 Discussion of Procedures by Variant Variant 1: Initial local staging of pretreatment cervical cancer; assessment of local tumor extension (T staging) for any clinically visible lesion. Imaging is recommended for staging evaluation in any person with a clinically visible tumor or a microscopic tumor that is found to have >5 mm of invasion on biopsy, corresponding to stage 1B or greater disease [2]. Accurate determination of the size and local extent of the tumor is critical because this determines the treatment strategy used. Definitive surgery with radical hysterectomy with lymph node sampling is the treatment of choice for smaller (<4 cm), locally confined invasive cervical cancers (within the cervix or invading only the upper two-thirds of the vagina): stages IA2, IB1, IB2, and IIA1 [2]. Alternatively, trachelectomy can be considered for patients with stage IA2 or IB1 tumors who wish to maintain fertility. In this procedure, the cervix, parametrium, and vaginal cuff are removed with pelvic sentinel node biopsy or lymphadenectomy, and a cerclage suture is placed around the uterine isthmus to preserve uterine competency. Tumor size and location are critical factors in the assessment of trachelectomy candidacy, with cervix-confined tumors <2 cm in size and located >1 cm from the internal cervical os considered ideal features. Some centers will consider trachelectomy for patients with tumors <4 cm or as close to 0.5 cm from the internal os [7,8]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix.  Discussion of Procedures by Variant Variant 1: Initial local staging of pretreatment cervical cancer; assessment of local tumor extension (T staging) for any clinically visible lesion. Imaging is recommended for staging evaluation in any person with a clinically visible tumor or a microscopic tumor that is found to have >5 mm of invasion on biopsy, corresponding to stage 1B or greater disease [2]. Accurate determination of the size and local extent of the tumor is critical because this determines the treatment strategy used. Definitive surgery with radical hysterectomy with lymph node sampling is the treatment of choice for smaller (<4 cm), locally confined invasive cervical cancers (within the cervix or invading only the upper two-thirds of the vagina): stages IA2, IB1, IB2, and IIA1 [2]. Alternatively, trachelectomy can be considered for patients with stage IA2 or IB1 tumors who wish to maintain fertility. In this procedure, the cervix, parametrium, and vaginal cuff are removed with pelvic sentinel node biopsy or lymphadenectomy, and a cerclage suture is placed around the uterine isthmus to preserve uterine competency. Tumor size and location are critical factors in the assessment of trachelectomy candidacy, with cervix-confined tumors <2 cm in size and located >1 cm from the internal cervical os considered ideal features. Some centers will consider trachelectomy for patients with tumors <4 cm or as close to 0.5 cm from the internal os [7,8]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org