The importance of fine needle aspiration biopsy and sonographic evaluation of parametria in cervical cancer

Objective: The aim of study was to estimate of the value of fine needle aspiration biopsy (FNAB) and transvaginal ultrasonography (TVS) in the preoperative assessment of the parametria in cervical cancer. We compared parametrial infiltration before and postoperatively by histopathology to verified and confirmed staging of disease. Correct staging qualification, especially evaluation of the parametrium, is very useful in choosing an adequate method of treatment, and thereby in patient survival.

Material and method: 52 women (median age 56 years, range 33-85) with cervical cancer in Stage Ib and 49 (median age 51, range 36-71) in Stage II and III, were included in the study. Assessment of parametrial invasion before treatment was performed by fine needle aspiration biopsy (FNAB) with endovaginal ultrasound assistance. The sonographic evaluation of parametria was performed by Siemens Sonoline Versa Pro with a transvaginal 7 MHz mechanical transducer with a biopsy guide and 21-gauge needle. The probe was covered with a disposable latex sheath filled with ultrasound gel. The aspirated material was placed on a glass slide, fixed in 95% alcohol and submitted to cytologic evaluation. All of the patients with cervical cancer in Stage Ib underwent a Wertheim-Meigs hysterectomy. The preoperative findings were compared with data obtained by histopathology findings. Moreover, in the whole group of 101 patients a comparison of FNAB and sonography was performed. The sensitivity, specificity and diagnostic accuracy of this method were evaluated.

Results: Parametrial involvement assessed postoperatively by histopathology, in clinical Stage Ib cervical cancer was found in eight of 52 cases (15.4%). FNAB of parametrial involvement in the operated group was accurate in 14 of 18 (accuracy--83%, sensitivity--78%, specificity--84%, PPV--50%, NPV--95%). Sonographic assessment of parametrial involvement was correct in 12 of 18 cases (accuracy--58%, sensitivity--67%, specificity--56%, PPV--24%, NPV--89%). In the whole group of patients (operated and non-operated), sonographic evaluation of parametria verified by FNAB was correct in 104 of 202 cases (accuracy--78%, sensitivity--71%, specificity--86%, PPV--84%, NPV--74%).

Conclusions: FNAB and TVS assessment of the parametria are very useful methods in confirmation of neoplastic infiltration. Correct preoperative diagnosis may improve staging, treatment and indirectly, survival of patients with cervical cancer.

Fine needle aspiration biopsy; Ultrasonography; Parametria; Cervical cancer

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