Table 6 MRI in cervical cancer staging. Pitfalls and pearls
From: Role of MRI in staging and follow-up of endometrial and cervical cancer: pitfalls and mimickers
Staging (FIGO) | Pitfall | Pearl |
|---|---|---|
1. STAGE IA, IB1 (< 2 cm) • Very small (< 1 cm) tumors • Isointense tumors in young women | No detection | • DWI and DCE improve detection and delineation of small tumors |
2. STAGE IB3 • Cervical edema and/or inflammation secondary to a recent biopsy or to cervical/vaginal compression by a large tumor (> 4 cm)a | Overstaging IB3 as stage IIA in large and exophytic tumors Overstaging as FIGO IIB tumor (parametrial invasion) | • Use vaginal gel to distend vaginal walls • DWI and DCE improve the accuracy of T2WI for the evaluation of parametrial invasion Ancillary findings for parametrial invasion: • Irregular interface between tumor and parametrium • Asymmetric tumoral bulge • Vascular encasement |
3. Stage IIB • Diffuse T2 signal inhomogeneity of the cervical rim due to complete tumoral invasion, without an evident parametrial mass | Understaging IIB as IB2–IB3 tumors | • Full-thickness cervical stromal replacement by cancerous tissue may be the only feature associated with parametrial invasion • The cervical rim must be thick (> 3 mm) and homogeneous on T2WI to exclude parametrial invasion |
4. STAGE III • IIIB • IIIC | Misinterpreting a benign hydronephrosis as malignant ureteral infiltration Misinterpreting benign adenopathies as malignant lymphatic spread Misinterpreting malignant adenopathies as other pelvic masses (ovaries …) | • Review clinical data and symptoms, and use other techniques (i.e., ultrasound, CT urography, or large-FOV MRI). • Review clinical data and symptoms and perform node aspiration or biopsy whenever possible • Knowledge of pelvic fascia, peritoneal-extraperitoneal spaces, and other pelvic structures is critical |
5. STAGE IV Same as in endometrial cancer (see Table 5) |