Imaging of endometrial and cervical cancer

Abstract

In this article we review the ever increasing role of imaging in endometrial and cervical cancer. Magnetic resonance imaging (MRI) has emerged as the most widely used technique in the management of women with gynaecological cancer. In endometrial cancer, MRI is reliable in identifying myometrial and cervical invasion and extra-uterine disease, thereby informing preoperative surgical planning. In cervical cancer, MRI plays a crucial role in distinguishing early from advanced disease, thereby stratifying patients for surgery and chemoradiation. MRI is also valuable in assessing proximal extension of cervical tumours in young women with early stage disease for feasibility of fertility preserving surgery. In both cancers, imaging is used for diagnosing nodal metastases, detection of recurrence, and dealing with complications of both the disease and treatment.

Current imaging strategies for the evaluation of uterine cervical cancer

“…PET-MRI may be promising for the assessment of primary tumor, with sensitivity and specificity values over 90%, but further studies with larger patient populations are needed to support clinical implementation [25] . MRI is the preferred imaging modality for evaluating local extent of cervical cancer due to its high contrast resolution which enables differentiation between cancerous and normal tissues [5,26,27] . In the following paragraphs, we will focus on the role of MRI in the pretreatment staging of cervical cancer.…”

“…MRI cannot discriminate between enlarged inflammatory lymph nodes and metastatic nodes. This results in moderate sensitivity and specificity values for both CT and MRI (43%73%) for detection of metastatic lymph nodes [5,26,27] . PET/CT has the highest diagnostic performance for detecting nodal metastases in cervical cancer patients; however, its accuracy decreases for nodal size < 5 mm [24] .…”

“…Other morphologic features suggestive of a malignant node include round shape, irregular margins or extracapsular mass; central necrosis has 100% PPV for the diagnosis of nodal metastases. Care should be taken not to mistake a necrotic lymph node for a normal ovary with follicles [27,31] . Rarely, calcifications within the metastatic nodes may be present (Figures 6 and 7).…”

Is adjuvant hysterectomy an option after radio-chemotherapy for locally advanced cervical cancer? A review

“…Surgical staging can identify microscopic nodal involvement and is superior to abdominopelvic MRI. PET-CT has higher sensibility and specificity for nodal involvement, but it not always available (9,10).…”

Added Value of Perfusion in Gynaecological Imaging

“…To date, the standard of care is as follows; following presentation, the initial examination of choice is TVUS. Abnormally thick endometrium (≤ 5 mm) warrants endometrial sampling [33]. After histopathological confirmation of endometrial carcinoma, MRI is recommended for proper staging.…”