Peter de Boer, Maaike C. G. Bleeker, Anje M. Spijkerboer, Agustinus J

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Craniocaudal tumour extension in uterine cervical cancer on MRI compared to histopathology Peter de Boer, Maaike C.G. Bleeker, Anje M. Spijkerboer, Agustinus J.A.J. van de Schoot, Shandra Bipat, Marrije R. Buist, Coen R.N. Rasch, Jaap Stoker, Lukas J.A. Stalpers European Journal of Radiology Open Volume 2, Pages 111-117 (January 2015) DOI: 10.1016/j.ejro.2015.07.001 Copyright © 2015 The Authors Terms and Conditions

Fig. 1 (A) Craniocaudal tumour extension of the primary tumour measured parallel to the endocervical channel in sagittal plane. (B) Example of measuring craniocaudal tumour extension in a 51-year-old woman with FIGO stage IB1 uterine cervical cancer in sagittal plane on MRI and on pathology (C). The two-headed arrow indicates the cranial and caudal extension. European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions

Fig. 2 Flow diagram of patient inclusion. European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions

Fig. 3 (A) Due to diffuse vaso-invasion, the craniocaudal extension of uterine cervical cancer (arrows) could not be properly measured in sagittal plane on MRI (B) or on macroscopic images. European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions

Fig. 4 Bland–Altman plot for craniocaudal extension measured on MRI and histopathology. The dotted lines show a 95% confidence interval (−1.0 to1.9cm). It can be seen that MRI has a systematic error of −0.4cm or, in other words, MRI slightly underestimates histopathology by (on average) 0.4cm. The difference between MRI and histopathology seems to get smaller with larger tumours. There were two outlying cases (see Section 3). European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions

Fig. 5 Estimation of craniocaudal tumour extension by MRI compared to (histo) pathology as reference standard. For instance, in patient 21, MRI underestimates histopathology by 2.2cm. European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions

Fig. 6 Images from a 45-year old woman with FIGO stage IB uterine cervical cancer. On MRI the craniocaudal tumour extension measured in sagittal plane parallel to the endocervical channel is 1.9cm (A). Despite measurements in exactly the same sagittal plane both on MRI and pathology, the spatial shape of the tumour is substantially altered at pathology and a craniocaudal tumour extension of 4.0cm is measured (B). Note that on both images the tumour is very well distinguishable from normal tissue. European Journal of Radiology Open 2015 2, 111-117DOI: (10.1016/j.ejro.2015.07.001) Copyright © 2015 The Authors Terms and Conditions