European Radiology

, Volume 21, Issue 5, pp 1102–1110 | Cite as

Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology

  • Corinne Balleyguier
  • E. Sala
  • T. Da Cunha
  • A. Bergman
  • B. Brkljacic
  • F. Danza
  • R. Forstner
  • B. Hamm
  • R. Kubik-Huch
  • C. Lopez
  • R. Manfredi
  • J. McHugo
  • L. Oleaga
  • K. Togashi
  • K. Kinkel
Urogenital

Abstract

Objective: To design clear guidelines for the staging and follow-up of patients with uterine cervical cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences. Methods: Guidelines for uterine cervical cancer staging and follow-up were defined by the female imaging subcommittee of the ESUR (European Society of Urogenital Radiology) based on the expert consensus of imaging protocols of 11 leading institutions and a critical review of the literature. Results: The results indicated that high field Magnetic Resonance Imaging (MRI) should include at least two T2-weighted sequences in sagittal, axial oblique or coronal oblique orientation (short and long axis of the uterine cervix) of the pelvic content. Axial T1-weighted sequence is useful to detect suspicious pelvic and abdominal lymph nodes, and images from symphysis to the left renal vein are required. The intravenous administration of Gadolinium-chelates is optional but is often required for small lesions (<2 cm) and for follow-up after treatment. Diffusion-weighted sequences are optional but are recommended to help evaluate lymph nodes and to detect a residual lesion after chemoradiotherapy. Conclusions: Expert consensus and literature review lead to an optimized MRI protocol to stage uterine cervical cancer. MRI is the imaging modality of choice for preoperative staging and follow-up in patients with uterine cervical cancer.

Keywords

Uterus Cervix Cervical cancer Staging Magnetic resonance (MR) 

