < 0.001). The
recurrence-free survival rates of the cancer-invisible and cancer-visible groups were 99.0%
(104/105) and 76.8% (182/237) (p < 0.001), respectively (Figure 4A). The overall 5-year
survival rates of these groups were 98.1% (103/105) and 87.8% (208/237) (p = 0.003),
respectively (Figure 4B).
Among the post-hysterectomy histologic findings, parametrial invasion provided
the highest odds ratio, 53.8 in the cancer-visible group versus the cancer-invisible group
(Table 3). The other odds ratios were 31.4, 15.7, 5.8, 5.1, and 0.3 regarding recurrent tumor,
residual tumor, LN metastasis, LVS invasion, and vaginal invasion, respectively.
–
–
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–
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Table 2. Comparison of post-hysterectomy findings between the groups.
Histologic Findings
Patients (n = 342) with FIGO Stage IB1 Cervical Cancer: Cancer Visibility on 3T MRI
Tumor size (mm)
Invasion depth (%)
Residual tumor
LVS invasion
Parametrial invasion
Vaginal invasion
LN metastasis
Cancer-Invisible Group (n = 105)
—
11.5 ± 12.2 (0–55.0)
20.5 ± 23.6 (0–100)
71 (67.6%)
12 (11.7%)
0 (0.0%)
2 (1.9%)
6 (5.9%)
Cancer-Visible Group (n = 237)
30.1 ± 16.2 (0–95.0)
63.5 ± 31.2 (0–100)
230 (97.0%)
95 (40.1%)
51 (21.5%)
13 (5.5%)
63 (26.6%)
p Value
<0.001
<0.001
<0.001
<0.001
<0.001
0.163
<0.001
Note—LN, lymph node; LVS, lymphovascular space. Tumor size and invasion depth are shown as the median ±
standard deviation (range).
–
Figure 4. Kaplan–Meier survival curves in patients with IB1 cervical cancer. (A) The cancerinvisible group (green line) achieves a higher recurrence-free 5-year survival rate (99.0% versus
76.8%) than the cancer-visible group (blue line) (p < 0.001). (B) The cancer-invisible group (green
line) achieves a higher overall 5-year survival rate (98.1% versus 87.8%) than the cancer-visible group
(blue line) (p = 0.003).
Table 3. Odd ratios of the post-hysterectomy and imaging findings.
Histologic and Imaging Findings
Parametrial invasion
Recurrent tumor
Residual tumor
LN metastasis
LVS invasion
Vaginal invasion
Cancer-Visible Group versus Cancer-Invisible Group
Odds Ratio
95% Confidence Interval
58.3
31.4
15.7
5.8
5.1
0.3
3.6–956.5
4.3–230.5
6.7–37.0
2.4–13.9
2.6–9.8
0.07–1.51
p Value
<0.001
<0.001
<0.001
<0.001
<0.001
0.163
Note—LN, lymph node; LVS, lymphovascular space.
4. Discussion
Our study showed that the cancer-invisible group had no parametrial invasion postoperatively. Furthermore, the residual tumor and invasion depth were much smaller
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than those in the cancer-visible group. The incidences of LN metastasis and LVS invasion
were also much lower than those in the cancer-invisible group. Subsequently, the cancerinvisible group had a much higher long-term recurrence-free or overall survival rate than
the cancer-visible group.
Parametrectomy is performed for radical hysterectomy in women with early cervical
cancer to reduce recurrent cervical cancer [4–7]. However, several investigations have
reported that a small tumor size, small depth of invasion, or no LVS invasion are good
prognostic factors for no parametrial involvement [8–13]. The risk factor that they predict
parametrial invasion most commonly is the tumor size [8–13]. If it is 2 cm or less, parametrial invasion is rare so that less invasive surgery is recommended in this small cervical
cancer [8–11,13]. Therefore, parametrectomy appears aggressive in these clinical settings.
From this point of view, invisible cancer on 3T MRI can be a much stronger indicator
than small tumor size. Our study showed that parametrial invasion was postoperatively
absent in the cancer-invisible group. Moreover, the odds ratio of this histologic finding was
much higher compared to those of the other histologic findings. Accordingly, invisible cancer on 3T MRI can strongly suggest no sign of parametrial invasion [3]. Park et al. also have
reported that there was no parametrial invasion in patients with 1B1 cervical cancer that
was invisible on 1.5T or 3T MRI [2]. However, the number of patients undergoing 3T MRI
was small in their study. Kamimori and Yamajaki et al. also have reported that parametrial invasion is rare in small cervical cancer preoperatively measured on preoperative
MRI [12,13]. They did not state whether their MRI scanner is 1.5T or 3T.
The other prognostic factors are still difficult to precisely identify with preoperative
MRI. LN metastasis was most commonly assessed with MRI. Previously reported papers
have showed that MRI sensitivity for detecting LN metastasis was only 30–73% [14–17].
They used the lymph node size in order to determine if there was metastasis. Diffusionweighted MRI improves the diagnostic accuracy, but the sensitivity and specificity were
86% and 84%, respectively [18]. Our study also showed that if IB1 cancer was invisible on
3T MRI, then the incidence of LN metastasis was much smaller than that in their study [18]
with diffusion-weighted imaging. However, further investigation is necessary to determine
if LN dissection can be skipped in invisible IB1 cervical cancer. The incidence of LN
metastasis was slightly higher in the cancer-invisible group compared to that in the Park
et al. investigation [2]. LVS invasion or depth of stromal invasion is still impossible to detect
with preoperative MRI. After all, assessing tumor depiction on 3T MRI is a good prognostic
factor for predicting parametrial invasion in patients with 1B1 cervical cancer. Ultrahighfield MRI at 7T or higher will be introduced in the near future and these prognostic factors
can then be assessed more precisely [19,20].
