Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guidelines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update of the ESGO-ESTRO-ESP recommendations was performed, further confirming this statement. Transvaginal/transrectal ultrasound (TRS/TVS) or pelvic magnetic resonance (MRI) enables tumor delineation and precise assessment of its local extent, including the evaluation of the depth of infiltration in the bladder- or rectal wall. Additionally, both techniques have very high specificity to confirm the presence of metastatic pelvic lymph nodes but fail to exclude them due to insufficient sensitivity to detect small-volume metastases, as in any other currently available imaging modality. In early-stage disease (T1a to T2a1, except T1b3) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging should be performed. In all other situations, contrast-enhanced computed tomography (CECT) or 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET-CT) is recommended to assess extrapelvic spread. This paper aims to review the evidence supporting the implementation of diagnostic imaging with a focus on ultrasound at primary diagnostic workup of cervical cancer.

Department of Biomedical Science for Health University of Milan 20133 Milan Italy

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Gynecologic Oncology Centre Department of Gynaecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Mohn Medical Imaging and Visualization Centre Department of Radiology Haukeland University Hospital N 5021 Bergen Norway

Section for Radiology Department of Clinical Medicine University of Bergen 5020 Bergen Norway

Zobrazit více v PubMed

Quinn M.A., Benedet J.L., Odicino F., Maisonneuve P., Beller U., Creasman W.T., Heintz A.P.M., Ngan H.Y.S., Pecorelli S. Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int. J. Gynaecol. Obstet. 2006;95((Suppl. 1)):S43–S103. PubMed

Pecorelli S., Zigliani L., Odicino F. Revised FIGO staging for carcinoma of the cervix. Int. J. Gynecol. Obstet. 2009;105:107–108. doi: 10.1016/j.ijgo.2009.02.009. PubMed DOI

Innocenti P., Pulli F., Savino L., Nicolucci A., Pandimiglio A., Menchi I., Massi G. Staging of cervical cancer: Reliability of transrectal US. Radiology. 1992;185:201–205. doi: 10.1148/radiology.185.1.1523308. PubMed DOI

Mitchell D.G., Snyder B., Coakley F., Reinhold C., Thomas G., Amendola M., Schwartz L.H., Woodward P., Pannu H., Hricak H. Early Invasive Cervical Cancer: Tumor Delineation by Magnetic Resonance Imaging, Computed Tomography, and Clinical Examination, Verified by Pathologic Results, in the ACRIN 6651/GOG 183 Intergroup Study. J. Clin. Oncol. 2006;24:5687–5694. doi: 10.1200/JCO.2006.07.4799. PubMed DOI

Hricak H., Gatsonis C., Chi D.S., Amendola M.A., Brandt K., Schwartz L.H., Koelliker S., Siegelman E.S., Brown J.J., McGhee R.B., et al. Role of Imaging in Pretreatment Evaluation of Early Invasive Cervical Cancer: Results of the Intergroup Study American College of Radiology Imaging Network 6651–Gynecologic Oncology Group 183. J. Clin. Oncol. 2005;23:9329–9337. doi: 10.1200/JCO.2005.02.0354. PubMed DOI

Thomeer M.G., Gerestein C., Spronk S., van Doorn H.C., van der Ham E., Hunink M.G. Clinical examination versus magnetic resonance imaging in the pretreatment staging of cervical carcinoma: Systematic review and meta-analysis. Eur. Radiol. 2013;23:2005–2018. doi: 10.1007/s00330-013-2783-4. PubMed DOI

Amendola M.A., Hricak H., Mitchell D.G., Snyder B., Chi D.S., Long H.J., 3rd, Fiorica J.V., Gatsonis C. Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: Results of intergroup protocol ACRIN 6651/GOG 183. J. Clin. Oncol. 2005;23:7454–7459. doi: 10.1200/JCO.2004.00.5397. PubMed DOI

Dostalek L., Åvall-Lundqvist E., Creutzberg C.L., Kurdiani D., Ponce J., Dostalkova I., Cibula D. ESGO Survey on Current Practice in the Management of Cervical Cancer. Int. J. Gynecol. Cancer. 2018;28:1226–1231. doi: 10.1097/IGC.0000000000001314. PubMed DOI

Cibula D., Pötter R., Planchamp F., Avall-Lundqvist E., Fischerova D., Meder C.H., Köhler C., Landoni F., Lax S., Lindegaard J.C., et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer. Int. J. Gynecol. Cancer. 2018;28:641–655. doi: 10.1097/IGC.0000000000001216. PubMed DOI

