US Pelvis Transabdominal Transabdominal US of the pelvis plays a limited role in the staging of cervical cancers because of its incomplete evaluation of the gynecologic organs. For pelvic imaging, TVUS is preferred. US Pelvis Transvaginal Although TVUS of the pelvis plays an important role in local disease assessment, its limited depth of penetration makes it a poor choice of modality for a complete nodal and metastatic disease assessment. Cross-sectional imaging is preferred. Variant 3: Initial treatment response assessment of cervical cancer after chemoradiation. This variant primarily applies to response assessment of the locally advanced primary tumor after chemoradiation. Literature on assessment of initial treatment response of cervical cancer after chemoradiation is evolving, with emphasis on the use of MRI or PET/CT, which can help in both response assessment and detection of complete response versus residual disease. This information is critical for the management because patients with refractory disease (presence of residual tumor after 6 months of completion of treatment) in the pelvis without distant metastases may be considered for pelvic exenteration. There is also a growing body of literature exploring the use of the functional parameters such as DWI or ADC images on MRI or metabolic parameters on PET/CT as prognostic biomarkers. CT Abdomen and Pelvis With IV Contrast There is no relevant literature supporting the use of CT abdomen and pelvis with IV contrast for the evaluation of initial treatment response assessment of primary cervical cancer after chemoradiation. CT may be used for response assessment of nodal and distant metastatic disease [37]. Use of IV contrast material is generally preferred. If there is distant metastatic disease, imaging of the chest, abdomen, and pelvis is concurrently performed.
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. US Pelvis Transabdominal Transabdominal US of the pelvis plays a limited role in the staging of cervical cancers because of its incomplete evaluation of the gynecologic organs. For pelvic imaging, TVUS is preferred. US Pelvis Transvaginal Although TVUS of the pelvis plays an important role in local disease assessment, its limited depth of penetration makes it a poor choice of modality for a complete nodal and metastatic disease assessment. Cross-sectional imaging is preferred. Variant 3: Initial treatment response assessment of cervical cancer after chemoradiation. This variant primarily applies to response assessment of the locally advanced primary tumor after chemoradiation. Literature on assessment of initial treatment response of cervical cancer after chemoradiation is evolving, with emphasis on the use of MRI or PET/CT, which can help in both response assessment and detection of complete response versus residual disease. This information is critical for the management because patients with refractory disease (presence of residual tumor after 6 months of completion of treatment) in the pelvis without distant metastases may be considered for pelvic exenteration. There is also a growing body of literature exploring the use of the functional parameters such as DWI or ADC images on MRI or metabolic parameters on PET/CT as prognostic biomarkers. CT Abdomen and Pelvis With IV Contrast There is no relevant literature supporting the use of CT abdomen and pelvis with IV contrast for the evaluation of initial treatment response assessment of primary cervical cancer after chemoradiation. CT may be used for response assessment of nodal and distant metastatic disease [37]. Use of IV contrast material is generally preferred. If there is distant metastatic disease, imaging of the chest, abdomen, and pelvis is concurrently performed.