Is imaging relevant for treatment choice in early stage cervical uterine cancer?

Improvement in the selection of patients with early cervical cancer eligible for different therapeutic options is expected from imaging.

We examined key tumoral features such as tumor diameter cut-off values of 2 cm or 4 cm in largest dimension, distance between tumor and internal os, outer third stromal cervical invasion, parametrial invasion and lymph node invasion.

We conducted a literature search to identify all relevant studies based on imaging that evaluated these parameters.

Articles were only considered when data of imaging modalities were compared with histopathological findings of the surgical specimens, considered as the gold standard.

We examined series that included more than 30 patients with primary untreated biopsy-confirmed cervical cancer. When numerous articles were obtained for one investigational modality, only series that included more than fifty patients were taken into account.

Data is lacking for the diagnostic value of imaging for assessing tumor diameter cut-off values of 2 cm or 4 cm, and distance between tumor and internal os. There is a high negative predictive value of MRI for complete stromal invasion. Accurate assessment of lymph node status in patients with early cervical cancer is still lacking. PET-CT role is promising, but the diagnostic value of normal-sized hypermetabolic lymph nodes needs further investigation.

Based on imaging, accurate selection of patients for treatment choice is still lacking in patients with early cervical cancer.