Comparative Efficacy of Transvaginal Ultrasound and MRI in the Diagnosis and Local Staging of Cervical Carcinoma

Abstract

Introduction: Cervical carcinoma is a leading cause of cancer-related morbidity in women worldwide. Accurate local staging is critical for treatment planning. While MRI is considered the reference standard for local staging, transvaginal ultrasound (TVUS) offers a cost-effective and accessible alternative, particularly in resource-limited settings. Objective: To compare the diagnostic performance of TVUS and MRI in the detection and local staging of cervical carcinoma, using histopathology as the reference standard. Materials and Methods: This prospective study included 46 patients with Histopathologically confirmed cervical carcinoma. All patients underwent both TVUS and MRI for tumor detection, measurement of tumor size, and assessment of stromal, parametrial, and vaginal invasion. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and inter-modality agreement (Cohen’s kappa) were calculated. Statistical analysis was performed using SPSS version 26. Results: TVUS demonstrated slightly higher sensitivity for tumor detection (93.5%) compared to MRI (89.1%), while both modalities had 100% specificity. Tumor size measurement showed strong correlation with histopathology (TVUS: r = 0.91; MRI: r = 0.93). MRI showed marginally better specificity and accuracy in assessing stromal (MRI: 89.1% vs. TVUS: 86.9%) and parametrial invasion (MRI: 91.3% vs. TVUS: 89.1%), while TVUS had higher sensitivity for parametrial involvement (83% vs. 75%). Vaginal invasion was detected with high accuracy by both modalities (TVUS: 95.6%, MRI: 95.7%). Inter-modality agreement was good to excellent across all parameters (κ = 0.69–0.81). Conclusion: Both TVUS and MRI are highly accurate for tumor detection and local staging of cervical carcinoma. TVUS is a reliable, accessible first-line imaging modality, particularly for early-stage disease, while MRI provides superior soft tissue delineation for complex or advanced cases. A combined imaging approach can optimize diagnostic accuracy and guide appropriate management.

Keywords: Cervical carcinoma; Transvaginal ultrasound; MRI; Tumor staging; Diagnostic accuracy; FIGO staging