Interobserver agreement and prognostic impact for MRI–based 2018 FIGO staging parameters in uterine cervical cancer

Objectives To evaluate the interobserver agreement for MRI–based 2018 International Federation of Gynecology and Obstetrics (FIGO) staging parameters in patients with cervical cancer and assess the prognostic value of these MRI parameters in relation to other clinicopathological markers. Methods This retrospective study included 416 women with histologically confirmed cervical cancer who underwent pretreatment pelvic MRI from May 2002 to December 2017. Three radiologists independently recorded MRI–derived staging parameters incorporated in the 2018 FIGO staging system. Kappa coefficients ( κ ) for interobserver agreement were calculated. The predictive and prognostic values of the MRI parameters were explored using ROC analyses and Kaplan–Meier with log-rank tests, and analyzed in relation to clinicopathological patient characteristics. Results Overall agreement was substantial for the staging parameters: tumor size > 2 cm ( κ = 0.80), tumor size > 4 cm ( κ = 0.76), tumor size categories (≤ 2 cm; > 2 and ≤ 4 cm; > 4 cm) ( κ = 0.78), parametrial invasion ( κ = 0.63), vaginal invasion ( κ = 0.61), and enlarged lymph nodes ( κ = 0.63). Higher MRI–derived tumor size category (≤ 2 cm; > 2 and ≤ 4 cm; > 4 cm) was associated with a stepwise reduction in survival ( p ≤ 0.001 for all). Tumor size > 4 cm and parametrial invasion at MRI were associated with aggressive clinicopathological features, and the incorporation of these MRI–based staging parameters improved risk stratification when compared to corresponding clinical assessments alone. Conclusion The interobserver agreement for central MRI–derived 2018 FIGO staging parameters was substantial. MRI improved the identification of patients with aggressive clinicopathological features and poor survival, demonstrating the potential impact of MRI enabling better prognostication and treatment tailoring in cervical cancer. Key Points • The overall interobserver agreement was substantial (κ values 0.61–0.80) for central MRI staging parameters in the 2018 FIGO system. • Higher MRI–derived tumor size category was linked to a stepwise reduction in survival (p ≤ 0.001 for all). • MRI–derived tumor size > 4 cm and parametrial invasion were associated with aggressive clinicopathological features, and the incorporation of these MRI–derived staging parameters improved risk stratification when compared to clinical assessments alone.