Because of its inherent superior soft tissue contrast, a noncontrast MRI is strongly preferred to a noncontrast CT. US Pelvis Transabdominal Transabdominal US of the pelvis plays a limited role in local staging of cervical cancers because of poorer evaluation of the gynecologic organs. For pelvic imaging, transvaginal US (TVUS) is preferred. US Pelvis Transvaginal TVUS of the pelvis has been evaluated as an alternative to MRI for the assessment of local disease extent. One meta-analysis, which compared the performance of US and MRI for local extent of disease assessment, showed similar performance between the 2 modalities, with US demonstrating a pooled sensitivity of 78% (95% CI, 48%- 93%) and specificity of 96% (95% CI, 84%-99%) for parametrial involvement, compared to 68% sensitivity (95% CI, 54%-80%) and 91% specificity (95% CI, 94%-95%) for MRI [30]. Contrast-enhanced US also shows similar diagnostic performance to MRI, with a study of 108 women with invasive cervical cancer who underwent both contrast-enhanced US and MRI demonstrating strong correlation between the 2 modalities for tumor size (r = 0.84- 0.88) and moderate concordance for vaginal and parametrial invasion [31]. Weaknesses of TVUS compared to MRI include the assessment of bulky tumors >4 cm [32]. Variant 2: Initial systemic staging of pretreatment cervical cancer; assessment of lymph node and distant metastases (N/M staging). As of 2018, the FIGO staging system incorporates radiologic and pathologic data in the assessment [2]. A new stage was created as a result of this, corresponding to radiologically suspected or pathologically confirmed nodal disease in the pelvis (IIIC1) and para-aortic (IIIC2) stations. When unsuspected nodal disease is found at surgical pathology, adjuvant radiation is necessary, with high morbidity. Therefore, the identification of nodal disease on preoperative imaging is paramount for the selection of the appropriate treatment strategy.
Pretreatment Evaluation and Follow up of Invasive Cancer of the Cervix. Because of its inherent superior soft tissue contrast, a noncontrast MRI is strongly preferred to a noncontrast CT. US Pelvis Transabdominal Transabdominal US of the pelvis plays a limited role in local staging of cervical cancers because of poorer evaluation of the gynecologic organs. For pelvic imaging, transvaginal US (TVUS) is preferred. US Pelvis Transvaginal TVUS of the pelvis has been evaluated as an alternative to MRI for the assessment of local disease extent. One meta-analysis, which compared the performance of US and MRI for local extent of disease assessment, showed similar performance between the 2 modalities, with US demonstrating a pooled sensitivity of 78% (95% CI, 48%- 93%) and specificity of 96% (95% CI, 84%-99%) for parametrial involvement, compared to 68% sensitivity (95% CI, 54%-80%) and 91% specificity (95% CI, 94%-95%) for MRI [30]. Contrast-enhanced US also shows similar diagnostic performance to MRI, with a study of 108 women with invasive cervical cancer who underwent both contrast-enhanced US and MRI demonstrating strong correlation between the 2 modalities for tumor size (r = 0.84- 0.88) and moderate concordance for vaginal and parametrial invasion [31]. Weaknesses of TVUS compared to MRI include the assessment of bulky tumors >4 cm [32]. Variant 2: Initial systemic staging of pretreatment cervical cancer; assessment of lymph node and distant metastases (N/M staging). As of 2018, the FIGO staging system incorporates radiologic and pathologic data in the assessment [2]. A new stage was created as a result of this, corresponding to radiologically suspected or pathologically confirmed nodal disease in the pelvis (IIIC1) and para-aortic (IIIC2) stations. When unsuspected nodal disease is found at surgical pathology, adjuvant radiation is necessary, with high morbidity. Therefore, the identification of nodal disease on preoperative imaging is paramount for the selection of the appropriate treatment strategy.