Cibula D., Raspollini M.R., Planchamp F., Centeno C., Chargari C., Felix A., Fischerová D., Jahnn-Kuch D., Joly F., Kohler C., et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer—Update 2023. Int. J. Gynecol. Cancer. 2023;33:649–666. doi: 10.1136/ijgc-2023-004429. PubMed DOI PMC

Olawaiye A.B., Baker T.P., Washington M.K., Mutch D.G. The new (Version 9) American Joint Committee on Cancer tumor, node, metastasis staging for cervical cancer. CA Cancer J. Clin. 2021;71:287–298. doi: 10.3322/caac.21663. PubMed DOI

Bhatla N., Aoki D., Sharma D.N., Sankaranarayanan R. Cancer of the cervix uteri. Int. J. Gynaecol. Obstet. 2018;143((Suppl. S2)):22–36. doi: 10.1002/ijgo.12611. PubMed DOI

Bhatla N., Denny L. FIGO Cancer Report 2018. Int. J. Gynecol. Obstet. 2018;143:2–3. doi: 10.1002/ijgo.12608. PubMed DOI

Bhatla N., Berek J.S., Cuello Fredes M., Denny L.A., Grenman S., Karunaratne K., Kehoe S.T., Konishi I., Olawaiye A.B., Prat J., et al. Revised FIGO staging for carcinoma of the cervix uteri. Int. J. Gynaecol. Obstet. 2019;145:129–135. doi: 10.1002/ijgo.12969. Correction Int. J. Gynecol. Obstet. 2019, 147, 279–280. PubMed DOI

Bhatla N., Berek J.S., Cuello Fredes M., Denny L.A., Grenman S., Karunaratne K., Kehoe S.T., Konishi I., Olawaiye A.B., Prat J., et al. Revised FIGO staging for carcinoma of the cervix uteri. Int. J. Gynecol. Obstet. 2019;145:129–135. doi: 10.1002/ijgo.12749. PubMed DOI

Bhatla N., Aoki D., Sharma D.N., Sankaranarayanan R. Cancer of the cervix uteri: 2021 update. Int. J. Gynecol. Obstet. 2021;155((Suppl. S1)):28–44. doi: 10.1002/ijgo.13865. PubMed DOI PMC

Sponholtz S.E., Mogensen O., Hildebrandt M.G., Schledermann D., Parner E., Markauskas A., Frøding L.P., Fuglsang K., Holm J., Bjørnholt S.M., et al. From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups? Gynecol. Oncol. 2021;163:281–288. doi: 10.1016/j.ygyno.2021.08.026. PubMed DOI

Grigsby P.W., Massad L.S., Mutch D.G., Powell M.A., Thaker P.H., McCourt C., Hagemann A., Fuh K., Kuroki L., Schwarz J.K., et al. FIGO 2018 staging criteria for cervical cancer: Impact on stage migration and survival. Gynecol. Oncol. 2020;157:639–643. doi: 10.1016/j.ygyno.2020.03.027. PubMed DOI

Matsuo K., Machida H., Mandelbaum R.S., Konishi I., Mikami M. Validation of the 2018 FIGO cervical cancer staging system. Gynecol. Oncol. 2018;152:87–93. doi: 10.1016/j.ygyno.2018.10.026. PubMed DOI PMC

McComas K.N., Torgeson A.M., Ager B.J., Hellekson C., Burt L.M., Maurer K.A., Werner T.L., Gaffney D.K. The variable impact of positive lymph nodes in cervical cancer: Implications of the new FIGO staging system. Gynecol. Oncol. 2019;156:85–92. doi: 10.1016/j.ygyno.2019.10.025. PubMed DOI

de Boer P., Adam J.A., Buist M.R., van de Vijver M.J., Rasch C.R., Stoker J., Bipat S., Stalpers L.J.A. Role of MRI in detecting involvement of the uterine internal os in uterine cervical cancer: Systematic review of diagnostic test accuracy. Eur. J. Radiol. 2013;82:e422–e428. doi: 10.1016/j.ejrad.2013.04.027. PubMed DOI

Cibula D., Slama J., Dostálek L., Fischerová D., Germanova A., Frühauf F., Dundr P., Nemejcova K., Jarkovsky J., Sebestova S., et al. Tumour-free distance: A novel prognostic marker in patients with early-stage cervical cancer treated by primary surgery. Br. J. Cancer. 2020;124:1121–1129. doi: 10.1038/s41416-020-01204-w. PubMed DOI PMC

