OC129: Role of ultrasound in guiding of surgery radicality in cervical cancer management

Abstract

Objectives: Standard treatment for early-stage cervical cancer (stage IA2-IB2) is radical hysterectomy (RH). This is accompanied by side effects that affect the quality of life. Moreover there are young patients who want to preserve fertility. If the disease is accurately graded (tumor volume, depth of invasion [DOI]), radicality of surgery could be adjusted and patients offered alternatives to the standard technique that include fertility-sparing surgery (FSS) using radical trachelectomy (RT), or nerve-sparing (NS) surgery that offers lower morbidity. This study aims to evaluate the role of US in guiding of surgery radicality and the importance of a novel marker distance measurement between tumor and pericervical fascia (DTF). Methods: 106 early stage cervical cancer patients treated between January 2005 and December 2007 were enrolled. All underwent US examination including the staging and topography of tumor, distance evaluation between tumor and pericervical fascia in all directions, and volumometry of tumor/cervix. US data were confirmed by histopathology. Results: Based on US topography and volumometry, 4 RT, 2 NS RT, 26 type II RH, 38 type II NS RH (8 site-differentiated surgeries) and 36 type III RH were performed. The correlation coefficient (R) for US volumometry (compared to histopathology) was 0.996, the accuracy of US tumor topography reached 93%. Based on US measurement of craniocaudal distance and tumor topography, 6 RT were performed (2 of them NS), one of them requiring completion of RH due to peroperationally determined endometrial extent of disease. Conclusion: Ultrasound is an invaluable tool in cervical cancer management. While radical hysterectomy type III is still needed in bulky tumors and insufficient DTF, many patients with tumors ≤40 mm and tumor-pericervical fascia distance ≥ 5 mm (determined by US) could undergo less radical nerve-sparing parametrial resection, or, based on the measurement of craniocaudal extent ≥10 mm, be offered FSS.