Cervical Malignancies: Status of MRI
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REVIEW ARTICLE
Cervical Malignancies: Status of MRI Parveen Gulati1
•
Ankita Agarwal2 • Vaibhav Gulati1,2
Received: 6 June 2020 / Revised: 16 July 2020 / Accepted: 25 July 2020 / Published online: 5 August 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Purpose Cervical malignancies account for 14% of all female malignancies. Revised FIGO staging guidelines of 2018 give importance to and take into consideration the imaging findings. This article aims to review the role of MRI in preoperative as well as postoperative evaluation of these malignancies. Method A systematic literature review was conducted through online databases including PubMed and Medline. Relevant publications on the role of MRI in detection, staging and follow-up of cervical malignancies were reviewed and included in the analysis. Results MRI has emerged as the most sensitive noninvasive imaging modality for accurately assessing the tumor volume, parametrial invasion, pelvic wall/lymph node involvement and bladder or rectal invasion. Dynamic contrast studies with diffusion-weighted imaging can help in the evaluation of recurrence of the disease as well as in differentiating metastatic nodes from infective nodes. Conclusion MRI with advanced techniques like dynamic contrast studies and diffusion-weighted imaging is the most sensitive imaging modality available today for pre- and post-treatment cervical malignancies. Keywords Cervical cancer MRI FIGO DWI
Introduction Cervical cancer is the third most common cause of death due to cancer in females in developing nations and is the fourth most common cancer in females [1, 2]. In India, it is the second most common cancer after breast, accounting for almost 14% of all female cancer cases in females of 35–45 years of age [3, 4]. Most cases are associated with human papillomavirus, especially strains 16 and 18, which are seen in 71% of cases. Screening of cervical cancers is routinely done and started from a young age in sexually active females with Pap smear along with HPV detection. Histopathologically, the most common type of cervical cancer is squamous cell type, followed by adenocarcinoma. A small number is also constituted by other rare varieties like neuroendocrine, adenoid cystic, adenoid basal, and & Parveen Gulati [email protected] 1
Dr. Gulati Imaging Institute, J-16, Hauz Khas Enclave, New Delhi 110016, India
2
National Heart Institute, New Delhi, India
small cell carcinoma. Adenocarcinoma carries a worse prognosis than squamous cell carcinoma [5]. The management and prognosis depend upon the extent of disease at the time of diagnosis. The earlier FIGO classification was solely clinical; however, the modified FIGO classification system also gives due consideration to cross-sectional imaging when available. Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) are all being used for the evaluation of cervical malignancies as well as for followup. The overall staging accuracy of CT ranges between 32 and 80%, but it
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