A prospective study to analyse the concordance in staging of carcinoma cervix between clinical examination, examination under anaesthesia and CECT

Abstract

Carcinoma cervix is the second most common gynaecological cancer among women in India, with high prevalence in rural regions. Accurate staging is imperative for providing appropriate treatment. This study aims to analyse the concordance among clinical examination, examination under anaesthesia, and CECT in evaluating the clinical components of the staging. Carcinoma cervix patients with clinical examination staging upto stage lll, admitted in government royapettah hospital, department of surgical oncology between November 2017 and October 2019 were subjected to examination under spinal anaesthesia. CECT taken for all patients. Results regarding tumour size, fornix and parametrium involvement were tabulated and analysed. Tumour size: In 21.2% (17/80) of patients who had bulky disease in EUA, CECT has reported tumour size as <4cm. Based on tumour size 5/81(6.2%) patients were down-staged by EUA in comparison with clinical examination. In 5% of patients (4/80) EUA upstaged tumour size in comparison with clinical examination. Fornix: Clinical examination failed to identify fornix involvement in 8 out of the 83 patients who had fornix involvement in EUA (9.6%). Parametrium: Out of 67 cases who had parametrium involvement in EUA, clinical examination failed to identify it in 5. (7.4%). In 28.3% of patients (19/67) who had parametrium involvement in EUA, there was no parametrium involvement in CECT. Among the 71 patients with parametrium involvement, 4 patients were identified only in CECT (5.6%). Out of 16 patients who had parametrium involvement upto side wall in EUA, CECT had no HUN or lateral pelvic wall in 11 patients(68.5%). Clinical examination failed to identify parametrium involvement upto side wall in 11/16 patients stage lllB according to EUA (68%). In significant number of patients CECT did not identify parametrium involvement, and it had very low sensitivity for identifying disease upto side wall. There is a non-significant under staging of tumour size in CECT in comparison to EUA. Clinical examination has low sensitivity for identifying parametrium involvement and its extent in comparison to EUA. There is no significant difference.