Bizzarri N., Anchora L.P., Zannoni G.F., Carbone V., Bruno M., Fedele C., Gallotta V., Chiantera V., Avesani G., Gui B., et al. Validation of tumour-free distance as novel prognostic marker in early-stage cervical cancer: A retrospective, single-centre, cohort study. Br. J. Cancer. 2021;125:561–568. doi: 10.1038/s41416-021-01384-z. PubMed DOI PMC

Pradhan T.S., Duan H., Katsoulakis E., Salame G., Lee Y.-C., Abulafia O. Hydronephrosis as a Prognostic Indicator of Survival in Advanced Cervix Cancer. Int. J. Gynecol. Cancer. 2011;21:1091–1096. doi: 10.1097/IGC.0b013e31821cabc8. PubMed DOI

Nam H., Huh S.J., Park W., Bae D.S., Kim B.G., Lee J.H., Kim C.K., Park B.K. Prognostic significance of MRI-detected bladder muscle and/or serosal invasion in patients with cervical cancer treated with radiotherapy. Br. J. Radiol. 2010;83:868–873. doi: 10.1259/bjr/6646798. PubMed DOI PMC

Cibula D.J.J., Kocian R., Dundr P., Klat J., Zapardiel I., Landoni L., van Lonkhuijzen L., Frühauf F., Zikan M., Siegler K., et al. Magnetic resonance or expert ultrasound in preoperative local staging of patients with early-stage cervical cancer: Final results of the SENTIX prospective, single-arm, international trial (CEEGOG CX-01; ENGOT-CX2) Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2023;33:A2.

A Tsalafoutas I., Koukourakis G.V. Patient dose considerations in computed tomography examinations. World J. Radiol. 2010;2:262–268. doi: 10.4329/wjr.v2.i7.262. PubMed DOI PMC

Bipat S., Glas A.S., van der Velden J., Zwinderman A.H., Bossuyt P.M., Stoker J. Computed tomography and magnetic resonance imaging in staging of uterine cervical carcinoma: A systematic review. Gynecol. Oncol. 2003;91:59–66. doi: 10.1016/S0090-8258(03)00409-8. PubMed DOI

Haldorsen I.S., Lura N., Blaakær J., Fischerova D., Werner H.M.J. What Is the Role of Imaging at Primary Diagnostic Work-Up in Uterine Cervical Cancer? Curr. Oncol. Rep. 2019;21:77. doi: 10.1007/s11912-019-0824-0. PubMed DOI PMC

Lee S.I., Catalano O.A., Dehdashti F. Evaluation of Gynecologic Cancer with MR Imaging, 18F-FDG PET/CT, and PET/MR Imaging. J. Nucl. Med. 2015;56:436–443. doi: 10.2967/jnumed.114.145011. PubMed DOI

Lazzari R., Cecconi A., Jereczek-Fossa B.A., Travaini L.L., Dell’ Acqua V., Cattani F., Rizzo S., Fodor C., Landoni F., Orecchia R. The role of [(18)F]FDG-PET/CT in staging and treatment planning for volumetric modulated Rapidarc radiotherapy in cervical cancer: Experience of the European Institute of Oncology, Milan, Italy. Ecancermedicalscience. 2014;8:405. PubMed PMC

Dwarakanath B.S., Kaushik A., Jaimini A., Tripathi M., D′Souza M., Sharma R., Mondal A., Mishra A.K. Estimation of radiation dose to patients from [18]FDG whole body PET/CT investigations using dynamic PET scan protocol. Indian J. Med. Res. 2015;142:721–730. doi: 10.4103/0971-5916.174563. PubMed DOI PMC

Balleyguier C., Sala E., Da Cunha T., Bergman A., Brkljacic B., Danza F., Forstner R., Hamm B., Kubik-Huch R., Lopez C., et al. Staging of uterine cervical cancer with MRI: Guidelines of the European Society of Urogenital Radiology. Eur. Radiol. 2010;21:1102–1110. doi: 10.1007/s00330-010-1998-x. PubMed DOI

Lura N., Wagner-Larsen K.S., Forsse D., Trovik J., Halle M.K., Bertelsen B.I., Salvesen Ø., Woie K., Krakstad C., Haldorsen I.S. What MRI-based tumor size measurement is best for predicting long-term survival in uterine cervical cancer? Insights Imaging. 2022;13:105. doi: 10.1186/s13244-022-01239-y. PubMed DOI PMC

