European Radiology

, Volume 17, Issue 8, pp 2009–2019 | Cite as

Staging of carcinoma of the uterine cervix and endometrium



Carcinoma of the uterine cervix and endometrium are common gynecologic malignancies. Both carcinomas are staged and managed by means of the International Federation of Gynecology and Obstetrics (FIGO) staging system. In uterine cervical cancer, the FIGO staging system is determined preoperatively by limited conventional procedures. Although this system is effective for early stage disease, it has inherent inaccuracies in advanced stage diseases and does not address nodal involvement. CT and MR imaging are widely used as comprehensive imaging modalities to evaluate tumor size and extent, and nodal involvement. MR imaging is an excellent modality for depicting invasive cervical carcinoma and can provide objective measurement of tumor volume, and provides high negative predictive value for parametrial invasion and stage IVA disease. In contrast, endometrial cancer is surgically staged. Beside recognition of the important prognostic factors, including histologic subtype and grade, accurate assessment of the tumor extent on preoperative MR imaging is expected to greatly optimize surgical procedure and therapeutic strategy. Contrast-enhanced MR imaging can offer “one stop” examination for evaluating the depth of myometrial invasion cervical invasion and nodal metastases. Evaluation of myometrial invasion on MR imaging may be an alternative to gross inspection of the uterus during the surgery.


Cancer Cervix Endometrium Staging MRI 


  1. 1.
    Sironi S, Belloni C, Taccagni G, DelMaschio A (1991) Invasive cervical carcinoma: MR imaging after preoperative chemotherapy. Radiology 180:719–722PubMedGoogle Scholar
  2. 2.
    Kim KH, Lee BH, Do YS, Chin SY, Park SY, Kim BG, Jang JJ (1994) Stage IIb cervical carcinoma: MR evaluation of effect of intraarterial chemotherapy. Radiology 192:61–65PubMedGoogle Scholar
  3. 3.
    Eifel PJ, Morris M, Wharton JT, Oswald MJ (1994) The influence of tumor size and morphology on the outcome of patients with FIGO stage IB squamous cell carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys 29:9–16PubMedGoogle Scholar
  4. 4.
    Itoh N, Sawairi M, Hanabayashi T, Mori H, Yamawaki Y, Tamaya T (1992) Neoadjuvant intraarterial infusion chemotherapy with a combination of mitomycin-C, vincristine, and cisplatin for locally advanced cervical cancer: a preliminary report. Gynecol Oncol 47:391–394PubMedCrossRefGoogle Scholar
  5. 5.
    Pandit-Taskar N (2005) Oncologic imaging in gynecologic malignancies. J Nucl Med 46:1842–1850PubMedGoogle Scholar
  6. 6.
    Miller AB, Lindsay J, Hill GB (1976) Mortality from cancer of the uterus in Canada and its relationship to screening for cancer of the cervix. Int J Cancer 17:602–612PubMedCrossRefGoogle Scholar
  7. 7.
    Devesa SS, Young JL Jr, Brinton LA, Fraumeni JF Jr (1989) Recent trends in cervix uteri cancer. Cancer 64:2184–2190PubMedCrossRefGoogle Scholar
  8. 8.
    Benedet JL, Anderson GH, Matisic JP (1992) A comprehensive program for cervical cancer detection and management. Am J Obstet Gynecol 166:1254–1259PubMedGoogle Scholar
  9. 9.
    Cannistra SA, Niloff JM (1996) Cancer of the uterine cervix. N Engl J Med 334:1030–1038PubMedCrossRefGoogle Scholar
  10. 10.
    Togashi K, Morikawa K, Kataoka ML, Konishi J (1998) Cervical cancer. J Magn Reson Imaging 8:391–397PubMedCrossRefGoogle Scholar
  11. 11.
    Subak LL, Hricak H, Powell CB, Azizi L, Stern JL (1995) Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 86:43–50PubMedCrossRefGoogle Scholar
  12. 12.
    Mayr NA, Tali ET, Yuh WT, Brown BP, Wen BC, Buller RE, Anderson B, Hussey DH (1993) Cervical cancer: application of MR imaging in radiation therapy. Radiology 189:601–608PubMedGoogle Scholar
  13. 13.
    Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S (1999) Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 340:1144–1153PubMedCrossRefGoogle Scholar
  14. 14.
