Fergus Vincent Coakley MD, Presenter: Nothing to Disclose

1. Understand the role of imaging in the diagnosis of cervical cancer. 2. Describe the imaging findings of critical prognostic importance when evaluating newly diagnosed cervical cancer. 3. List established and emerging imaging options for the evaluation of cervical cancer, and describe their relative role and utility.

The diagnosis of cervical cancer is primarily clinical, although MR imaging may be useful in the identification of entirely endocervical cancer, in the distinction of endometrial from endocervical cancer, and in the recognition of adenoma malignum. With respect to staging, numerous histopathologic studies utilizing multivariate analysis have investigated the locoregional T and N findings that are independently predictive of prognosis. These studies consistently suggest that tumor size, parametrial invasion, and lymph node metastases are all of significant prognostic important. These three morphologic factors can all be assessed by MR imaging, which is of proven superiority to CT. However, there are substantial limitations to the accuracy of MR imaging, including sizeable interobserver variability. Transabdominal and transvaginal ultrasound are currently of limited utility in the imaging of cervical cancer, although this may change as new contrast agents expand the role of these techniques in examining parametrial invasion and lymph node metastases. Meta-analysis has shown that lymphangiography is no more accurate than CT or MRI in nodal assessment. More recent outcome studies have suggested PET scan may be a useful method of nodal assessment, such that a positive PET scan is a poor prognostic finding irrespective of cross-sectional imaging evaluation of nodal size. MR lymphangiography using ultrasmall paramagnetic iron oxide particles might be expected to improve imaging of nodal metastases, although no large series for patient with cervical cancer have been reported to date. Finally, uterine body invasion is a T finding that is of particular importance in younger patients considering radical trachelectomy as a treatment option in order to preserve fertility, and preliminary data suggest MR imaging can help in the preoperative stratification of such cases.

Coakley, F, Cervical Carcinoma.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4405029.html