Lucas R., Dias J.L., Cunha T.M. Added value of diffusion-weighted MRI in detection of cervical cancer recurrence: Comparison with morphologic and dynamic contrast-enhanced MRI sequences. Diagn. Interv. Radiol. 2015;21:368–375. doi: 10.5152/dir.2015.14427. PubMed DOI PMC

Manganaro L., Lakhman Y., Bharwani N., Gui B., Gigli S., Vinci V., Rizzo S., Kido A., Cunha T.M., Sala E., et al. Staging, recurrence and follow-up of uterine cervical cancer using MRI: Updated Guidelines of the European Society of Urogenital Radiology after revised FIGO staging 2018. Eur. Radiol. 2021;31:7802–7816. doi: 10.1007/s00330-020-07632-9. PubMed DOI

Sala E., Rockall A., Rangarajan D., Kubik-Huch R.A. The role of dynamic contrast-enhanced and diffusion weighted magnetic resonance imaging in the female pelvis. Eur. J. Radiol. 2010;76:367–385. doi: 10.1016/j.ejrad.2010.01.026. PubMed DOI

Park J.J., Kim C.K., Park S.Y., Park B.K., Kim B. Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2–IIA cervical cancer. Eur. Radiol. 2014;24:1081–1088. doi: 10.1007/s00330-014-3109-x. PubMed DOI

Qu J.-R., Qin L., Li X., Luo J.-P., Li J., Zhang H.-K., Wang L., Shao N.-N., Zhang S.-N., Li Y.-L., et al. Predicting Parametrial Invasion in Cervical Carcinoma (Stages IB1, IB2, and IIA): Diagnostic Accuracy of T2-Weighted Imaging Combined With DWI at 3 T. Am. J. Roentgenol. 2018;210:677–684. doi: 10.2214/AJR.17.18104. PubMed DOI

Han K., Croke J., Foltz W., Metser U., Xie J., Shek T., Driscoll B., Ménard C., Vines D., Coolens C., et al. A prospective study of DWI, DCE-MRI and FDG PET imaging for target delineation in brachytherapy for cervical cancer. Radiother. Oncol. 2016;120:519–525. doi: 10.1016/j.radonc.2016.08.002. PubMed DOI

Chopra S., Kundu S., Verma A., Mahantshetty U., Engineer R., Shrivastava S.K. Functional magnetic resonance imaging in cervical cancer: Current evidence and future directions. J. Cancer Res. Ther. 2012;8:11–18. doi: 10.4103/0973-1482.95167. PubMed DOI

Matani H., Patel A.K., Horne Z.D., Beriwal S. Utilization of functional MRI in the diagnosis and management of cervical cancer. Front. Oncol. 2022;12:1030967. doi: 10.3389/fonc.2022.1030967. PubMed DOI PMC

Sarabhai T., Schaarschmidt B.M., Wetter A., Kirchner J., Aktas B., Forsting M., Ruhlmann V., Herrmann K., Umutlu L., Grueneisen J. Comparison of 18F-FDG PET/MRI and MRI for pre-therapeutic tumor staging of patients with primary cancer of the uterine cervix. Eur. J. Nucl. Med. 2017;45:67–76. doi: 10.1007/s00259-017-3809-y. PubMed DOI

Chiappa V., Di Legge A., Valentini A.L., Gui B., Miccò M., Ludovisi M., Giansiracusa C., Testa A.C., Valentin L. Agreement of two-dimensional and three-dimensional transvaginal ultrasound with magnetic resonance imaging in assessment of parametrial infiltration in cervical cancer. Ultrasound Obstet. Gynecol. 2015;45:459–469. doi: 10.1002/uog.14637. PubMed DOI

Fischerova D. Ultrasound scanning of the pelvis and abdomen for staging of gynecological tumors: A review. Ultrasound Obstet. Gynecol. 2011;38:246–266. doi: 10.1002/uog.10054. PubMed DOI

Fischerova D., Cibula D., Stenhova H., Vondrichova H., Calda P., Zikan M., Freitag P., Slama J., Dundr P., Belacek J. Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer. Int. J. Gynecol. Cancer. 2008;18:766–772. doi: 10.1111/j.1525-1438.2007.01072.x. PubMed DOI

