Surgical and radiologic staging of cervical cancer.

PURPOSE OF REVIEW: The roles of radiologic and surgical staging in cervical carcinoma have been controversial. This review updates publications in this area.

RECENT FINDINGS: Conventional computed tomography or MRI has been suboptimal in detecting depth of cervical stromal invasion and nodal metastasis.18-Fluorodeoxyglucose PET or integrated PET/computed tomography (thereafter as PET collectively) is valuable for assessing prognosis, treatment response after the completion of concurrent chemoradiation, documented recurrent cervical cancer, and posttreatment unexplained tumor marker elevation. Results of MRI using nanoparticle contrast media, higher Tesla machines, or diffusion-weighted imaging without contrast may be promising. Although surgical staging is feasible, level 1 evidence is still lacking for survival benefit before definitive radiotherapy/chemoradiation in locally advanced cervical cancer. A randomized controlled trial of additional PET in MRI-defined pelvic node-positive patients prior to chemoradiation did not show significant survival benefit.

SUMMARY: Nonsurgical staging is still the gold standard for advanced cervical cancer treatment planning unless well designed phase III study could show a significant survival benefit of surgical staging. The roles of molecular imaging (new MRI technology or PET with fluorodeoxyglucose or other radiotracers) as an early predictor of response to treatment need more researches.