Subscribe to RSS
DOI: 10.1055/s-0041-1735502
Imaging in Carcinoma Cervix and Revised 2018 FIGO Staging System: Implications in Radiology Reporting
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) staging system of carcinoma cervix saw a radical change in 2018 with the inclusion of cross-sectional imaging tools for the assessment of disease extent and staging. One of the major revisions is the inclusion of lymph node status, detected either on imaging or pathological evaluation, in the staging system. The changes were based on long-term patient follow-up and survival rates reported in literature. Thus, it becomes imperative for a radiologist to be well versed with the recent staging system, its limitations, and implications on the patient management.
Source(s) of Support
None.
Presentation at a Meeting
None.
Publication History
Article published online:
07 September 2021
© 2021. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
- 2 Jemal A, Siegel R, Ward E. et al. Cancer statistics, 2006. CA Cancer J Clin 2006; 56 (02) 106-130
- 3 Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet 2009; 105 (02) 107-108
- 4 Chuang LT, Temin S, Camacho R. et al. Management and care of women with invasive cervical cancer: American Society of Clinical Oncology Resource-Stratified Clinical Practice Guideline. J Glob Oncol 2016; 2 (05) 311-340
- 5 Bhatla N, Berek JS, Cuello Fredes M. et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145 (01) 129-135
- 6 Epstein E, Testa A, Gaurilcikas A. et al. Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound—a European multicenter trial. Gynecol Oncol 2013; 128 (03) 449-453
- 7 Testa AC, Ludovisi M, Manfredi R. et al. Transvaginal ultrasonography and magnetic resonance imaging for assessment of presence, size and extent of invasive cervical cancer. Ultrasound Obstet Gynecol 2009; 34 (03) 335-344
- 8 Moloney F, Ryan D, Twomey M, Hewitt M, Barry J. Comparison of MRI and high-resolution transvaginal sonography for the local staging of cervical cancer. J Clin Ultrasound 2016; 44 (02) 78-84
- 9 Ma X, Li Q, Wang JL. et al. Comparison of elastography based on transvaginal ultrasound and MRI in assessing parametrial invasion of cervical cancer. Clin Hemorheol Microcirc 2017; 66 (01) 27-35
- 10 Fischerova D, Cibula D, Stenhova H. et al. Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int J Gynecol Cancer 2008; 18 (04) 766-772
- 11 Alcázar JL, Arribas S, Mínguez JA, Jurado M. The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India 2014; 64 (05) 311-316
- 12 Alcazar JL, García E, Machuca M. et al. Magnetic resonance imaging and ultrasound for assessing parametrial infiltration in cervical cancer. A systematic review and meta-analysis. Med Ultrason 2020; 22 (01) 85-91
- 13 Innocenti P, Pulli F, Savino L. et al. Staging of cervical cancer: reliability of transrectal US. Radiology 1992; 185 (01) 201-205
- 14 Aoki S, Hata T, Senoh D. et al. Parametrial invasion of uterine cervical cancer assessed by transrectal ultrasonography: preliminary report. Gynecol Oncol 1990; 36 (01) 82-89
- 15 Csutak C, Badea R, Bolboacă SD. et al. Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report. Med Ultrason 2016; 18 (01) 75-81
- 16 Yang WT, Walkden SB, Ho S. et al. Transrectal ultrasound in the evaluation of cervical carcinoma and comparison with spiral computed tomography and magnetic resonance imaging. Br J Radiol 1996; 69 (823) 610-616
- 17 Hancke K, Heilmann V, Straka P, Kreienberg R, Kurzeder C. Pretreatment staging of cervical cancer: is imaging better than palpation? Role of CT and MRI in preoperative staging of cervical cancer: single institution results for 255 patients. Ann Surg Oncol 2008; 15 (10) 2856-2861
- 18 Bipat S, Glas AS, van der Velden J, Zwinderman AH, Bossuyt PMM, Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: a systematic review. Gynecol Oncol 2003; 91 (01) 59-66
