Accuracy of Magnetic Resonance Imaging in Pretreatment Lymph Node Assessment for Gynecological Malignancies

  • Sufian, Saira Naz (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi) ;
  • Masroor, Imrana (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi) ;
  • Mirza, Waseem (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi) ;
  • Hussain, Zainab (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi) ;
  • Hafeez, Saima (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi) ;
  • Sajjad, Zafar (Department of Diagnostic Radiology, The Aga Khan University Hospital Karachi)
  • Published : 2014.06.15


Objective: To determine the accuracy of magnetic resonance imaging (MRI) in detection of metastasis in pelvic and para-aortic lymph nodes from different gynecological malignancies. Materials and Methods: This retrospective cross sectional analytic study was conducted at the Department of Diagnostic Radiology, Aga Khan University Hospital Karachi Pakistan from January 2011 to December 2012. A sample of 48 women, age range between 20-79 years, fulfilling inclusion criteria were included. All patients had histopathologically proven gynecological malignancies in the cervix, endometrium or ovary and presented for a pretreatment MRI to our radiology department. Results: MRI was 100% sensitive and had a 100% positive predictive value to detect lymph node metastasis in lymph nodes with spiculated margins and 100% sensitive with a 75% positive predictive value to detect lymph node metastasis in a lymph node with lobulated margins. The sensitivity and positive predictive value of MRI to detect heterogeneous nodal enhancement were 100% and 75% respectively. Conclusions: Our study results reinforce that MRI should be used as a modality of choice in the pretreatment assessment of lymph nodes in proven gynaecological malignancies in order to determine the line of patientmanagement, distinguishing surgical from non-surgical cases.


  1. Bipat S, Glas AS, Slors FJ, et al (2004). Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology, 232, 773-83.
  2. Bankhead CR, Collins C, Stokes-Lampard H, et al (2008). Identifying symptoms of ovarian cancer: a qualitative and quantitative study. BJOG, 115, 1008-14.
  3. Barentsz JO, Engelbrecht MRW, Witjes JAM, et al (1999). MR imaging of the male pelvis. EurRadiol, 9, 1722-36.
  4. Bipat S, Glas AS, Van der Velden J, et al (2003). Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol, 91, 59-66.
  5. Choi SH, Kim SH, Choi HJ, Park BK, Lee HJ (2004). Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study. J Comput Assist Tomogr, 28, 620-7.
  6. Choi HJ, Kim SH, San-Soo, et al (2006). MRI for Pretreatment Lymph Node Staging in Uterine Cervical Cancer. AJR, 187, 538-43.
  7. Chumworathayi B (2013). Personalized cancer treatment for ovarian cancer. Asian Pac J Cancer Prev, 14, 1661-4.
  8. de Bondt RBJ, Nelemans PJ, Bakers F, et al (2009). Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes. EurRadiol, 19, 626-33.
  9. Downey GO, Potish RA, Adcock LL, Prem KA, Twiggs LB (1989). Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resection. Am J Obstet Gynecol, 160, 1055-61.
  10. Gao C, Li -T, Fang L, et al (2013). Pre-operative predictive factors for intra-operative pathological lymph node metastasis in rectal cancers. Asian Pac J Cancer Prev, 14, 6293-9.
  11. Joshi JV, Paradkar PH, Jagtap SS, et al (2011). Chemopreventive potential and safety profile of a Curcuma longa extract in women with cervical low-grade squamous intraepithelial neoplasia. Asian Pac J Cancer Prev, 12, 3305-11.
  12. Grubnic S, Vinnicombe SJ, Norman A, Husband JE (2002). MR evaluation of normal retroperitoneal and pelvic lymph nodes.Clin Radiol, 57, 193-200.
  13. Hoque M, Ibekwe CM, Ntuli-Ngcobo B (2009). Screening and perceived severity of cervical cancer among. women attending Mahalapye district hospital, Botswana. Asian Pac J Cancer Prev, 10, 1095-100.
  14. Jelovac D, Armstrong DK (2011). Recent progress in the diagnosis and treatment of ovarian cancer. CA Cancer J Clin, 61, 183-203.
  15. Kasuya G, Toita T, Furutani K, et al (2013). Distribution patterns of metastatic pelvic lymph nodes assessed by CT/MRI in patients with uterine cervical cancer. Radiat Oncol, 8-139.
  16. Kim SH, Kim SC, Choi BI, Han MC (1994). Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology, 190, 807-11.
  17. Lambregts DM, Beets GL, Maas M, et al (2011). Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg, 253, 539-45.
  18. Li-Na Li, Xin Zhou, Yang Gu, Jun Yan (2013). Prognostic value of MMP-9 in ovarian cancer: a meta-analysis. Asian Pac J Cancer Prev, 14, 4107-13.
  19. Melin A, Sparen P, Bergqvist A (2007). The risk of cancer and the role of parity among women with endometriosis. Hum Reprod, 22, 3021-6.
  20. Missaoui N, Hmissa S, Dante R, Frappart L (2010). Global DNA methylation in precancerous and cancerous lesions of the uterine cervix. Asian Pac J Cancer Prev, 11, 1741-4.
  21. PecorelliS (2009). Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet, 105, 103-4.
  22. Morch LS, Lokkegaard E, Andreasen AH, et al (2012) Hormone therapy and different ovarian cancers: a national cohort study. Am J Epidemiol, 175, 1234-42.
  23. Murthy NS, et al (2009). Changing trends in incidence of ovarian cancer - the indian scenario. Asian Pac J Cancer Prev, 10, 1025-30.
  24. Outwater E, Kressel HY (1992). Evaluation of gynecologic malignancy by magnetic resonance imaging. Radiol Clin North Am, 30, 789-806.
  25. Petsuksiri J, Jaishuen A, Pattaranutaporn P, Chansilpa Y (2012). Advanced imaging applications for locally advanced cervical cancer. Asian Pac J Cancer Prev, 13, 1713-8.
  26. Potish RA, Twigg LB, Okagaki T, Prem KA, Addcock LL (1985). Therapeutic implications of the natural history of advanced cervical cancer as defined by pretreatment surgical staging.Cancer, 56, 956-60.<956::AID-CNCR2820560442>3.0.CO;2-U
  27. Takeshima N, Yanoh K, Tabata T, et al (1999). Assessment of the revised international federation of gynecology and obstetrics staging for early invasive squamous cervical cancer. Gynecol Oncol, 74, 165-9.
  28. Tanaka Y, Sawada S, Murata T (1984). Relationship between lymph node metastases and prognosis inpatients irradiated postoperatively for carcinoma of the uterine cervix. Acta Radiol Oncol, 23, 455-9.
  29. Togashi K, Nishimura K, Itoh K, et al (1986). Uterine cervical cancer: assessment with high-field MR imaging. Radiology, 160, 431-5.
  30. Togashi K, Nishimura K, Sagoh T, et al (1989). Carcinoma of cervix: staging with MR imaging. Radiology, 171, 245-51.
  31. Wanitchar Wilairat, Mongkol Benjapibal (2012). Presence of anemia and poor prognostic factors in patients with endometrial carcinoma. Asian Pac J Cancer Prev, 13, 3187-90.
  32. Toita T, Ohno T, Kaneyasu Y, et al (2010). A consensus-base guideline defining the clinical target volume for pelvic lymph nodes in external beam radiotherapy for uterine cervical cancer. Jpn J ClinOncol, 40, 456-63.
  33. Vinnicombe S, Norman A, Husband J, Nicolson V (1995). Normal pelvic lymph nodes: documentation by CT scanning after bipedal lymphangiography. Radiology, 194, 349-55.
  34. Waggenspack GA, Amparo EG, Hanninan EV (1998). MR imaging of uterine cervical carcinoma. J Comput Assist Tomogr, 12, 409-14.
  35. Yang WT, Lam WW, Yu MY, Cheung TH, Metreweli C (2000). Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR, 175, 759-66.
  36. Yasmin B, Bhurgri A, Sania N, et al (2006). Pakistan - Country profile of cancer and cancer control 1995-2004. J Pak Med Assoc, 56, 124-30.
  37. Yu KK, Hricak H, Subak LL, Zaloudek CJ, Powell CB (1998). Preoperative staging of cervical carcinoma: phased array coil fast spin-echo versus body coil spin-echo T2-weighted MR imaging. AJR, 171, 707-11.