Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers

Abstract

MRI plays important roles in endometrial and cervical cancer assessment, from detection to recurrent disease evaluation. Endometrial cancer (EC) is the most common malignant tumor of the female genital tract in Western countries. EC patients are divided into risk categories based on histopathological tumor type, grade, and myometrial invasion depth. EC is surgically staged using the International Federation of Gynecology and Obstetrics (FIGO) system. Since FIGO (2009) stage correlates with prognosis, preoperative staging is essential for tailored treatment. MRI reveals myometrial invasion depth, which correlates with tumor grade and lymph node metastases, and thus correlates with prognosis. Cervical cancer (CC) is the second most common cancer, and the third leading cause of cancer-related death among females in developing countries. The FIGO Gynecologic Oncology Committee recently revised its CC staging guidelines, allowing staging based on imaging and pathological findings when available. The revised FIGO (2018) staging includes node involvement and thus enables both therapy selection and evaluation, prognosis estimation, and calculation of end results. MRI can accurately assess prognostic indicators, e.g., tumor size, parametrial invasion, pelvic sidewall, and lymph node invasion. Despite these important roles of MRI, radiologists still face challenges due to the technical and interpretation pitfalls of MRI during all phases of endometrial and cervical cancer evaluation. Awareness of mimics that can simulate both cancers is critical. With careful application, functional MRI with DWI and DCE sequences can help establish a correct diagnosis, although it is sometimes necessary to perform biopsy and histopathological analysis.

Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

“…In our experience, sensitivity and specificity of 18 F-FDG PET/CT when we considered distant metastasis was 100% and 97%, respectively; these values were higher than for MRI (71% and 91%, respectively). These values are similar to data from studies reporting 82%-100% and 78%-100% sensitivity and specificity rates for MRI, respectively, and 83%-100% and 50%-100% for 18 F-FDG PET/CT, respectively [38,39]. The sensitivity and specificity of PET increases for distant metastases (86% and 100%, respectively).…”

The upper limit of optimal tumor size in patients with FIGO 2018 stage IB2 cervical cancer undergoing radical hysterectomy

“…Among the diagnostic imaging tools, MRI has 90% sensitivity, 98% specificity, and up to 95% accuracy for stage IB or higher with primary tumors over 1 cm in size. [21][22][23] Other imaging studies including ultrasound, CT, and positron emission tomography based on local resources provide comparable information but have limitations, especially in the detection of the primary tumor and parametrial involvement. 24 25 There are several strengths of this study.…”

Epithelial ovarian cancer: a review of preoperative imaging features indicating suboptimal surgery

“…Preservation of the normal fat plane between the tumor and bladder excludes stage IVA cancer [27]. Appropriate preparation is important since this anatomic plane is difficult to assess in patients with an overdistended bladder.…”