Testa A.C., Ludovisi M., Manfredi R., Zannoni G., Gui B., Basso D., Di Legge A., Licameli A., Di Bidino R., Scambia G., et al. Transvaginal ultrasonography and magnetic resonance imaging for assessment of presence, size and extent of invasive cervical cancer. Ultrasound Obstet. Gynecol. 2009;34:335–344. doi: 10.1002/uog.7325. PubMed DOI

Epstein E., Testa A., Gaurilcikas A., Di Legge A., Ameye L., Atstupenaite V., Valentini A.L., Gui B., Wallengren N.-O., Pudaric S., et al. Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound—A European multicenter trial. Gynecol. Oncol. 2013;128:449–453. doi: 10.1016/j.ygyno.2012.09.025. PubMed DOI

Szabó G., Madár I., Hudelist G., Arányi Z., Turtóczki K., Rigó J., Ács N., Lipták L., Fancsovits V., Bokor A. Visualization of sacral nerve roots and sacral plexus on gynecological transvaginal ultrasound: Feasibility study. Ultrasound Obstet. Gynecol. 2023;62:290–299. doi: 10.1002/uog.26204. PubMed DOI

Fischerova D., Santos G., Wong L., Yulzari V., Bennett R.J., Dundr P., Burgetova A., Barsa P., Szabó G., Sousa N., et al. Imaging in gynecological disease (26): Clinical and ultrasound characteristics of benign retroperitoneal pelvic peripheral-nerve-sheath tumors. Ultrasound Obstet. Gynecol. 2023;62:727–738. doi: 10.1002/uog.26223. PubMed DOI

Iwamoto K., Kigawa J., Minagawa Y., Miura H., Terakawa N. Transvaginal ultrasonographic diagnosis of bladder-wall invasion in patients with cervical cancer. Obstet. Gynecol. 1994;83:217–219. PubMed

Huang W., Yang J., Yang Y., Yang S. Ultrasonographic characteristics and cystoscopic correlates of bladder wall invasion by endophytic cervical cancer. Ultrasound Obstet. Gynecol. 2006;27:680–686. doi: 10.1002/uog.2775. PubMed DOI

Testa A.C., Ferrandina G., Moro F., Pasciuto T., Moruzzi M.C., De Blasis I., Mascilini F., Foti E., Autorino R., Collarino A., et al. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: Role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. Ultrasound Obstet. Gynecol. 2018;51:684–695. doi: 10.1002/uog.17551. PubMed DOI

Alcázar J.L., Castillo G., Martínez-Monge R., Jurado M. Transvaginal color Doppler sonography for predicting response to concurrent chemoradiotherapy for locally advanced cervical carcinoma. J. Clin. Ultrasound. 2004;32:267–272. doi: 10.1002/jcu.20033. PubMed DOI

Vanderpuye V. Renal sonography in the diagnosis of renal obstruction or hydronephrosis in patients with cervical cancer. J. Clin. Ultrasound. 2002;30:424–427. doi: 10.1002/jcu.10092. PubMed DOI

Pálsdóttir K., Epstein E. A Pilot Study on Diagnostic Performance of Contrast-Enhanced Ultrasonography for Detection of Early Cervical Cancer. Ultrasound Med. Biol. 2018;44:1664–1671. doi: 10.1016/j.ultrasmedbio.2018.04.018. PubMed DOI

Sidhu P.S., Cantisani V., Dietrich C.F., Gilja O.H., Saftoiu A., Bartels E., Bertolotto M., Calliada F., Clevert D.-A., Cosgrove D., et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version) Ultraschall Med. Eur. J. Ultrasound. 2018;39:e2–e44. doi: 10.1055/a-0586-1107. PubMed DOI

Hricak H., Gatsonis C., Coakley F.V., Snyder B., Reinhold C., Schwartz L.H., Woodward P.J., Pannu H.K., Amendola M., Mitchell D.G. Early Invasive Cervical Cancer: CT and MR Imaging in Preoperative Evaluation—ACRIN/GOG Comparative Study of Diagnostic Performance and Interobserver Variability. Radiology. 2007;245:491–498. doi: 10.1148/radiol.2452061983. PubMed DOI

Pálsdóttir K., Fridsten S., Blomqvist L., Alagic Z., Fischerova D., Gaurilcikas A., Hasselrot K., Jäderling F., Testa A.C., Sundin A., et al. Interobserver agreement of transvaginal ultrasound and magnetic resonance imaging in local staging of cervical cancer. Ultrasound Obstet. Gynecol. 2021;58:773–779. doi: 10.1002/uog.23662. PubMed DOI PMC

