Imaging in cervical cancer

Abstract

Cervical cancer (CC) is diagnosis based on histopathological analysis. Although cancer staging is performed clinically, using the International Federation of Gynecology and Obstetrics (FIGO) criteria, cancer staging systems have been shown to be deficient for the examination of prognostic factors of CC, including tumor size and infiltration of the parametria or pelvic wall, as well as for the evaluation of nodal metastases. In this regard, imaging methods are considered crucial in the assessment of CC, as imaging data complement the information obtained from a clinical examination. Ultrasound has a limited role in CC staging; it is inadequate for assessing nodal status or pelvic wall involvement. Tomography is used to evaluate adenopathies, define the extent of disease progression, assess metastasis, plan radiotherapy, and guide percutaneous biopsy. Magnetic resonance imaging (MRI) has been established to be superior for the characterization of lesions and local extension of disease. The main indications for 18F-FDG positron emission tomography-computed tomography (PET-CT) are initial staging (determination of locoregional nodal involvement and extrapelvic extension), evaluation of the response to therapy and detection of recurrence.