- 19 Mitchell DG, Snyder B, Coakley F. et al. Early invasive cervical cancer: tumor delineation by magnetic resonance imaging, computed tomography, and clinical examination, verified by pathologic results, in the ACRIN 6651/GOG 183 Intergroup Study. J Clin Oncol 2006; 24 (36) 5687-5694
- 20 Özsarlak O, Tjalma W, Schepens E. et al. The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma. Eur Radiol 2003; 13 (10) 2338-2345
- 21 Massad LS, Calvello C, Gilkey SH, Abu-Rustum NR. Assessing disease extent in women with bulky or clinically evident metastatic cervical cancer: yield of pretreatment studies. Gynecol Oncol 2000; 76 (03) 383-387
- 22 Sharma DN, Thulkar S, Goyal S. et al. Revisiting the role of computerized tomographic scan and cystoscopy for detecting bladder invasion in the revised FIGO staging system for carcinoma of the uterine cervix. Int J Gynecol Cancer 2010; 20 (03) 368-372
- 23 Olpin J, Chuang L, Berek J, Gaffney D. Imaging and cancer of the cervix in low- and middle-income countries. Gynecol Oncol Rep 2018; 25: 115-121
- 24 Bellomi M, Bonomo G, Landoni F. et al. Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma. Eur Radiol 2005; 15 (12) 2469-2474
- 25 Scoutt LM, McCauley TR, Flynn SD, Luthringer DJ, McCarthy SM. Zonal anatomy of the cervix: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 1993; 186 (01) 159-162
- 26 Yitta S, Hecht EM, Mausner EV, Bennett GL. Normal or abnormal? Demystifying uterine and cervical contrast enhancement at multidetector CT. Radiographics 2011; 31 (03) 647-661
- 27 deSouza NM, Rockall A, Freeman S. Functional MR imaging in gynecologic cancer. Magn Reson Imaging Clin N Am 2016; 24 (01) 205-222
- 28 Choi SH, Kim SH, Choi HJ, Park BK, Lee HJ. Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study. J Comput Assist Tomogr 2004; 28 (05) 620-627
- 29 Young P, Daniel B, Sommer G, Kim B, Herfkens R. Intravaginal gel for staging of female pelvic cancers–preliminary report of safety, distention, and gel-mucosal contrast during magnetic resonance examination. J Comput Assist Tomogr 2012; 36 (02) 253-256
- 30 Pötter R, Georg P, Dimopoulos JCA. et al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 2011; 100 (01) 116-123
- 31 Addley H, Moyle P, Freeman S. Diffusion-weighted imaging in gynaecological malignancy. Clin Radiol 2017; 72 (11) 981-990
- 32 Hameeduddin A, Sahdev A. Diffusion-weighted imaging and dynamic contrast-enhanced MRI in assessing response and recurrent disease in gynaecological malignancies. Cancer Imaging 2015; 15: 3
- 33 Fu C, Bian D, Liu F, Feng X, Du W, Wang X. The value of diffusion-weighted magnetic resonance imaging in assessing the response of locally advanced cervical cancer to neoadjuvant chemotherapy. Int J Gynecol Cancer 2012; 22 (06) 1037-1043
- 34 Donaldson SB, Buckley DL, O'Connor JP. et al. Enhancing fraction measured using dynamic contrast-enhanced MRI predicts disease-free survival in patients with carcinoma of the cervix. Br J Cancer 2010; 102 (01) 23-26
- 35 Andersen EKF, Hole KH, Lund KV. et al. Dynamic contrast-enhanced MRI of cervical cancers: temporal percentile screening of contrast enhancement identifies parameters for prediction of chemoradioresistance. Int J Radiat Oncol Biol Phys 2012; 82 (03) e485-e492
- 36 Zahra MA, Tan LT, Priest AN. et al. Semiquantitative and quantitative dynamic contrast-enhanced magnetic resonance imaging measurements predict radiation response in cervix cancer. Int J Radiat Oncol Biol Phys 2009; 74 (03) 766-773
- 37 Van Vierzen PBJ, Massuger LFAG, Ruys SHJ, Barentsz JO. Fast dynamic contrast enhanced MR imaging of cervical carcinoma. Clin Radiol 1998; 53 (03) 183-192
- 38 Atri M, Zhang Z, Dehdashti F. et al. Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN6671/GOG0233 trial. Gynecol Oncol 2016; 142 (03) 413-419
