Imaging to assist fertility-sparing surgery

Area of Science:

• Oncology
• Radiology
• Gynecology

Background:

• Cervical cancer diagnosis is improving in young women due to screening.
• Accurate disease staging is crucial for selecting fertility-sparing surgical options.

Purpose of the Study:

• To evaluate the utility of advanced magnetic resonance imaging (MRI) techniques for cervical cancer staging.
• To determine if MRI can accurately assess tumor extent for fertility-sparing surgery planning.

Main Methods:

• High-resolution T2-weighted and diffusion-weighted (DW) MRI using an endovaginal coil.
• Comparison of MRI measurements (tumor size, volume, endocervical canal length) with histological data.
• Assessment of parametrial invasion using T2-weighted MRI and contrast-enhanced MRI.
• Evaluation of 18-fluorodeoxyglucose positron emission tomography-computerised tomography (18FDG PET-CT) for nodal assessment.

Main Results:

• MRI accurately correlates tumor size and volume between observers and with histology.
• No significant difference was found between MRI and histology for normal endocervical canal length.
• T2-weighted MRI is effective for assessing parametrial invasion; DW imaging has limitations due to fat content.
• Contrast-enhanced MRI offers no additional benefit over T2-weighted images for parametrial assessment.

Conclusions:

• Endovaginal MRI provides high-resolution imaging for precise cervical cancer staging.
• This MRI technique aids in planning fertility-sparing surgery, optimizing oncological outcomes and minimizing obstetric risks.
• 18FDG PET-CT remains the standard for nodal staging in cervical cancer.