Federico M., Hernandez-Socorro C.R., Ribeiro I., Martin J.G., Oramas M.D.R.-B., Saez-Bravo M.L., Jimenez P.C.L. Prospective intra/inter-observer evaluation of pre-brachytherapy cervical cancer tumor width measured in TRUS and MR imaging. Radiat. Oncol. 2019;14:173. doi: 10.1186/s13014-019-1352-7. PubMed DOI PMC

Wagner-Larsen K.S., Lura N., Salvesen O., Salvesen Halle M.K., Forsse D., Trovik J., Smit N., Krakstad C., Haldorsen I.S. Interobserver agreement and prognostic impact for MRI–based 2018 FIGO staging parameters in uterine cervical cancer. Eur. Radiol. 2022;32:6444–6455. doi: 10.1007/s00330-022-08666-x. PubMed DOI PMC

Epstein E., Di Legge A., MÅsbäck A., Lindqvist P.G., Kannisto P., Testa A.C. Sonographic characteristics of squamous cell cancer and adenocarcinoma of the uterine cervix. Ultrasound Obstet. Gynecol. 2010;36:512–516. doi: 10.1002/uog.7638. PubMed DOI

Okamoto Y., Tanaka Y.O., Nishida M., Tsunoda H., Yoshikawa H., Itai Y. MR Imaging of the Uterine Cervix: Imaging-Pathologic Correlation. RadioGraphics. 2003;23:425–445. doi: 10.1148/rg.232025065. PubMed DOI

Vandecaveye V., Dresen R., De Keyzer F. Novel imaging techniques in gynaecological cancer. Curr. Opin. Oncol. 2017;29:335–342. doi: 10.1097/CCO.0000000000000385. PubMed DOI

Xiao M., Yan B., Li Y., Lu J., Qiang J. Diagnostic performance of MR imaging in evaluating prognostic factors in patients with cervical cancer: A meta-analysis. Eur. Radiol. 2019;30:1405–1418. doi: 10.1007/s00330-019-06461-9. PubMed DOI

Woo S., Atun R., Ward Z.J., Scott A.M., Hricak H., Vargas H.A. Diagnostic performance of conventional and advanced imaging modalities for assessing newly diagnosed cervical cancer: Systematic review and meta-analysis. Eur. Radiol. 2020;30:5560–5577. doi: 10.1007/s00330-020-06909-3. PubMed DOI PMC

Stukan M., Buderath P., Szulczyński B., Gębicki J., Kimmig R. Accuracy of Ultrasonography and Magnetic Resonance Imaging for Preoperative Staging of Cervical Cancer—Analysis of Patients from the Prospective Study on Total Mesometrial Resection. Diagnostics. 2021;11:1749. doi: 10.3390/diagnostics11101749. PubMed DOI PMC

Pinkavova I., Dundr P., Fischerova D., Zikan M., Slama J., Cibula D. OC24.04: Intra-operative ultrasound in fertility sparing procedures for cervical cancer. Ultrasound Obstet. Gynecol. 2012;40:51. doi: 10.1002/uog.11379. DOI

Pinkavova I., Fischerova D., Zikan M., Burgetova A., Slama J., Svarovsky J., Dundr P., Dusek L., Cibula D. Transrectal ultrasound and magnetic resonance imaging in the evaluation of tumor size following neoadjuvant chemotherapy for locally advanced cervical cancer. Ultrasound Obstet. Gynecol. 2013;42:705–712. doi: 10.1002/uog.12455. PubMed DOI

Rizzo S., Calareso G., Maccagnoni S., Angileri S.A., Landoni F., Raimondi S., Pasquali E., Lazzari R., Bellomi M. Pre-operative MR evaluation of features that indicate the need of adjuvant therapies in early stage cervical cancer patients. A single-centre experience. Eur. J. Radiol. 2014;83:858–864. doi: 10.1016/j.ejrad.2014.01.029. PubMed DOI

Kim M.J., Chung J.J., Lee Y.H., Lee J.T., Yoo H.S. Comparison of the use of the transrectal surface coil and the pelvic phased-array coil in MR imaging for preoperative evaluation of uterine cervical carcinoma. Am. J. Roentgenol. 1997;168:1215–1221. doi: 10.2214/ajr.168.5.9129414. PubMed DOI

