Imaging techniques for the evaluation of cervical cancer

Testa, Antonia Carla; Legge, A. Di; Blasis, I. De; Moruzzi, Maria Cristina; Bonatti, Matteo; Collarino, Angela; Rufini, Vittoria; Manfredi, Riccardo

doi:10.1016/j.bpobgyn.2014.04.009

Cited by 59 publications

(61 citation statements)

References 77 publications

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“…Abnormal vascularization of one parametrium was diagnosed when the hypoechoic parametrial tumor extension presented the same vascular pattern and density as the cervical tumor, or when one parametrium presented vessels with higher density than the opposite. Tumoral infiltration of the rectal wall and/or posterior wall of the bladder was diagnosed when a breach of continuity of the layers was seen with direct continuation of the cervical cancer at least as deep as the muscular layer of the rectum or bladder [11,18]. Also, tumoral infiltration of rectal and/or bladder wall was diagnosed when immobility of the vaginal fornix against these structures was seen on real time examination [19].…”

Section: Us Protocolsmentioning

confidence: 99%

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

et al. 2016

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Aims: The aim of this study was to evaluate the use of pre and post-therapy transrectal and transvaginal ultrasonography (TRUS, TVUS) with contrast enhancement and strain elastography compared with clinical examination and magnetic resonance imaging (MRI) in the assessment of advanced stage cervical cancer. Material and methods: This was a prospective study, carried out over a period of nine months on subjects with advanced-stage cervical cancer (stage ≥IIB). All included patients were examined clinically and underwent abdomino-pelvic contrast enhanced MRI and multimodal US examinations (TRUS with strain elastography and contrast enhanced TVUS) at the time of diagnosis and after radiochemotherapy. Tumor size and staging at TRUS and TVUS was compared with the same data obtained by clinical examination and MRI. Pathology was the golden standard. Results: Eight patients accomplished the inclusion criteria. In five cases the tumor stage was identical on clinical and MRI examinations. In all cases parametrial infiltration was diagnosed by all pre-treatment examinations. No significant differences were observed in tumor size between clinical, US and MRI exams either at baseline or post-therapy, in native or post-contrast examinations. The size of the tumor evaluated pre-treatment proved to be significantly smaller post-contrast in both US and MRI examinations compared with the native images. Post-therapy, no significant differences were observed on US measured tumor dimensions when comparing native with post-contrast images. Oppositely, significant smaller dimensions were observed on post-contrast MRI compared with native scans. Conclusions: TRUS is accurate in the estimation of pre-therapy cervical cancer dimension. The post therapy tumor evaluation is better performed with MRI. The use of intravenous contrast agents on both examinations did not improved the accuracy of tumor evaluation pre-or post-therapy.

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Section: Us Protocolsmentioning

confidence: 99%

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

et al. 2016

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“…PET-CT is more reliable than CT or MRI for evaluating distant or nodal spread. Therefore, a combination of MRI and PET-CT is preferred for the diagnosis of cervical cancer relapse [42] .…”

Section: Guidelines For Cervical Cancer Follow-up (Ct Mri Pet-ct)mentioning

confidence: 99%

“…In some centers and mostly for patients with adverse surgico-pathological features predisposing to relapse, like large tumor volume, small cell histology, lymphvascular space invasion, FIGO stage ≥ ⅡB and positive surgical margins, follow-up MRI is recommended every 6 mo for a total of 2 years; the same follow-up is recommended for patients who had fertility preserving surgery. In patients with clinical evidence of tumor recurrence, PET-CT is the preferred imaging modality because it can more accurately evaluate lymph node status and extrapelvic spread of the disease [42] . In patients with advanced cervical cancer who received conservative therapy (chemotherapy, external radiation and brachytherapy), determination of complete vs partial response of the tumor is important due to differences in management; patients with residual cancer after completion of chemoradiation, may be candidates for pelvic exenteration ( Figure 10); patients with complete regression of tumor do not need further imaging, if suspicious clinical findings are not present [39,42] .…”