References

  1. 1.
    Ozsarlak O, Tjalma W, Schepens E, Corthouts B, Op de Beeck B, Van Marck E et al (2003) The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma. Eur Radiol 13:2338–2345PubMedCrossRefGoogle Scholar
  2. 2.
    Odicino F, Tisi G, Rampinelli F, Miscioscia R, Sartori E, Pecorelli S (2007) New development of the FIGO staging system. Gynecol Oncol 107(1 Suppl 1):S8–S9PubMedCrossRefGoogle Scholar
  3. 3.
    Lagasse LD, Creasman WT, Shingleton HM, Ford JH, Blessing JA (1980) Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. Gynecol Oncol 9:90–98PubMedCrossRefGoogle Scholar
  4. 4.
    Piver MS, Chung WS (1975) Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol 46:507–510PubMedGoogle Scholar
  5. 5.
    Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104PubMedCrossRefGoogle Scholar
  6. 6.
    Hori M, Kim T, Murakami T, Imaoka I, Onishi H, Tomoda K et al (2009) Uterine cervical carcinoma: preoperative staging with 3.0-T MR imaging–comparison with 1.5-T MR imaging. Radiology 251:96–104PubMedCrossRefGoogle Scholar
  7. 7.
    Engin G, Cervical cancer (2006) MR imaging findings before, during, and after radiation therapy. Eur Radiol 16:313–324PubMedCrossRefGoogle Scholar
  8. 8.
    Liu Y, Bai R, Sun H, Liu H, Zhao X, Li Y (2009) Diffusion-weighted imaging in predicting and monitoring the response of uterine cervical cancer to combined chemoradiation. Clin Radiol 64:1067–1074PubMedCrossRefGoogle Scholar
  9. 9.
    Haider MA, Patlas M, Jhaveri K, Chapman W, Fyles A, Rosen B (2006) Adenocarcinoma involving the uterine cervix: magnetic resonance imaging findings in tumours of endometrial, compared with cervical, origin. Can Assoc Radiol J 57:43–48PubMedGoogle Scholar
  10. 10.
    Van Hoe L, Vanbeckevoort D, Oyen R, Itzlinger U, Vergote I (1999) Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging–preliminary results. Radiology 213:608–611PubMedGoogle Scholar
  11. 11.
    Haider MA, Sitartchouk I, Roberts TP, Fyles A, Hashmi AT, Milosevic M (2007) Correlations between dynamic contrast-enhanced magnetic resonance imaging-derived measures of tumour microvasculature and interstitial fluid pressure in patients with cervical cancer. J Magn Reson Imaging 25:153–159PubMedCrossRefGoogle Scholar
  12. 12.
    Hricak H, Yu KK, Powell CB, Subak LL, Stem J, Arenson RL (1996) Comparison of diagnostic studies in the pretreatment evaluation of stage Ib carcinoma of the cervix. Acad Radiol 3(Suppl 1):S44–S46PubMedCrossRefGoogle Scholar
  13. 13.
    deSouza NM, Dina R, McIndoe GA, Soutter WP (2006) Cervical cancer: value of an endovaginal coil magnetic resonance imaging technique in detecting small volume disease and assessing parametrial extension. Gynecol Oncol 102:80–85PubMedCrossRefGoogle Scholar
  14. 14.
    Rockall AG, Ghosh S, Alexander-Sefre F, Babar S, Younis MT, Naz S et al (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
  15. 15.
    Van Vierzen PB, Massuger LF, Ruys SH, Barentsz JO (1998) Fast dynamic contrast enhanced MR imaging of cervical carcinoma. Clin Radiol 53:183–192PubMedCrossRefGoogle Scholar
  16. 16.
    Kinkel K, Ariche M, Tardivon AA, Spatz A, Castaigne D, Lhomme C et al (1997) Differentiation between recurrent tumour and benign conditions after treatment of gynecologic pelvic carcinoma: value of dynamic contrast-enhanced subtraction MR imaging. Radiology 204:55–63PubMedGoogle Scholar
  17. 17.
    Hricak H, Gatsonis C, Chi DS, Amendola MA, Brandt K, Schwartz LH et al (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
  18. 18.
    Keller TM, Michel SC, Frohlich J, Fink D, Caduff R, Marincek B et al (2004) USPIO-enhanced MRI for preoperative staging of gynecological pelvic tumours: preliminary results. Eur Radiol 14:937–944CrossRefGoogle Scholar
  19. 19.
    Choi SH, Kim SH, Choi HJ, Park BK, Lee HJ (2004) Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study. J Comput Assist Tomogr 28:620–627PubMedCrossRefGoogle Scholar
  20. 20.
    Akata D, Kerimoglu U, Hazirolan T, Karcaaltincaba M, Kose F, Ozmen MN et al (2005) Efficacy of transvaginal contrast-enhanced MRI in the early staging of cervical carcinoma. Eur Radiol 15:1727–1733PubMedCrossRefGoogle Scholar
  21. 21.
    Hancke K, Heilmann V, Straka P, Kreienberg R, Kurzeder C (2008) 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 15:2856–2861PubMedCrossRefGoogle Scholar
  22. 22.
    Messiou C, Morgan VA, De Silva SS, Ind TE, deSouza NM (2009) Diffusion weighted imaging of the uterus: regional ADC variation with oral contraceptive usage and comparison with cervical cancer. Acta Radiol 50:696–701PubMedCrossRefGoogle Scholar
  23. 23.
    Charles-Edwards EM, Messiou C, Morgan VA, De Silva SS, McWhinney NA, Katesmark M et al (2008) Diffusion-weighted imaging in cervical cancer with an endovaginal technique: potential value for improving tumour detection in stage Ia and Ib1 disease. Radiology 249:541–550PubMedCrossRefGoogle Scholar
  24. 24.
    Harry VN, Semple SI, Gilbert FJ, Parkin DE (2008) Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer. Gynecol Oncol 111:213–220PubMedCrossRefGoogle Scholar
  25. 25.
    Whittaker CS, Coady A, Culver L, Rustin G, Padwick M, Padhani AR (2009) Diffusion-weighted MR imaging of female pelvic tumours: a pictorial review. Radiographics 29:759–774, discussion 74-8PubMedCrossRefGoogle Scholar
  26. 26.
    Naganawa S, Sato C, Kumada H, Ishigaki T, Miura S, Takizawa O (2005) Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol 15:71–78PubMedCrossRefGoogle Scholar
