Comparison of Magnetic Resonance Imaging and Ultrasonography in Tumor Size: Evaluation of Equality in Advanced Cervical Cancer Patients.

Background: Cervical cancer is the fourth most common cancer among women worldwide. In Indonesia, cervical cancer is the second most frequent disease related to cancer. Based on staging system criteria, clinical findings are the main criteria to determine cervical cancer stage. In the revised version of the Federation of Gynecology and Obstetrics staging system criteria for cervical cancer, radiological examination for pretreatment evaluation in gynecological malignancies has been used in routine modalities. Magnetic resonance imaging (MRI) and ultrasonography (USG) are commonly used in the presurgery determination of tumor size and the follow-up of cervical cancer patients. Tumor size determines cancer stage which influences the treatment and the survival. The equality of diagnostic accuracy was compared for MRI and ultrasound in this study for tumor size evaluation of cervical cancer patients. Methods: This was a prospective study including 195 patients with cervical cancer Stage IIIB in Dr. Cipto Mangunkusumo Hospital from 2016 to 2018. The tumor sizes and stages of cervical cancer were assessed on MRI and ultrasound. This study evaluated diagnostic accuracy between MRI and US. The sensitivity and specificity were compared by using McNemar test. Results: The result of the study showed that from 195 patients, 76 patients fulfilled the study inclusion criteria. There is a significant difference in assessing tumor size in cervical cancer patients between ultrasound and MRI (mean, 1.72 cm; P < 0.0001). US had 82% sensitivity, 88% specificity, and 82% diagnostic accuracy (P = 0.003, McNemar test). Conclusion: Ultrasound examination showed a comparable accuracy to MRI for assessing tumor size in cervical cancer. US is an affordable and feasible diagnostic staging tool with accuracy comparable to MRI.

Evidence-based case report: How to deal with unpredicted endometriosis nodule closed to ureter and rectum during laparoscopy.

INTRODUCTION: Endometriosis is characterized by the growth of endometrial-like tissue within and outside the pelvic cavity. Peritoneum nodules invaded more than 5 mm representing the commonest form of deep infiltrating endometriosis nodules might challenge inexperienced operator due to its location near ureter and the rectum. The aim is to provide important steps on how to deal with unexpected peritoneal endometrial nodules located closed to ureter and rectum. PRESENTATION OF CASE: A 43-year-old female underwent laparoscopic cystectomy after being diagnosed to have right endometriosis cyst. The researchers found multiple endometriosis nodules located closed to rectum and ureter after performing cystectomy. A search was conducted on PubMed® with the keywords of "Peritoneal endometriosis nodule" AND "rectovaginal endometriosis nodule" AND "Surgical ablation" OR "Surgical excision" AND "Laparoscopy" AND "Pelvic pain". Reference lists of relevant articles were searched for other possible relevant studies. After selecting the articles, the critical review was performed based on a standardized appraisal form for the treatment study. DISCUSSION: Three eligible studies were appraised to assess the surgery outcome (dyspareunia), based on ablation and excision criteria. The pain was decreased during 6 months of follow up, with no difference in both techniques. The minimal requirement to remove the posterior nodules is knowledge of pelvic retroperitoneal anatomy. CONCLUSION: In all endometriosis cases which require surgery will need to be performed by an experienced operator. If rectovaginal endometriosis nodule was unexpectedly found during intraoperative and recognition of rectum and ureter must be done, knowledge of retroperitoneal anatomy is required.