Various investigators used lymphangiography, computed tomography (CT), ultrasonography, magnetic resonance imaging (MRI), and positron emission tomography (PET) in an attempt to improve the accuracy of clinical staging (15–25). These modalities suffer from poor sensitivity and high false-negative rates. Evaluation of the para-aortic lymph nodes with lymphangiography is associated with a false-positive rate of 20% to 40% and a false-negative rate of 10% to 20% (15–17). Overall, lymphangiography has a sensitivity of 79% and specificity of 73% (20). CT has poor sensitivity (34%) but excellent specificity (97%) (21). The accuracy of CT scanning is 80% to 85%; the false-negative rate is 10% to 15%, and the false-positive rate is 20% to 25% (16–18). Ultrasound has a high false-negative rate (30%), low sensitivity (19%), but high specificity (99%) (19). Early data showed that MRI results were comparable to those of CT scanning, a finding confirmed on meta-analysis (21,22). However, a systematic review comparing CT scan with MRI showed that MRI is significantly more sensitive with
Table 36.1 FIGO Staging of Carcinoma of the Cervix Uteri (2008)
Stage I The carcinoma is strictly confined to the cervix (extension to the corpus would be disregarded) IA Invasive carcinoma which can be diagnosed only by microscopy, with deepest invasion ≤5mmand largest extension ≤7mm IA1 Measured stromal invasion of ≤3.0 mm in depth and extension of ≤7.0 mm IA2 Measured stromal invasion of >3.0 mm and not >5.0 mm with an extension of not >7.0 mm
IB Clinically visible lesions limited to the cervix uteri or pre-clinical cancers greater than stage IAa IB1 Clinically visible lesion ≤4.0 cm in greatest dimension IB2 Clinically visible lesion >4.0 cm in greatest dimension
Stage II Cervical carcinoma invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina
IIA Without parametrial invasion IIA1 Clinically visible lesion ≤4.0 cm in greatest dimension IIA2 Clinically visible lesion >4 cm in greatest dimension
Stage III The tumor extends to the pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis or non-functioning kidneyb IIIA Tumor involves lower third of the vagina, with no extension to the pelvic wall IIIB Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney
Stage IV The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous edema, as such, does not permit a case to be allotted to Stage IV IVA Spread of the growth to adjacent organs IVB Spread to distant organs
FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int Cynecol Obst 2009;105:103–104.
aAll macroscopically visible lesions, even those with superficial invasion, are allotted to stage IB carcinomas. Invasion is limited to a measured stroma invasion with a maximal depth of 5.0 mm and a horizontal extension greater than 7.0 mm. Dept of invasion should not be greater than 5 mm taken from the base of the epithelium of the original tissue squamous or glandular. The depth of invasion should always be reported in millimeters, even those cases with “early minimal stromal invasion” (∼1 mm). The involvement of vascular/lymphatic spaces should not change stage allotment.