  27. 27.
    McVeigh PZ, Syed AM, Milosevic M, Fyles A, Haider MA (2008) Diffusion-weighted MRI in cervical cancer. Eur Radiol 18:1058–1064PubMedCrossRefGoogle Scholar
  28. 28.
    Park SO, Kim JK, Kim KA, Park BW, Kim N, Cho G et al (2009) Relative apparent diffusion coefficient: determination of reference site and validation of benefit for detecting metastatic lymph nodes in uterine cervical cancer. J Magn Reson Imaging 29:383–390PubMedCrossRefGoogle Scholar
  29. 29.
    Xue HD, Li S, Sun F, Sun HY, Jin ZY, Yang JX et al (2008) Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer. Chin Med Sci J 23:133–137PubMedCrossRefGoogle Scholar
  30. 30.
    Torashima M, Yamashita Y, Hatanaka Y, Takahashi M, Miyazaki K, Okamura H (1997) Invasive adenocarcinoma of the uterine cervix: MR imaging. Comput Med Imaging Graph 21:253–260CrossRefGoogle Scholar
  31. 31.
    Liu PF, Krestin GP, Huch RA, Gohde SC, Caduff RF, Debatin JF (1998) MRI of the uterus, uterine cervix, and vagina: diagnostic performance of dynamic contrast-enhanced fast multiplanar gradient-echo imaging in comparison with fast spin-echo T2-weighted pulse imaging. Eur Radiol 8:1433–1440PubMedCrossRefGoogle Scholar
  32. 32.
    Sheu MH, Chang CY, Wang JH, Yen MS (2001) Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls. Eur Radiol 11:1828–1833PubMedCrossRefGoogle Scholar
  33. 33.
    Dimopoulos JC, Kirisits C, Petric P, Georg P, Lang S, Berger D et al (2006) The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: clinical feasibility and preliminary results. Int J Radiat Oncol Biol Phys 66:83–90PubMedCrossRefGoogle Scholar
  34. 34.
    Ferrandina G, Distefano M, Ludovisi M, Morganti A, Smaniotto D, D’Agostino G et al (2007) Lymph node involvement in locally advanced cervical cancer patients administered preoperative chemoradiation versus chemotherapy. Ann Surg Oncol 14:1129–1135PubMedCrossRefGoogle Scholar
  35. 35.
    Narayan K, McKenzie AF, Hicks RJ, Fisher R, Bernshaw D, Bau S (2003) Relation between FIGO stage, primary tumour volume, and presence of lymph node metastases in cervical cancer patients referred for radiotherapy. Int J Gynecol Cancer 13:657–663PubMedCrossRefGoogle Scholar
  36. 36.
    Hawighorst H (1999) Dynamic MR imaging in cervical carcinoma. Radiology 213:617–618PubMedGoogle Scholar
  37. 37.
    Scheidler J, Hricak H, Yu KK, Subak L, Segal MR (1997) Radiological evaluation of lymph node metastases in patients with cervical cancer. A meta-analysis. JAMA 278:1096–1101PubMedCrossRefGoogle Scholar
  38. 38.
    Pandharipande PV, Choy G, del Carmen MG, Gazelle GS, Russell AH, Lee SI (2009) 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 192:802–814PubMedCrossRefGoogle Scholar
  39. 39.
    Mitchell DG, Snyder B, Coakley F, Reinhold C, Thomas G, Amendola MA et al (2009) Early invasive cervical cancer: MRI and CT predictors of lymphatic metastases in the ACRIN 6651/GOG 183 intergroup study. Gynecol Oncol 112:95–103PubMedCrossRefGoogle Scholar
  40. 40.
    Jimenez de la Pena M, de Vega M, Fernandez V, Recio Rodriguez M, Carrascoso Arranz J, Herraiz Hidalgo L, Alvarez Moreno E (2008) Current imaging modalities in the diagnosis of cervical cancer. Gynecol Oncol 110:S49–S54PubMedCrossRefGoogle Scholar
  41. 41.
    Haie-Meder C, Fervers B, Chauvergne J, Fondrinier E, Lhomme C, Bataillard A et al (2000) Radiochimiothérapie concomitante dans les cancers du col de l’utérus: analyse critique des données et mise a jour des Standards, Options et Recommandations. Cancer Radiother 4:60–75PubMedGoogle Scholar
  42. 42.
    Gong QY, Brunt JN, Romaniuk CS, Oakley JP, Tan LT, Roberts N et al (1999) Contrast enhanced dynamic MRI of cervical carcinoma during radiotherapy: early prediction of tumour regression rate. Br J Radiol 72:1177–1184PubMedGoogle Scholar
  43. 43.
    Plante M, Roy M (2006) Fertility-preserving options for cervical cancer. Oncology 20:479–488, discussion 491-3PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Corinne Balleyguier
    • 1
  • E. Sala
    • 2
  • T. Da Cunha
    • 3
  • A. Bergman
    • 4
  • B. Brkljacic
    • 5
  • F. Danza
    • 6
  • R. Forstner
    • 7
  • B. Hamm
    • 8
  • R. Kubik-Huch
    • 9
  • C. Lopez
    • 10
  • R. Manfredi
    • 10
  • J. McHugo
    • 11
  • L. Oleaga
    • 12
  • K. Togashi
    • 13
  • K. Kinkel
    • 14
  1. 1.Radiology DepartmentInstitut Gustave RoussyVillejuifFrance
  2. 2.Radiology DepartmentAddenbrooke’s HospitalCambridgeUK
  3. 3.Radiology DepartmentInstituto Português de Oncologia de Lisboa Francisco GentilLisbonPortugal
  4. 4.Department of RadiologyUppsala University HospitalUppsalaSweden
  5. 5.Department of Diagnostic and Interventional RadiologyUniversity Hospital “Dubrava”ZagrebCroatia
  6. 6.Dipartimento di Bioimmaginie scienze radiologicheUniversità Cattolica del S. CuoreRomeItaly
  7. 7.ZentralröntgeninstitutLandesklinikenSalzburgSalzburgAustria
  8. 8.Department of RadiologyCharité Humboldt Universität BerlinBerlinGermany
  9. 9.Institut Radiologie Kantonsspital BadenBadenGermany
  10. 10.Department of Radiology“A. Gemelli” University HospitalRomeItaly
  11. 11.Department of RadiologyBirmingham Women’s HospitalBirminghamUK
  12. 12.Radiology DepartmentHospital ClinicBarcelonaSpain
  13. 13.Department of Diagnostic Imaging and Nuclear MedicineKyoto University Graduate School of MedicineKyotoJapan
  14. 14.Institut de radiologieClinique des GrangettesChêne-Bougerie/GenevaSwitzerland

Personalised recommendations