- 39 Paño B, Sebastià C, Ripoll E. et al. Pathways of lymphatic spread in gynecologic malignancies. Radiographics 2015; 35 (03) 916-945
- 40 Amendola MA, Hricak H, Mitchell DG. et al. Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183. J Clin Oncol 2005; 23 (30) 7454-7459
- 41 Mayr NA, Yuh WTC, Zheng J. et al. Tumor size evaluated by pelvic examination compared with 3-D quantitative analysis in the prediction of outcome for cervical cancer. Int J Radiat Oncol Biol Phys 1997; 39 (02) 395-404
- 42 Van Nagell Jr JR, Roddick Jr JW, Lowin DM. The staging of cervical cancer: inevitable discrepancies between clinical staging and pathologic findings. Am J Obstet Gynecol 1971; 110 (07) 973-978
- 43 Pandharipande PV, Choy G, del Carmen MG, Gazelle GS, Russell AH, Lee SI. MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes. AJR Am J Roentgenol 2009; 192 (03) 802-814
- 44 Matsuo K, Machida H, Mandelbaum RS, Konishi I, Mikami M. Validation of the 2018 FIGO cervical cancer staging system. Gynecol Oncol 2019; 152 (01) 87-93
- 45 Liu X, Wang J, Hu K. et al. Validation of the 2018 FIGO staging system of cervical cancer for stage III patients with a cohort from China. Cancer Manag Res 2020; 12: 1405-1410
- 46 Cheng X, Cai S, Li Z, Tang M, Xue M, Zang R. The prognosis of women with stage IB1-IIB node-positive cervical carcinoma after radical surgery. World J Surg Oncol 2004; 2: 47
- 47 Koh W-J, Abu-Rustum NR, Bean S. et al. Cervical cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17 (01) 64-84
- 48 Siegel CL, Andreotti RF, Cardenes HR. et al; American College of Radiology. ACR Appropriateness Criteria® pretreatment planning of invasive cancer of the cervix. J Am Coll Radiol 2012; 9 (06) 395-402
- 49 Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 22-36
- 50 Jolly S, Uppal S, Bhatla N, Johnston C, Maturen K. Improving global outcomes in cervical cancer: the time has come for international federation of gynecology and obstetrics staging to formally incorporate advanced imaging. J Glob Oncol 2018; 4: 1-6
- 51 Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013; 266 (03) 717-740
- 52 Wakefield JC, Downey K, Kyriazi S, deSouza NM. New MR techniques in gynecologic cancer. AJR Am J Roentgenol 2013; 200 (02) 249-260
- 53 Patel-Lippmann K, Robbins JB, Barroilhet L, Anderson B, Sadowski EA, Boyum J. MR imaging of cervical cancer. Magn Reson Imaging Clin N Am 2017; 25 (03) 635-649
- 54 Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol 2016; 8 (04) 342-354
- 55 Devine C, Gardner C, Sagebiel T, Bhosale P. Magnetic resonance imaging in the diagnosis, staging, and surveillance of cervical carcinoma. Semin Ultrasound CT MR 2015; 36 (04) 361-368
- 56 Akin O, Mironov S, Pandit-Taskar N, Hann LE. Imaging of uterine cancer. Radiol Clin North Am 2007; 45 (01) 167-182
- 57 McMahon CJ, Rofsky NM, Pedrosa I. Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging. Radiology 2010; 254 (01) 31-46
- 58 Cibula D, Pötter R, Planchamp F. et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer. Virchows Arch 2018; 472 (06) 919-936
- 59 Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. ESMO Guidelines Committee. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28 (Suppl. 04) iv72-iv83
- 60 Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013; 49 (06) 1374-1403
- 61 Lee SI, Atri M. 2018 FIGO staging system for uterine cervical cancer: enter cross-sectional imaging. Radiology 2019; 292 (01) 15-24
- 62 Yan D-D, Tang Q, Chen J-H, Tu Y-Q, Lv X-J. Prognostic value of the 2018 FIGO staging system for cervical cancer patients with surgical risk factors. Cancer Manag Res 2019; 11: 5473-5480
- 63 Bhatla N, Rajaram S, Maheshwari A. The revised FIGO staging of cervical cancer (2018): implications for India and the LMICs. Indian J Gynecol Oncol 2019; 17: 92