Yu K.K., Hricak H., Subak L.L., Zaloudek C.J., Powell C.B., Yu H.H.K.K., Sala E., Wakely S., Senior E., Lomas D., et al. Preoperative staging of cervical carcinoma: Phased array coil fast spin-echo versus body coil spin-echo T2-weighted MR imaging. Am. J. Roentgenol. 1998;171:707–711. doi: 10.2214/ajr.171.3.9725301. PubMed DOI

Alcazar J.L., García E., Machuca M., Quintana R., Escrig J., Chacón E., Mínguez J.A., Chiva L. Magnetic resonance imaging and ultrasound for assessing parametrial infiltration in cervical cancer. A systematic review and meta-analysis. Med. Ultrason. 2020;1:85–93. doi: 10.11152/mu-2361. PubMed DOI

Moro F., Zermano S., Ianieri M.M., Nardone A.D.C., Carfagna P., Ciccarone F., Ercoli A., Querleu D., Scambia G., Testa A.C. Dynamic transvaginal ultrasound examination for assessing anatomy of parametrium. Ultrasound Obstet. Gynecol. 2023;62:904–906. doi: 10.1002/uog.26313. PubMed DOI

Nicolet V., Carignan L., Bourdon F., Prosmanne O. MR Imaging of Cervical Carcinoma: A Practical Staging Approach. RadioGraphics. 2000;20:1539–1549. doi: 10.1148/radiographics.20.6.g00nv111539. PubMed DOI

Rockall A.G., Ghosh S., Alexander-Sefre F., Babar S., Younis M.T.S., Naz S., Jacobs I.J., Reznek R.H. Can MRI rule out bladder and rectal invasion in cervical cancer to help select patients for limited EUA? Gynecol. Oncol. 2006;101:244–249. doi: 10.1016/j.ygyno.2005.10.012. PubMed DOI

Fischerova D., Garganese G., Reina H., Fragomeni S.M., Cibula D., Nanka O., Rettenbacher T., Testa A.C., Epstein E., Guiggi I., et al. Terms, definitions and measurements to describe sonographic features of lymph nodes: Consensus opinion from the Vulvar International Tumor Analysis (VITA) group. Ultrasound Obstet. Gynecol. 2021;57:861–879. doi: 10.1002/uog.23617. PubMed DOI

Shen G., Zhou H., Jia Z., Deng H. Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: A systematic review and meta-analysis. Br. J. Radiol. 2015;88:20150063. doi: 10.1259/bjr.20150063. PubMed DOI

Han S.N., Amant F., Michielsen K., De Keyzer F., Fieuws S., Van Calsteren K., Dresen R.C., Gziri M.M., Vandecaveye V. Feasibility of whole-body diffusion-weighted MRI for detection of primary tumour, nodal and distant metastases in women with cancer during pregnancy: A pilot study. Eur. Radiol. 2017;28:1862–1874. doi: 10.1007/s00330-017-5126-z. PubMed DOI

Kapoor V., McCook B.M., Torok F.S. An Introduction to PET-CT Imaging. RadioGraphics. 2004;24:523–543. doi: 10.1148/rg.242025724. PubMed DOI

Kitajima K., Murakami K., Yamasaki E., Kaji Y., Sugimura K. Accuracy of integrated FDG-PET/contrast-enhanced CT in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer. Eur. Radiol. 2009;19:1529–1536. doi: 10.1007/s00330-008-1271-8. PubMed DOI

Kim S.-K., Choi H.J., Park S.-Y., Lee H.-Y., Seo S.-S., Yoo C.W., Jung D.C., Kang S., Cho K.-S. Additional value of MR/PET fusion compared with PET/CT in the detection of lymph node metastases in cervical cancer patients. Eur. J. Cancer. 2009;45:2103–2109. doi: 10.1016/j.ejca.2009.04.006. PubMed DOI

Nie J., Zhang J., Gao J., Guo L., Zhou H., Hu Y., Zhu C., Li Q., Ma X. Diagnostic role of 18F-FDG PET/MRI in patients with gynecological malignancies of the pelvis: A systematic review and meta-analysis. PLoS ONE. 2017;12:e0175401. doi: 10.1371/journal.pone.0175401. PubMed DOI PMC

Choi H.J., Ju W., Myung S.K., Kim Y. Diagnostic performance of computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with cervical cancer: Meta-analysis. Cancer Sci. 2010;101:1471–1479. doi: 10.1111/j.1349-7006.2010.01532.x. PubMed DOI PMC

