The Use and Abuse of Imaging in Gynecologic Cancer

Abstract

The radiologic detection in staging of gynecologic malignancies comprises a variety of noninvasive and invasive procedures. In the last few years, the emergence of the cross-sectional imaging techniques such as ultrasonography (US), computerized tomography (CT), and more recently, magnetic resonance imaging (MRI) have enabled the radiologist to determine more accurately the entire degree and extent of pathologic processes both within the pelvis and spread of disease outside the pelvis. The radiologist has also become more involved in invasive procedures such as percutaneous biopsies, aspirations of fluid collections, and transcatheter intraarterial infusion and occlusions. Although the newer imaging modalities will be emphasized, an attempt will be made to point out both their strengths and weaknesses relative to the older modalities. The discussion will concentrate on ovarian and cervical cancers while the other cancers of the female genital tract will be superficially discussed. The thrust of the presentation will emphasize the workup of gynecologic patients, that the workup may be quick, thorough, and as practical as possible.U relied upon the indirect assessment of the pelvic organs in women with radiographs (KUB), intravenous urograms, and barium examinations. With the advent of the cross-sectional imaging techniques; US, CT, and MRI and the established ease and safety of laparoscopy, the traditional radiographic techniques have been nearly abandoned in evaluating the gynecologic patient. Hysterosalpingography remains the modality of choice for the delineation and patency of the fallopian tubes and is of course reserved primarily for the work-up of infertility-related problems.US, which is noninvasive and without ionizing radiation, is simple to perform and is relatively inexpensive. It allows detailed visualization of the pelvic structures in both sagittal and transverse planes and is also able to detect spread of disease outside the pelvis. To date, there is no known deleterious effects of exposure to US within the diagnostic range of 2.5 MHz to 10 MHz. In the majority of gynecological problems, pelvic US will be used for the initial evaluation of the patient.Although there is exposure to ionizing radiation with CT, the overall resolution is better than US and CT

Imaging in cervical cancer

“…The high percentage of false-negative results was attributed to microscopic neoplastic foci in pelvic and paraaortic lymph nodes that did not become opaque. 28,41,42 …”

Evaluation of cervical cancer by computed tomography: Current status

“…11 In addition to staging, CT is used to guide lymph node biopsies, to plan radiation therapy, and to follow up. 7,8 CT has high sensitivity and specificity for detecting recurrent tumor. 2 Eighty-five percent of local recurrences were diagnosed correctly on CT in a study of 39 patients with recurrent disease.…”

CT Evaluation of Cervical Cancer: Spectrum of Disease

“…Patients with cervical cancer can have secondary infection that results in adenopathy (10). Enlarged malignant and hyperplastic nodes cannot be distinguished at CT (9).…”

“…. CT can also be used to guide biopsy of enlarged nodes, plan radiation therapy ports, and monitor patients for tumor recurrence (9,10). Regional lymph node metastases staging were performed by using scanners with 1-3-second scanning times and 8 -10-mm-thick sections (7).…”