Parametrectomy may injure the ureter or nerve in the parametrium [5–7,21]. Ureter
injury manifests postoperatively in urine leakage or ureter obstruction [21]. This complication needs interventional or surgical procedures. Furthermore, many bundles of
autonomic nerves are interrupted by parametrectomy so that autonomic function of the
bladder, vagina, or rectum can be impaired. Subsequently, follow-up CT and MRI can
show gradual deformity of the urinary bladder, such as a thick wall, coarse trabeculation,
residual urine, or over-distended bladder [5–7]. Neurogenic bladder is not uncommon
after radical hysterectomy, as many patients undergo urinary frequency changes, recurrent
cystitis, or self-catheterization. The autonomic nerve injury may also induce sexual or
anorectal dysfunction [22–24]. Therefore, parametrectomy should be avoided in patients
who do not have parametrial invasion.
The incidence of invisible 1B1 cancer on MRI is not well-known. Park et al. have
reported that it accounts for 24.9% (86/346) among the IB1 cervical cancers [2]. Our study
showed that it slightly increased to 30.7% (105/342). More available screening tests and
MRI examinations may increase the early detection of IB1 cervical cancer [3]. Besides,
the ongoing development of MRI techniques will provide more precise information on
cancer detection. Importantly, most of those patients have early stage disease. As a
result, parametrectomy can be skipped in a larger number of patients with 1B1 cervical
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cancer. The incidence of postoperative complications will be reduced with less invasive
surgery. Nevertheless, gadolinium has been found to cross the placenta and to stimulate
malformations in animal models [25]. Hence, its use during pregnancy is contraindicated
in the first trimester of pregnancy in patients with cervical cancer and improved MRI
techniques are warranted [26].
Compared to the results of Park et al.’s study, the incidences of residual tumor, vaginal
invasion, lymph node metastasis, and lymphovascular space invasion were slightly higher
in our study. Our study showed that the proportion (38.1%) of adenocarcinoma was
relatively higher compared to that (29.1%) in their study. Thus, we think that increasing
the proportion of non-SCC cervical cancer might influence the incidence differences of
other pathologic findings. An invisible tumor on 3T MRI does not contribute to skipping
vaginectomy and lymph node dissection in patients with 1B1 non-SCC cervical cancer.
Further investigations are necessary to compare SCC and non-SCC in terms of MRI findings
or clinical outcomes.
This study has some limitations. First, it was conducted using a retrospective design.
The likelihood for selection bias cannot be excluded. This limitation may influence the
histologic type of cervical cancers. Second, baseline characteristics were not matched with
propensity scores between the groups. Third, the incidence of non-squamous cell cancers
was relatively higher than that of previously published studies. This finding might result
from selection bias in that many squamous cell carcinomas unfit given the inclusion criteria
were excluded. These cancers showed poor behavior compared to SCC. This finding might
influence the residual tumor, vaginal invasion, LVS invasion, or LN metastasis. Fourth,
post-operative complications were not qualitatively or quantitatively assessed to compare
between the groups. We relied on follow-up CT or MRI findings to detect anatomical
changes. However, this assessment is not sufficient to precisely identify functional changes.
Fifth, our scanners were the initial version of 3T MRI. Currently these scanners are replaced
with upgraded 3T MRI. Furthermore, non-SCC cervical cancer had a greater number of
residual tumors than SCC cervical cancer. These factors may result in discordant findings
between 3T MRI and pathologic examination in terms of residual tumors. Advanced
ultrasonography with 3D and color Doppler display as well as transvaginal elastography
also may be useful to evaluate early cervical cancer [27].
5. Conclusions
3T MRI can be a useful application to guide surgical interventions in patients with
IB1 cervical cancer. If a cervical cancer is not depicted on 3T MRI, gynecologists can skip
parametrectomy or remove as little as possible of the parametrial tissue. Subsequently, postoperative complications, such as bladder dysfunction, sexual dissatisfaction, or anorectal
dysfunction, will be reduced in patients with invisible IB1 on 3T MRI. However, invisible
cancer on 3T MRI cannot completely exclude the likelihood of vaginal invasion or LN
metastasis, even if the incidences are much lower than those in patients with visible IB1
cervical cancer on MRI. Future introduction of higher than 3T MRI will contribute to better
determining if less invasive surgery is necessary.
Author Contributions: Conceptualization, all authors; methodology, all authors; software, S.Y.J. and
B.K.P.; validation, S.Y.J. and B.K.P.; formal analysis, S.Y.J. and B.K.P.; investigation, S.Y.J., B.K.P. and
C.H.C.; resources, B.K.P.; data curation, B.K.P.; writing—original draft preparation, S.Y.J. and B.K.P.;
writing—review and editing, all authors; visualization, B.K.P. and C.H.C.; supervision, B.K.P.; project
administration, B.K.P.; funding acquisition, none. All authors have read and agreed to the published
version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: IRB in Samsung Medical Center approved this study (File
No.: 2018-06-114).
Informed Consent Statement: Waived due to retrospective study.
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Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: None of any authors have conflict of interest to declare.
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