# Added value of radiological staging to clinical examination in different histopathological subtypes of uterine cervical cancer: A retrospective study

## TL;DR

This study shows that radiological staging of uterine cervical cancer often reveals more advanced disease than clinical exams, with no subtype-specific differences.

## Contribution

The study demonstrates the added value of radiological staging over clinical staging in uterine cervical cancer, regardless of histopathological subtype.

## Key findings

- Radiological staging (rFIGO) leads to substantial up-staging compared to clinical staging (cFIGO).
- Imaging detects lymph node and extra pelvic metastases not identified by clinical exams.
- Poor agreement was found between clinical and radiological staging methods.

## Abstract

Accurate staging of uterine cervical cancer (UCC) is crucial for treatment guidance and prognostic predictions. This study investigated the added value of conventional diagnostic imaging for different histopathological subtypes of UCC by comparing clinical staging according to International Federation of Gynaecology and Obstetrics staging system (cFIGO) and radiological staging (rFIGO) with histopathological staging (pFIGO) as reference.

26 consecutive patients with UCC from the retrospective part of the PRODIGYN study (ethical approval number 2022-04207-01; NCT05855941) were included in the present study. Data from study participants was collected from radiological and histopathological records 2016–2022 at the University hospital of Umeå. Staging was assessed according to the FIGO 2018 staging system. Statistical analysis included descriptive statistics and Cohen’s weighted kappa coefficient (κ) for calculation of agreement between cFIGO and rFIGO, and between rFIGO and pFIGO.

With rFIGO staging, more advanced disease stages were found in 67 % (8/12 patients with known cFIGO). Poor agreement was found between cFIGO and rFIGO (κ =0.057) and between rFIGO and pFIGO (κ= 0169). Among the patients with squamous cell carcinoma (SCC) positive for human papilloma virus (HPV+), 67 % (4/6) were assigned a higher stage by rFIGO compared to cFIGO. For the single patients with HPV-negative SCC and HPV status unknown SCC, both were upstaged by rFIGO. In the case of adenocarcinomas, 67 % (2/3) of the patients were assigned a higher stage with rFIGO.

In primary staging of UCC, rFIGO leads to substantial up-staging compared to cFIGO, without obvious differences in subtypes.

•Radiological staging identifies higher disease stage compared to clinical staging.•No staging differences between histopathological subtypes of Uterine Cervical Cancer.•Poor agreement between clinical and radiological staging.•Imaging detects lymph node and extra pelvic metastases compared to clinical exam.

Radiological staging identifies higher disease stage compared to clinical staging.

No staging differences between histopathological subtypes of Uterine Cervical Cancer.

Poor agreement between clinical and radiological staging.

Imaging detects lymph node and extra pelvic metastases compared to clinical exam.