Learning objectives
TheobjectiveofthisstudyistoillustrateasystematicapproachtostagingUCCabasedonMRI,aimingatcontinuingeducationofradiologists.
Background
UterineCervixCancer(UCCa)isthesecondmostcommonmalignancyinwomenworldwide,oftenwithaggressivebehaviorandpredominantlylocalspread.Accuratepre-therapeutic
evaluationisimportantbecauseitnotonlyinfluencestheprognosis,butalsodefinesthebesttreatmentoption.MRIpotentiallyprovidesaccurateinformationontheexacttumorextension.
Findings and procedure details
LIMITS OF THE FIGO CLASSIFICATION
• Clinical classification (Intravenous-urography,
cystoscopy,
rectoscopy…)
• Does not include ganglionic extension
• Poor correlation to surgical findings
Stade IStade IIStade III
Concordance68-80%25-55%10-50%
5-year survival95%65%41%
ROLE OF IMAGING
üTumor size
üVaginal and stromal extension
üExtension to parametria
üParietal extension
üExtension to rectum and bladder
üGanglionic extension
Imaging strategy to evaluate cervical cancer
•MRIèall patients with a proven cancer (except FIGO IV)
Including thin T2 slices perpendicular to the cervix + sequences exploring the urinary tractus and the para-aortic gangliona
•Contrast-enhanced...
Conclusion
•It must be part of any initial assessment of cervical cancer because it plays a "key" role in:
•guiding the therapeutic choices:
–in particular by identifying,
with a strong VPN,
the patients without parametrial invasion,
candidates for surgery
–by selecting patients at an early stage who can benefit from conservative fertility surgery (trachelectomy)
•giving benchmarks for radiotherapy
•identifying essential prognostic factors accurate assessment of tumor size,
evaluation of the ganglionic and parametrial extensions
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