Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers

Otero-García, María Milagros; Mesa-Álvarez, Alicia; Nikolic, Olivera; Blanco-Lobato, Patricia; Basta-Nikolic, Marijana; de Llano-Ortega, Rafael Menéndez; Paredes-Velázquez, Laura; Nikolic, Nikola; Szewczyk-Bieda, Magda

doi:10.1186/s13244-019-0696-8

Insights into Imaging

Table 2 TNM (8^th Edition) and FIGO (2018) Classification of cervical cancer (from refs. 26, 31)

From: Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers

TNM	FIGO	Description
Tx		Primary tumor cannot be assessed
T0		No evidence of primary tumor
Tis		Preinvasive carcinoma
T1	I	The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)
T1a	IA	Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion < 5 mm^a
T1a1	IA1	Measured stromal invasion depth of < 3 mm
T1a2	IA2	Measured stromal invasion depth ≥ 3 mm and < 5 mm
T1b	IB	Invasive carcinoma with measured deepest invasion of ≥ 5 mm (greater than Stage IA), lesion limited to the cervix uteri^b
T1b1	IB1	Invasive carcinoma with measured deepest stromal invasion of ≥ 5 mm, and greatest dimension of < 2 cm
T1b2	IB2	Invasive carcinoma with greatest dimension of ≥ 2 cm and < 4 cm
-	IB3^d	Invasive carcinoma with greatest dimension of > 4 cm
T2	II	The carcinoma invades beyond the uterus, but has not extended into the lower third of the vagina or to the pelvic wall
T2a	IIA	Involvement limited to the upper two-thirds of the vagina without parametrial invasion
T2a1	IIA1	Invasive carcinoma with greatest dimension of < 4 cm
T2a2	IIA2	Invasive carcinoma with greatest dimension of ≥ 4 cm
T2b	IIB	With parametrial involvement but not up to the pelvic wall
T3	III	The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes^c
T3a	IIIA	The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
T3b	IIIB	Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
N^d	IIIC^d	Involvement of pelvic and/or para-aortic lymph nodes, irrespective of tumor size and extent (with r and p notations)^c
	IIIC1^d	Pelvic lymph node metastasis only
	IIIC2^d	Para-aortic lymph nodes metastasis
T4	IV	The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum (the presence of bullous edema is not sufficient to classify a case as Stage IV)
T4	IVA	Spread to adjacent pelvic organs
M1	IVB	Spread to distant organs

When in doubt, the lower staging should be assigned
^aImaging and pathology can be used, when available, to supplement clinical findings with respect to tumor size and extent in all stages
^bThe involvement of vascular/lymphatic spaces does not change the staging. The lateral extent of the lesion is no longer considered
^cThe notations of r (imaging) and p (pathology) are added to indicate the findings used to assign a case as Stage IIIC. For example, if imaging indicates pelvic lymph node metastasis, the stage allocation would be Stage IIIC1r, whereas if confirmed by pathologic findings, the stage would be Stage IIIC1p. The type of imaging modality or pathology technique used should always be documented
^dThe revised FIGO classification was recently published (October 2018). TNM (8^th Edition) does not include classification for the new FIGO groups IB3, IIIC1, and IIIC2. TNM defines only regional lymph nodes, with N0 (i+) indicating isolated tumor cells in regional lymph node(s) no greater than 0.2 mm, and N1 indicating regional lymph node metastasis

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