Initial staging and follow-up of invasive uterine cervix cancer

The diagnosis of cervical cancer is clinical. Diagnostic imaging is involved in the assessment of the loco-regional extension of the primary tumor (T) and in the search for nodal (N) and/or distant metastases (M). Echography is the simplest diagnostic method for assessing T. It is able to demonstrate the pelvic extension and particularly the parametrial invasion in the form of hyperdense bands extending to the pelvic walls. Computed tomography (CT) is not indicated for low stage tumors, except bulky cancers. On the other hand, it can detect the parametrial spread, bladder involvement and nodal metastases. The most recent technological innovation is Magnetic Resonance (MR), which features a multi-planar image acquisition and is able to document both the primary tumor (T2 weighted images) and the loco-regional extension. Urography is still important due to the frequency of pathologic findings and the significance of their prognostic worsening. Lymphography is still the most effective diagnostic method for the assessment of lymphatic areas, in spite of the interest in echography, the fair reliability of CT and the prospects offered by MR. The diagnostic accuracy of lymphography is 86.4% on regional pelvic nodes and 97.4% on juxtaregional chains. The prevailing error occurs in the false-negative sense, mainly due to embolic micrometastases. Furthermore a considerable prognostic value is to be attributed to lymphography. Lastly, the main nuclear-medicine methods are discussed together with the investigations for follow-up and the most modern interventional radiology techniques of major interest in the diagnosis and treatment of invasive cervical cancer.