    Amendola MA, Hricak H, Mitchell DG, Snyder B, Chi DS, Long HJ 3rd, Fiorica JV, Gatsonis C (2005) 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 23:7454–7459PubMedCrossRefGoogle Scholar
  15. 15.
    Hricak H, Gatsonis C, Chi DS, Amendola MA, Brandt K, Schwartz LH, Koelliker S, Siegelman ES, Brown JJ, McGhee RB Jr, Iyer R, Vitellas KM, Snyder B, Long HJ 3rd, Fiorica JV, Mitchell DG (2005) Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study; American College of Radiology Imaging Network 6651; Gynecologic Oncology Group 183. J Clin Oncol 23:9329–9337PubMedCrossRefGoogle Scholar
  16. 16.
    Togashi K, Nishimura K, Itoh K, Fujisawa I, Asato R, Nakano Y, Itoh H, Torizuka K, Ozasa H, Mori T (1986) Uterine cervical cancer: assessment with high-field MR imaging. Radiology 160:431–435PubMedGoogle Scholar
  17. 17.
    Hricak H, Lacey CG, Sandles LG, Chang YC, Winkler ML, Stern JL (1988) Invasive cervical carcinoma: comparison of MR imaging and surgical findings. Radiology 166:623–631PubMedGoogle Scholar
  18. 18.
    Togashi K, Nishimura K, Sagoh T, Minami S, Noma S, Fujisawa I, Nakano Y, Konishi J, Ozasa H, Konishi I et al (1989) Carcinoma of the cervix: staging with MR imaging. Radiology 171:245–251PubMedGoogle Scholar
  19. 19.
    Lien HH, Blomlie V, Kjorstad K, Abeler V, Kaalhus O (1991) Clinical stage I carcinoma of the cervix: value of MR imaging in determining degree of invasiveness. AJR Am J Roentgenol 156:1191–1194PubMedGoogle Scholar
  20. 20.
    Sironi S, Belloni C, Taccagni GL, DelMaschio A (1991) Carcinoma of the cervix: value of MR imaging in detecting parametrial involvement. AJR Am J Roentgenol 156:753–756PubMedGoogle Scholar
  21. 21.
    Fujiwara K, Yoden E, Asakawa T, Shimizu M, Hirokawa M, Mikami Y, Oda T, Joja I, Imajo Y, Kohno I (2000) Negative MRI findings with invasive cervical biopsy may indicate stage IA cervical carcinoma. Gynecol Oncol 79:451–456PubMedCrossRefGoogle Scholar
  22. 22.
    Fujiwara K, Yoden E, Asakawa T, Shimizu M, Hirokawa M, Oda T, Joja I, Imajo Y, Kohno I (2000) Role of magnetic resonance imaging (MRI) in early cervical cancer. Gan To Kagaku Ryoho 27(Suppl 2):576–81PubMedGoogle Scholar
  23. 23.
    Sironi S, Bellomi M, Villa G, Rossi S, Del Maschio A (2002) Clinical stage I carcinoma of the uterine cervix value of preoperative magnetic resonance imaging in assessing parametrial invasion. Tumori 88:291–295PubMedGoogle Scholar
  24. 24.
    Kim SH, Choi BI, Han JK, Kim HD, Lee HP, Kang SB, Lee JY, Han MC (1993) Preoperative staging of uterine cervical carcinoma: comparison of CT and MRI in 99 patients. J Comput Assist Tomogr 17:633–640PubMedCrossRefGoogle Scholar
  25. 25.
    Kim SH, Choi BI, Lee HP, Kang SB, Choi YM, Han MC, Kim CW (1990) Uterine cervical carcinoma: comparison of CT and MR findings. Radiology 175:45–51PubMedGoogle Scholar
  26. 26.
    Seki H, Azumi R, Kimura M, Sakai K (1997) Stromal invasion by carcinoma of the cervix: assessment with dynamic MR imaging. AJR Am J Roentgenol 168:1579–1585PubMedGoogle Scholar
  27. 27.
    Abe Y, Yamashita Y, Namimoto T, Takahashi M, Katabuchi H, Tanaka N, Okamura H (1998) Carcinoma of the uterine cervix. High-resolution turbo spin-echo MR imaging with contrast-enhanced dynamic scanning and T2-weighting. Acta Radiol 39:322–326PubMedCrossRefGoogle Scholar
  28. 28.