Section: Guidelines For Cervical Cancer Follow-up (Ct Mri Pet-ct)mentioning

confidence: 99%

“…In patients with clinical evidence of tumor recurrence, PET-CT is the preferred imaging modality because it can more accurately evaluate lymph node status and extrapelvic spread of the disease [42] . In patients with advanced cervical cancer who received conservative therapy (chemotherapy, external radiation and brachytherapy), determination of complete vs partial response of the tumor is important due to differences in management; patients with residual cancer after completion of chemoradiation, may be candidates for pelvic exenteration ( Figure 10); patients with complete regression of tumor do not need further imaging, if suspicious clinical findings are not present [39,42] . In patients with advanced disease, there are several findings on MRI studies following initiation of treatment, which may help early prediction of the therapeutic outcome.…”

Section: Guidelines For Cervical Cancer Follow-up (Ct Mri Pet-ct)mentioning

confidence: 99%

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Current imaging strategies for the evaluation of uterine cervical cancer

Bourgioti

Chatoupis

Moulopoulos

2016

WJR

105

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Uterine cervical cancer still remains an important socioeconomic issue because it largely affects women of reproductive age. Prognosis is highly depended on extent of the disease at diagnosis and, therefore, accurate staging is crucial for optimal management. Cervical cancer is clinically staged, according to International Federation of Gynecology and Obstetrics guidelines, but, currently, there is increased use of cross sectional imaging modalities [computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography-CT (PET-CT)] for the study of important prognostic factors like tumor size, parametrial invasion, endocervical extension, pelvic side wall or adjacent/distal organs involvement and lymph node status. Imaging indications also include cervical cancer follow-up, evaluation of tumor response to treatment and selection of suitable candidates for less radical surgeries like radical trachelectomy for fertility preservation. The preferred imaging method for local cervical cancer evaluation is MRI; CT is equally effective for evaluation of extrauterine spread of the disease. PET-CT shows high diagnostic performance for the detection of tumor relapse and metastatic lymph nodes. The aim of this review is to familiarize radiologists with the MRI appearance of cervical carcinoma and to discuss the indications of cross sectional imaging during the course of the disease in patients with cervical carcinoma.

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“…It is also worth noting that both histotype and tumor volume can be easily obtained preoperatively. In fact, MRI 25, 26 and transvaginal ultrasound 26, 27 show a very high diagnostic accuracy in measuring tumor volume. Moreover, tumor volume can also be evaluated intraoperatively at frozen section analysis.…”

Section: Discussionmentioning

confidence: 99%

Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

et al. 2016

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Nowadays cervical cancer is frequently diagnosed at early stage. For these patients lymph node metastasis (LNM) is considered the most important prognostic factor. During the last decade many efforts have been made to reduce rate of complications associated with lymphadenectomy (LND). A great interest has arisen in sentinel lymph node (SLN) biopsy as a technique able to decrease number of LND performed and, at the same time, to assess lymph nodal status. High diagnostic performances have been reached thanks to SLN surgical algorithm. However, despite the efforts, about 25% of these patients undergo at least unilateral LND to meet NCCN recommendations. Data of women with International Federation of Gynecology and Obstetrics stage IA1‐IB1/IIA1 cervical carcinoma were retrospectively collected by six Italian institutions. All patients underwent complete preoperative staging workup and were primarily treated by radical hysterectomy and pelvic bilateral LND. A total of 368 patients with early‐stage cervical cancer were identified. Among them 333 (90.5%) showed no suspicious enlarged nodes at the preoperative magnetic resonance imaging (MRI). In this subset, tumor diameter ≥20 mm was the only independent predictor of LN status (P = 0.003). None of the 106 patients with negative MRI nodal assessment, with squamous and adenosquamous histotype and a tumor diameter less than 2 cm had LNM. Based on these results we propose a new modified SLN surgical algorithm that could safely reduce LND performed in patients with very low‐risk early‐stage cervical cancer.

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Imaging techniques for the evaluation of cervical cancer

Cited by 59 publications

References 77 publications

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report.

Current imaging strategies for the evaluation of uterine cervical cancer

Beyond sentinel node algorithm. Toward a more tailored surgery for cervical cancer patients

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