Abstract
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.
Similar content being viewed by others
References
Sironi S, Belloni C, Taccagni G, DelMaschio A (1991) Invasive cervical carcinoma: MR imaging after preoperative chemotherapy. Radiology 180:719–722
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 192:61–65
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 29:9–16
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 47:391–394
Pandit-Taskar N (2005) Oncologic imaging in gynecologic malignancies. J Nucl Med 46:1842–1850
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 17:602–612
Devesa SS, Young JL Jr, Brinton LA, Fraumeni JF Jr (1989) Recent trends in cervix uteri cancer. Cancer 64:2184–2190
Benedet JL, Anderson GH, Matisic JP (1992) A comprehensive program for cervical cancer detection and management. Am J Obstet Gynecol 166:1254–1259
Cannistra SA, Niloff JM (1996) Cancer of the uterine cervix. N Engl J Med 334:1030–1038
Togashi K, Morikawa K, Kataoka ML, Konishi J (1998) Cervical cancer. J Magn Reson Imaging 8:391–397
Subak LL, Hricak H, Powell CB, Azizi L, Stern JL (1995) Cervical carcinoma: computed tomography and magnetic resonance imaging for preoperative staging. Obstet Gynecol 86:43–50
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 189:601–608
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 340:1144–1153
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 23:7454–7459
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 23:9329–9337
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 160:431–435
Hricak H, Lacey CG, Sandles LG, Chang YC, Winkler ML, Stern JL (1988) Invasive cervical carcinoma: comparison of MR imaging and surgical findings. Radiology 166:623–631
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 171:245–251
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 156:1191–1194
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 156:753–756
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 79:451–456
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):576–81
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 88:291–295
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 17:633–640
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 175:45–51
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 168:1579–1585
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 39:322–326
Yamashita Y, Takahashi M, Sawada T, Miyazaki K, Okamura H (1992) Carcinoma of the cervix: dynamic MR imaging. Radiology 182:643–648
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 198:403–409
Vick CW, Walsh JW, Wheelock JB, Brewer WH (1984) CT of the normal and abnormal parametria in cervical cancer. Am J Roentgenol 143:597–603
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 101:244–249
Popovich MJ, Hricak H, Sugimura K, Stern JL (1993) The role of MR imaging in determining surgical eligibility for pelvic exenteration. Am J Roentgenol 160:525–531
Kim SH, Han MC (1997) Invasion of the urinary bladder by uterine cervical carcinoma: evaluation with MR imaging. Am J Roentgenol 168:393–397
Hawnaur JM (1993) Staging of cervical and endometrial carcinoma. Clin Radiol 47:7–13
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 15:2469–2474
Kim SH, Kim SC, Choi BI, Han MC (1994) Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology 190:807–811
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 7:161–163
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 348:2491–2499
Frei KA, Kinkel K (2001) Staging endometrial cancer: role of magnetic resonance imaging. J Magn Reson Imaging 13:825–850
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 86:527–537
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 216:444–449
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 60:2035–2041
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 27:180–188
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 40:55–65
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 423–426
Landis SH, Murray T, Bolden S, Wingo PA (1998) Cancer statistics, 1998. CA Cancer J Clin 48:6–29
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 280:1510–1517
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 59:149–154
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 78:394–397
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 74:930–933
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 212:711–718
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 215:45–49
Hricak H, Stern JL, Fisher MR, Shapeero LG, Winkler ML, Lacey CG (1987) Endometrial carcinoma staging by MR imaging. Radiology 162:297–305
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 186:495–501
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 18:77–86
Seki H, Kimura M, Sakai K (1997) Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images. Clin Radiol 52:18–23
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 206:539–547
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 25:21–40
Hernandez E, Woodruff JD (1980) Endometrial adenocarcinoma arising in adenomyosis. Am J Obstet Gynecol 138:827–832
Hall JB, Young RH, Nelson JH Jr (1984) The prognostic significance of adenomyosis in endometrial carcinoma. Gynecol Oncol 17:32–40
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 49:197–201
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 74:827–831
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 231:372–378
Kinkel K (2006) Pitfalls in staging uterine neoplasm with imaging: a review. Abdom Imaging 31:164–173
Prat J (2004) Prognostic parameters of endometrial carcinoma. Hum Pathol 35:649–662
McCluggage WG, Wilkinson N (2005) Metastatic neoplasms involving the ovary: a review with an emphasis on morphological and immunohistochemical features. Histopathology 47:231–247
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koyama, T., Tamai, K. & Togashi, K. Staging of carcinoma of the uterine cervix and endometrium. Eur Radiol 17, 2009–2019 (2007). https://doi.org/10.1007/s00330-006-0555-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-006-0555-0