    Yamashita Y, Takahashi M, Sawada T, Miyazaki K, Okamura H (1992) Carcinoma of the cervix: dynamic MR imaging. Radiology 182:643–648PubMedGoogle Scholar
  29. 29.
    Hricak H, Powell CB, Yu KK, Washington E, Subak LL, Stern JL, Cisternas MG, Arenson RL (1996) Invasive cervical carcinoma: role of MR imaging in pretreatment work-up-cost minimization and diagnostic efficacy analysis. Radiology 198:403–409PubMedGoogle Scholar
  30. 30.
    Vick CW, Walsh JW, Wheelock JB, Brewer WH (1984) CT of the normal and abnormal parametria in cervical cancer. Am J Roentgenol 143:597–603Google Scholar
  31. 31.
    Rockall AG, Ghosh S, Alexander-Sefre F, Babar S, Younis MT, Naz S, Jacobs IJ, Reznek RH (2006) Can MRI rule out bladder and rectal invasion in cervical cancer to help select patients for limited EUA? Gynecol Oncol 101:244–249PubMedCrossRefGoogle Scholar
  32. 32.
    Popovich MJ, Hricak H, Sugimura K, Stern JL (1993) The role of MR imaging in determining surgical eligibility for pelvic exenteration. Am J Roentgenol 160:525–531Google Scholar
  33. 33.
    Kim SH, Han MC (1997) Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. Am J Roentgenol 168:393–397Google Scholar
  34. 34.
    Hawnaur JM (1993) Staging of cervical and endometrial carcinoma. Clin Radiol 47:7–13PubMedCrossRefGoogle Scholar
  35. 35.
    Bellomi M, Bonomo G, Landoni F, Villa G, Leon ME, Bocciolone L, Maggioni A, Viale G (2005) Accuracy of computed tomography and magnetic resonance imaging in the detection of lymph node involvement in cervix carcinoma. Eur Radiol 15:2469–2474PubMedCrossRefGoogle Scholar
  36. 36.
    Kim SH, Kim SC, Choi BI, Han MC (1994) Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology 190:807–811PubMedGoogle Scholar
  37. 37.
    Harisinghani MG, Saini S, Slater GJ, Schnall MD, Rifkin MD (1997) MR imaging of pelvic lymph nodes in primary pelvic carcinoma with ultrasmall superparamagnetic iron oxide (Combidex): preliminary observations. J Magn Reson Imaging 7:161–163PubMedCrossRefGoogle Scholar
  38. 38.
    Harisinghani MG, Barentsz J, Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, de la Rosette J, Weissleder R (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499PubMedCrossRefGoogle Scholar
  39. 39.
    Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:825–850CrossRefGoogle Scholar
  40. 40.
    Fisher B, Costantino JP, Redmond CK, Fisher ER, Wickerham DL, Cronin WM (1994) Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14. J Natl Cancer Inst 86:527–537PubMedCrossRefGoogle Scholar
  41. 41.
    Frei KA, Kinkel K, Bonel HM, Lu Y, Zaloudek C, Hricak H (2000) Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta-analysis and Bayesian analysis. Radiology 216:444–449PubMedGoogle Scholar
  42. 42.
    Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A gynecologic oncology group study. Cancer 60:2035–2041PubMedCrossRefGoogle Scholar
  43. 43.
    Chambers SK, Kapp DS, Peschel RE, Lawrence R, Merino M, Kohorn EI, Schwartz PE (1987) Prognostic factors and sites of failure in FIGO Stage I, Grade 3 endometrial carcinoma. Gynecol Oncol 27:180–188PubMedCrossRefGoogle Scholar
  44. 44.
    Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE (1991) Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 40:55–65PubMedCrossRefGoogle Scholar
  45. 45.
    Wilson TO, Podratz KC, Gaffey TA, Malkasian GD Jr, O’Brien PC, Naessens JM (1990) Evaluation of unfavorable histologic subtypes in endometrial adenocarcinoma. Am J Obstet Gynecol 162:418–423; discussion 423–426PubMedGoogle Scholar
  46. 46.
    Landis SH, Murray T, Bolden S, Wingo PA (1998) Cancer statistics, 1998. CA Cancer J Clin 48:6–29PubMedGoogle Scholar
  47. 47.
    Smith-Bindman R, Kerlikowske K, Feldstein VA, Subak L, Scheidler J, Segal M, Brand R, Grady D (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–1517PubMedCrossRefGoogle Scholar
  48. 48.
