The Revised FIGO Staging System for Uterine Malignancies: Implications for MR Imaging

Abstract

Cancers of the uterine corpus and cervix are the most common gynecologic malignancies worldwide. The International Federation of Gynecology and Obstetrics (FIGO) staging system was first established in 1958, when it was recognized that the recurrence rate and patient outcomes were directly related to the degree of tumor spread at the patient's initial presentation. Changes in understanding of tumor biology led to a recent update in the FIGO staging system that reflects the variation in treatment strategies between endometrial and cervical cancer. Patients with endometrial cancer are primarily treated with hysterectomy; thus, staging is done at surgery and histologic analysis. Magnetic resonance (MR) imaging may accurately depict the extent of endometrial cancer at diagnosis and, in conjunction with the tumor grade and histologic subtype, help stratify risk, which determines the therapeutic course. Cervical carcinoma is staged at clinical examination because many tumors are inoperable at the time of patient presentation. Preoperative MR imaging criteria are not formally included in the revised FIGO staging system because cervical carcinoma is most prevalent in developing countries, where imaging resources are limited. However, MR imaging is highly sensitive and specific for depicting important prognostic factors and, when available, is recommended as an adjunct to clinical examination. The MR imaging findings of uterine carcinoma should be discussed in a multidisciplinary setting in conjunction with clinical and histologic findings, an approach that provides accurate staging and risk stratification and allows for individualized treatment.

MR Imaging for Staging of Cervical Carcinoma: Update

“…Stage IVB is defined as distant spread of tumor to the lung, liver, bones, peritoneum, and paraaortic or inguinal lymph node metastases, although the latter do not change the FIGO staging system (1,16,23).…”

Diffusion weighted imaging in gynecological malignancies - present and future

“…Depth of tumour invasion into the myometrium and lymph node spread are two important parameters determining the management and prognosis of the patient [17,27] . Patients having greater depth of myometrial invasion and lymph node metastases have a higher incidence of recurrence and worse prognosis.…”

“…When there is breech of the junctional zone and the tumour invades into less than 50% of the myometrium it is staged as 1b and 1c when the depth of penetration into myometrium is greater than 50% (Figure 2) [27] . This differentiation can also be done on MRI with T2W and post gadolinium T1 weighted sequences.…”

“…In all such cases DWI acts as an important ancillary study to correctly stage the tumour. Correct staging is important as it determines management [type of hysterectomyRadical vs total abdominal hysterectomy (TAH)] and also in prognosis of the carcinoma [17,[27][28][29] . Another role of DWI is to differentiate residual tumour or recurrence from post-surgical/radiotherapy changes which leads to distortion of the normal anatomy.…”

Added Value of Perfusion in Gynaecological Imaging

“…Since the condition is predominantly treated surgically, staging according to the revised FIGO classification is mainly surgical [24]. Surgery is used to initially treat patients as well as to identify patients who need further therapy according to various factors, the most important of which is the depth of myometrial invasion, because it directly correlates with tumor grade, cervical involvement and the presence of lymph node metastasis [25][26][27].…”