Tian Y., Luo H. Diagnostic accuracy of transvaginal ultrasound examination for local staging of cervical cancer: A systematic review and meta-analysis. Med. Ultrason. 2021;24:348–355. doi: 10.11152/mu-3246. PubMed DOI

Kang S., Kim S.-K., Chung D.-C., Seo S.-S., Kim J.-Y., Nam B.-H., Park S.-Y. Diagnostic Value of 18F-FDG PET for Evaluation of Paraaortic Nodal Metastasis in Patients with Cervical Carcinoma: A Metaanalysis. J. Nucl. Med. 2010;51:360–367. doi: 10.2967/jnumed.109.066217. PubMed DOI

James R.M., E Cruickshank M., Siddiqui N. Management of cervical cancer: Summary of SIGN guidelines. BMJ. 2008;336:41–43. doi: 10.1136/bmj.39399.642894.AD. PubMed DOI PMC

Sironi S., Buda A., Picchio M., Perego P., Moreni R., Pellegrino A., Colombo M., Mangioni C., Messa C., Fazio F. Lymph Node Metastasis in Patients with Clinical Early-Stage Cervical Cancer: Detection with Integrated FDG PET/CT. Radiology. 2006;238:272–279. doi: 10.1148/radiol.2381041799. PubMed DOI

Signorelli M., Guerra L., Montanelli L., Crivellaro C., Buda A., Dell’Anna T., Picchio M., Milani R., Fruscio R., Messa C. Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease? Gynecol. Oncol. 2011;123:236–240. doi: 10.1016/j.ygyno.2011.07.096. PubMed DOI

Fruhauf F., Zikan M., Roman K., Cibula D., Fischerová D. OC11.05: Diagnostic accuracy of ultrasound in preoperative assessment of lymph nodes in cervical cancer. Ultrasound Obstet. Gynecol. 2022;60:33.

Selman T.J., Mann C., Zamora J., Appleyard T.-L., Khan K. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: A systematic review and meta-analysis. Can. Med. Assoc. J. 2008;178:855–862. doi: 10.1503/cmaj.071124. PubMed DOI PMC

Liu B., Gao S., Li S. A Comprehensive Comparison of CT, MRI, Positron Emission Tomography or Positron Emission Tomography/CT, and Diffusion Weighted Imaging-MRI for Detecting the Lymph Nodes Metastases in Patients with Cervical Cancer: A Meta-Analysis Based on 67 Studies. Gynecol. Obstet. Investig. 2017;82:209–222. doi: 10.1159/000456006. PubMed DOI

Ruan J., Zhang Y., Ren H. Meta-analysis of PET/CT detect lymph nodes metastases of cervical cancer. Open Med. 2018;13:436–442. doi: 10.1515/med-2018-0065. PubMed DOI PMC

Song Q., Yu Y., Zhang X., Zhu Y., Luo Y., Yu T., Sun J., Liu F., Dong Y. Value of MRI and diffusion-weighted imaging in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. Br. J. Radiol. 2022;95:20200203. doi: 10.1259/bjr.20200203. PubMed DOI PMC

Woo S., Suh C.H., Kim S.Y., Cho J.Y., Kim S.H. Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: An updated systematic review and meta-analysis of the literature between 2012 and 2016. Eur. Radiol. 2017;28:530–541. doi: 10.1007/s00330-017-4958-x. PubMed DOI

Gong Y., Wang Q., Dong L., Jia Y., Hua C., Mi F., Li C. Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: A systematic review and meta-analysis. Oncotarget. 2016;8:14107–14125. doi: 10.18632/oncotarget.12959. PubMed DOI PMC

Yu W., Kou C., Bai W., Yu X., Duan R., Zhu B., Li Y., Hua W., Ren X., Yang Y. The diagnostic performance of PET/CT scans for the detection of para-aortic metastatic lymph nodes in patients with cervical cancer: A meta-analysis. PLoS One. 2019;14:e0220080. doi: 10.1371/journal.pone.0220080. PubMed DOI PMC

He T., Sun J., Wu J., Wang H., Liang C., Wang H., Li S., Su S. PET-CT versus MRI in the diagnosis of lymph node metastasis of cervical cancer: A meta-analysis. Microsc. Res. Tech. 2022;85:1791–1798. doi: 10.1002/jemt.24039. PubMed DOI

Cosin J.A., Fowler J.M., