Uterine Cervical Cancer: Diagnostic Accuracy of Clinical Staging, Magnetic Resonance Imaging, and Histopathology Findings

Abstract

Background: Cervical cancer (CC) ranks as the fourth most commonly diagnosed cancer in women globally. Accurate staging is crucial for treatment planning. Although magnetic resonance imaging (MRI) has been validated as a reliable modality for CC staging, limited evidence exists on its accuracy compared to dual International Federation of Gynecology and Obstetrics (FIGO) classifications in an Iranian population. This study addresses this gap by evaluating the diagnostic accuracy of MRI against both clinical FIGO staging systems and the gold standard of histopathology in untreated CC patients. Materials and Methods: A prospective study was conducted on 45 CC patients from January 2021 to December 2023, at tertiary‑care centers in Isfahan, Iran. Clinical FIGO staging and pretreatment MRI were performed, followed by surgery and histopathological examination. MRI’s diagnostic accuracy was compared with clinical FIGO staging and postoperative pathological findings. Results: The overall diagnostic accuracy of MRI for staging cervical carcinoma was 82.20%, with clinical FIGO staging achieving 57.80% accuracy. MRI demonstrated higher sensitivity (82.20%) and positive predictive value (PPV; 97.40%) compared to clinical FIGO. However, both methods showed equal and lower specificity (50%) compared with the postoperative pathological findings. Conclusions: MRI appears to be more effective than FIGO in terms of sensitivity and PPV for staging cervical carcinoma. The present study underlines the need for cautious interpretation of the results and further research due to significant uncertainty in specificity and negative predictive value. Combining FIGO staging and MRI provides a comprehensive assessment essential for effective treatment planning.