Clinical staging versus pelvic MRI staging before and after chemoradiation among patients with cervical cancer in Rwanda: patients seen at RMH and KFH

Abstract

Background: Cervical cancer is among major public health concerns. Appropriate management of cervical cancer come from accurate staging. The objective of this retrospective study was to compare the performance of clinical and pelvis MRI staging before and after chemoradiation among cervical cancer patients seen at Rwanda Military Hospital (RMH)/Rwanda Cancer Centre (RCC) and at King Faisal Hospital (KFH). Methods: From January 2020 to June 2022, 88 patients with biopsy-proven locally advanced cervical cancer who met the inclusion requirements were recruited. The patients' MRI results before and after chemoradiation were reviewed and compared with their clinical staging findings for analysis. Results: Pre-treatment clinical and MRI staging showed a substantial agreement of 78.1% (K=0.63, P value=0.001). Invasion of the upper 2/3 vagina, parametrium and pelvic side wall all showed a fair-tosubstantial agreement between clinical and pre-treatment MRI examinations by percent agreement of 70.4%, 81.8% and 71.5% respectively. In pre-treatment assessment 72% patients were staged equally clinically and by MRI. 14.7% were under-staged and 12.5% were over staged by pelvis MRI compared to clinical staging. Post-treatment clinical and MRI staging showed a substantial agreement of 71.0% (K=0.71). Conclusion: There is substantial agreement between clinical and pelvic MRI staging before and after chemoradiation in patients with cervical cancer. On further evaluation it is seen that there is concordance of seventy-two percent between clinical and pelvis MRI staging.