    Minagawa Y, Sato S, Ito M, Onohara Y, Nakamoto S, Kigawa J (2005) Transvaginal ultrasonography and endometrial cytology as a diagnostic schema for endometrial cancer. Gynecol Obstet Invest 59:149–154PubMedCrossRefGoogle Scholar
  49. 49.
    Weaver J, McHugo JM, Clark TJ (2005) Accuracy of transvaginal ultrasound in diagnosing endometrial pathology in women with post-menopausal bleeding on tamoxifen. Br J Radiol 78:394–397PubMedCrossRefGoogle Scholar
  50. 50.
    Doering DL, Barnhill DR, Weiser EB, Burke TW, Woodward JE, Park RC (1989) Intraoperative evaluation of depth of myometrial invasion in stage I endometrial adenocarcinoma. Obstet Gynecol 74:930–933PubMedGoogle Scholar
  51. 51.
    Kinkel K, Kaji Y, Yu KK, Segal MR, Lu Y, Powell CB, Hricak H (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718PubMedGoogle Scholar
  52. 52.
    Hardesty LA, Sumkin JH, Nath ME, Edwards RP, Price FV, Chang TS, Johns CM, Kelley JL (2000) Use of preoperative MR imaging in the management of endometrial carcinoma: cost analysis. Radiology 215:45–49PubMedGoogle Scholar
  53. 53.
    Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305PubMedGoogle Scholar
  54. 54.
    Yamashita Y, Harada M, Sawada T, Takahashi M, Miyazaki K, Okamura H (1993) Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging. Radiology 186:495–501PubMedGoogle Scholar
  55. 55.
    Ito K, Matsumoto T, Nakada T, Nakanishi T, Fujita N, Yamashita H (1994) Assessing myometrial invasion by endometrial carcinoma with dynamic MRI. J Comput Assist Tomogr 18:77–86PubMedCrossRefGoogle Scholar
  56. 56.
    Seki H, Kimura M, Sakai K (1997) Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images. Clin Radiol 52:18–23PubMedCrossRefGoogle Scholar
  57. 57.
    Takahashi S, Murakami T, Narumi Y, Kurachi H, Tsuda K, Kim T, Enomoto T, Tomoda K, Miyake A, Murata Y, Nakamura H (1998) Preoperative staging of endometrial carcinoma: diagnostic effect of T2-weighted fast spin-echo MR imaging. Radiology 206:539–547PubMedGoogle Scholar
  58. 58.
    Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40PubMedCrossRefGoogle Scholar
  59. 59.
    Hernandez E, Woodruff JD (1980) Endometrial adenocarcinoma arising in adenomyosis. Am J Obstet Gynecol 138:827–832PubMedGoogle Scholar
  60. 60.
    Hall JB, Young RH, Nelson JH Jr (1984) The prognostic significance of adenomyosis in endometrial carcinoma. Gynecol Oncol 17:32–40PubMedCrossRefGoogle Scholar
  61. 61.
    Mittal KR, Barwick KW (1993) Endometrial adenocarcinoma involving adenomyosis without true myometrial invasion is characterized by frequent preceding estrogen therapy, low histologic grades, and excellent prognosis. Gynecol Oncol 49:197–201PubMedCrossRefGoogle Scholar
  62. 62.
    Minderhoud-Bassie W, Treurniet FE, Koops W, Chadha-Ajwani S, Hage JC, Huikeshoven FJ (1995) Magnetic resonance imaging (MRI) in endometrial carcinoma; preoperative estimation of depth of myometrial invasion. Acta Obstet Gynecol Scand 74:827–831PubMedGoogle Scholar
  63. 63.
    Manfredi R, Mirk P, Maresca G, Margariti PA, Testa A, Zannoni GF, Giordano D, Scambia G, Marano P (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378PubMedCrossRefGoogle Scholar
  64. 64.
    Kinkel K (2006) Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 31:164–173PubMedCrossRefGoogle Scholar
  65. 65.
    Prat J (2004) Prognostic parameters of endometrial carcinoma. Hum Pathol 35:649–662PubMedCrossRefGoogle Scholar
  66. 66.
    McCluggage WG, Wilkinson N (2005) Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features. Histopathology 47:231–247PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Department of Diagnostic Radiology, Graduate School of MedicineKyoto UniversityKyotoJapan

Personalised recommendations