MRI-defined parametrial venous invasion in locally advanced cervical cancer: association with pathological venous invasion, pretreatment lymph node metastasis, and survival outcomes.

Authors

Fumitaka Ejima, Ryoji Yamagishi, Arata Oose, Fumiko Kanzaki, Yuki Satake, Koji Takumi, Kiyohisa Kamimura, Hirokazu Otsuka, Shintaro Yanazume, Hiroaki Kobayashi, Ikumi Kitazono, Takashi Yoshiura

Published in

Japanese journal of radiology. Oct 17, 2026. Epub Oct 17, 2026.

Abstract

To evaluate MRI-defined parametrial venous invasion (mrPMVI) for detecting pathological parametrial venous invasion (pPMVI) and its associations with pretreatment lymph node metastasis (LNM) and survival outcomes in locally advanced cervical cancer.
This retrospective study included 42 patients with cervical cancer with parametrial invasion on MRI or histopathology, corresponding to International Federation of Gynecology and Obstetrics 2018 stage IIB or higher disease. Fifteen patients underwent surgery without preoperative therapy and were included in the pathological validation analysis. Image interpretation was primarily based on T2-weighted and diffusion-weighted imaging. Two radiologists independently assessed mrPMVI using a five-point scoring system. Scores ≥ 3 were predefined as mrPMVI-positive. Diagnostic performance for pPMVI and interobserver agreement were evaluated. Univariable logistic and Cox regression analyses were performed for pretreatment LNM and survival outcomes, respectively.
pPMVI was present in 10 of 15 patients. The five-point mrPMVI score showed an area under the receiver operating characteristic curve of 0.87 (95% confidence interval [CI], 0.60-0.98) for detecting pPMVI. The predefined threshold (≥ 3) yielded 30.0% sensitivity and 100% specificity. Interobserver agreement for the five-point mrPMVI score was substantial (linearly weighted κ = 0.75). mrPMVI positivity was associated with pretreatment LNM (odds ratio = 4.00, 95% CI: 1.05-15.26, p = 0.042). During a median follow-up of 24.0 months, 16 patients experienced disease progression and 10 died. mrPMVI positivity was associated with shorter progression-free survival (hazard ratio = 34.25, 95% CI: 4.35-269.91; p < 0.001) and overall survival (hazard ratio = 10.16; 95% CI: 1.28-80.61, p = 0.028).
The mrPMVI score showed potential for identifying pPMVI, although the predefined threshold was highly specific but insensitive. mrPMVI positivity was associated with pretreatment LNM and survival outcomes, suggesting potential complementary value for risk characterization in locally advanced cervical cancer.

PMID:
42888363
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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