Assessing the Clinical Utility of MRI for Preoperative Staging of Early-Stage Cervical Cancer in a Limited-Resource Setting: A Retrospective Cohort Study from Botswana

Background: Cervical cancer is the number one cause of cancer-related mortality for women in Botswana, the care of which is complicated by the country’s severe shortage of gynecologic oncologists. A recent noninferiority trial suggests that some stage I cervical cancers can successfully be treated with simple hysterectomy (SH) instead of radical hysterectomy (RH), potentially easing the burden on specialists, reducing recovery time, and avoiding excess morbidity associated with RH. However, accurate risk assessment of invasion is crucial when choosing between SH and RH to ensure optimal patient outcomes. Methods : This study aims to investigate the feasibility of using magnetic resonance imaging (MRI) to stage early cervical cancer and guide surgical decision-making in a limited-resource setting in Botswana through a descriptive case series. Data were retrospectively collected for patients who underwent preoperative MRI and curative surgery for cervical cancer at Princess Marina Hospital (PMH) in Gaborone from September 2022 to December 2024. All patients were FIGO stage IA1-IB2 and had not received chemotherapy or radiation prior to surgery. Descriptive analysis comparing staging and tumor sizes across clinical diagnosis, MRI results, and final pathology was completed. Results: Thirty-two patients with early-stage cervical cancer were included in this study, 15 (47%) of whom underwent RH and 17 (53%) underwent SH. Staging between MRI and final surgical pathology was concordant in 16 (50%) patients. Four patients had the same stage across clinical, MRI, and surgical staging. Conclusions: The use of MRI for staging early-stage cervical cancer in Botswana may not accurately capture the extent of tumor invasion, highlighting the challenges of translating evidence for less invasive surgical strategies to resource-limited settings.