What Is the Role of Imaging at Primary Diagnostic Work-Up in Uterine Cervical Cancer?

Abstract

Purpose of Review For uterine cervical cancer, the recently revised International Federation of Gynecology and Obstetrics (FIGO) staging system (2018) incorporates imaging and pathology assessments in its staging. In this review we summarize the reported staging performances of conventional and novel imaging methods and provide an overview of promising novel imaging methods relevant for cervical cancer patient care. Recent Findings Diagnostic imaging during the primary diagnostic work-up is recommended to better assess tumor extent and metastatic disease and is now reflected in the 2018 FIGO stages 3C1 and 3C2 (positive pelvic and/or paraaortic lymph nodes). For pretreatment local staging, imaging by transvaginal or transrectal ultrasound (TVS, TRS) and/or magnetic resonance imaging (MRI) is instrumental to define pelvic tumor extent, including a more accurate assessment of tumor size, stromal invasion depth, and parametrial invasion. In locally advanced cervical cancer, positron emission tomography-computed tomography (PET-CT) or computed tomography (CT) is recommended, since the identification of metastatic lymph nodes and distant metastases has therapeutic consequences. Furthermore, novel imaging techniques offer visualization of microstructural and functional tumor characteristics, reportedly linked to clinical phenotype, thus with a potential for further improving risk stratification and individualization of treatment. Summary Diagnostic imaging by MRI/TVS/TRS and PET-CT/CT is instrumental for pretreatment staging in uterine cervical cancer and guides optimal treatment strategy. Novel imaging techniques may also provide functional biomarkers with potential relevance for developing more targeted treatment strategies in cervical cancer.

Outcome and Subsequent Pregnancy after Fertility-Sparing Surgery of Early-Stage Cervical Cancers

“…Moreover, 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) tumor size measurements correlate highly with pathological tumor size. PET-CT or PET-MR also provide more accurate evaluation of lymph node metastases [ 31 ]. Therefore, we recommend using a comprehensive preoperative imaging study in choosing the optimal surgical procedure for any woman with early-stage ICC who is preparing for FSS.…”

Revised FIGO Staging for Cervical Cancer – A New Role for MRI

“…To further improve the diagnostic significance of MRI examinations, the vagina can be filled prior to the examination and, in the case of primary staging, the rectum can also be filled (e. g. with ultrasound gel). The IV administration of butylscopolamine (Buscopan ® ) minimizes intestinal peristalsis thereby further improving image quality [19,20].…”

“…T2-weighted sequences are therefore best suited for differentiating tumor tissue from healthy cervical stroma and are essential for the evaluation of tumor extent [12,21]. The extent of the tumor in the corpus uteri and in the vagina can be precisely evaluated on the sagittal plane, while the axial plane is particularly suitable for evaluating stromal invasion and infiltration of the parametria [19]. Strictly orthogonal (paraaxial) angulation of the axial plane with respect to the course of the cervix is helpful here.…”

Treatment of Cervical Cancer with Paraaortic Lymph Node Involvement – Retrospective Review

“…Pacientky v našem souboru podstoupily vstupní stagingová vyšetření v různých kombinacích dle aktuálně platných doporučení, dle indikace lékaře i dle dostupnosti -expertní onkogynekologický ultrazvuk [14], výpočetní tomografii, pozitronovou emisní tomografii / výpočetní tomografii (positron emission tomography / computed tomography -PET/ CT), magnetickou rezonanci [15]. V podsouboru 57 pacientek léčených s radikálním záměrem podstoupilo LPSK LAE pánevních a paraaortálních uzlin 22 (38,6 %) pacientek.…”