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Logo of jgoJournal of Gynecologic OncologyAims and ScopeInformations for Authorse-SubmissionThis Article
J Gynecol Oncol. 2008 September; 19(3): 205–206.
Published online 2008 September 30. doi:  10.3802/jgo.2008.19.3.206
PMCID: PMC2676468

In reply

In reply: We appreciate Dr. Choi and colleagues' interest in our recent paper describing pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer. These authors have raised interesting questions and made detailed clarifications of some issues regarding this controversial topic.

As the authors mentioned, CT and MR imaging might have different resolution. We agreed with their description, and our draft also demonstrated this limitation. The accuracy of cervical mass measured only by MRI was superior to that measured by CT or MRI in previous study1-4 as well as the reference which they described.5 In the subgroup analysis which we have performed after publication, MRI was more accurate than CT for the evaluation of cervical mass in 25 patients who underwent both CT and MRI, even though small number and even without statistically significance (p=0.06).

For the term, "clinically visible tumor", we do think that this expression leads the readers to confusion. We measured cervical mass not only by vision but by palpation as we mentioned in the section "protocol for diagnostic work up". And it is better to change the term to "clinically detectable tumor".

Dr. Choi et al. commented that the discrepancies between our paper and previous data, and we agreed that this study showed important data for us.6 However we do not think there was big discrepancy on the point of rs, even we could not compare the values of two studies directly. Above all, we assented to the superiority of MRI to CT. We just intended to propose that the studies in 90's and early 2000's have overestimated the role of imaging tools than recent studies.

About the last comment, 8 mm-sized paper seems very attractive tools for measurement of mass. Although we commonly use scale in millimeter attached on an eye lens in colposcopy, the papers might be good alternatives in many cases.


1. Hricak H, Gatsonis C, Chi DS, Amendola MA, Brandt K, Schwartz LH, et al. Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183. J Clin Oncol. 2005;23:9329–9337. [PubMed]
2. Kim SH, Choi BI, Han JK, Kim HD, Lee HP, Kang SB, et al. Preoperative staging of uterine cervical carcinoma: comparison of CT and MRI in 99 patients. J Comput Assist Tomogr. 1993;17:633–640. [PubMed]
3. Sironi S, De Cobelli F, Scarfone G, Colombo E, Bolis G, Ferrari A, et al. Carcinoma of the cervix: value of plain and gadolinium-enhanced MR imaging in assessing degree of invasiveness. Radiology. 1993;188:797–801. [PubMed]
4. Togashi K, Nishimura K, Sagoh T, Minami S, Noma S, Fujisawa I, et al. Carcinoma of the cervix: staging with MR imaging. Radiology. 1989;171:245–251. [PubMed]
5. Hricak H, Gatsonis C, Coakley FV, Snyder B, Reinhold C, Schwartz LH, et al. Early invasive cervical cancer: CT and MR imaging in preoperative evaluation - ACRIN/GOG comparative study of diagnostic performance and interobserver variability. Radiology. 2007;245:491–498. [PubMed]
6. Mitchell DG, Snyder B, Coakley F, Reinhold C, Thomas G, Amendola M, et al. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol. 2006;24:5687–5694. [PubMed]

Articles from Journal of Gynecologic Oncology are provided here courtesy of Asian Society of Gynecologic Oncology & Korean Society of Gynecologic Oncology and Colposcopy