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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)
  
  1. FOV field of view
  2. aThis pitfall can occur with any cervical mass (especially large masses) after biopsy because of peritumoral edema, or due to a false-positive estimation of vaginal invasion when the vaginal fornix is stretched by a bulky exophytic cervical tumor