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No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients.

Hoogendam JP, Zweemer RP, Verkooijen HM, de Jong PA, van den Bosch MA, Verheijen RH, Veldhuis WB - PLoS ONE (2015)

Bottom Line: Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography.Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease.In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecological Oncology, Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Aim: Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging.

Methods: All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 - September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography.

Results: Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman - with advanced pre-radiograph stage (IVA) disease - showed findings consistent with pulmonary metastases. Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%.

Conclusion: Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years.

No MeSH data available.


Related in: MedlinePlus

Stacked bar graph of the primary thoracic imaging examinations performed during the staging of all eligible patients (n = 402).CT: Computed Tomography; PET: Positron Emission Tomography; FIGO: International Federation for Gynecology and Obstetrics.
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pone.0131899.g002: Stacked bar graph of the primary thoracic imaging examinations performed during the staging of all eligible patients (n = 402).CT: Computed Tomography; PET: Positron Emission Tomography; FIGO: International Federation for Gynecology and Obstetrics.

Mentions: From a total 402 eligible patients, 114 were excluded based on an absent staging chest radiograph (n = 97; 24.1%) or <6 months follow-up (n = 17; 4.2%). Fig 1. None of these excluded lost-to-follow-up cases had radiographic findings suspicious for pulmonary or thoracic skeletal metastases. In the group with no radiograph, 26/97 women had already undergone chest CT (n = 23) or PET-CT (n = 3) in the referring hospital and chest radiography was omitted during formal staging at our institution. This group included a total 5 IVB cases, in all of whom stage IVB cervical cancer was already diagnosed prior to imaging (i.e. no upstaging occurred). A second reason for omitting a chest radiograph–in 24/97 patients–was microscopic, stage IA1-2 cervical cancer. At 63.2%, omission of radiography was much more common in stage IA1-2 patients than in other FIGO stages (p<0.001). The median percentage of cases with no chest imaging in stage IB1 –IVB was 11.7% (range: 0.0 ─ 16.5%), with no statistically significant differences among these stages. Fig 2.


No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients.

Hoogendam JP, Zweemer RP, Verkooijen HM, de Jong PA, van den Bosch MA, Verheijen RH, Veldhuis WB - PLoS ONE (2015)

Stacked bar graph of the primary thoracic imaging examinations performed during the staging of all eligible patients (n = 402).CT: Computed Tomography; PET: Positron Emission Tomography; FIGO: International Federation for Gynecology and Obstetrics.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489900&req=5

pone.0131899.g002: Stacked bar graph of the primary thoracic imaging examinations performed during the staging of all eligible patients (n = 402).CT: Computed Tomography; PET: Positron Emission Tomography; FIGO: International Federation for Gynecology and Obstetrics.
Mentions: From a total 402 eligible patients, 114 were excluded based on an absent staging chest radiograph (n = 97; 24.1%) or <6 months follow-up (n = 17; 4.2%). Fig 1. None of these excluded lost-to-follow-up cases had radiographic findings suspicious for pulmonary or thoracic skeletal metastases. In the group with no radiograph, 26/97 women had already undergone chest CT (n = 23) or PET-CT (n = 3) in the referring hospital and chest radiography was omitted during formal staging at our institution. This group included a total 5 IVB cases, in all of whom stage IVB cervical cancer was already diagnosed prior to imaging (i.e. no upstaging occurred). A second reason for omitting a chest radiograph–in 24/97 patients–was microscopic, stage IA1-2 cervical cancer. At 63.2%, omission of radiography was much more common in stage IA1-2 patients than in other FIGO stages (p<0.001). The median percentage of cases with no chest imaging in stage IB1 –IVB was 11.7% (range: 0.0 ─ 16.5%), with no statistically significant differences among these stages. Fig 2.

Bottom Line: Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography.Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease.In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynaecological Oncology, Oncology Division, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Aim: Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging.

Methods: All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 - September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography.

Results: Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman - with advanced pre-radiograph stage (IVA) disease - showed findings consistent with pulmonary metastases. Radiographs of 7 other women - 4 early, 3 advanced stage disease - were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%.

Conclusion: Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years.

No MeSH data available.


Related in: MedlinePlus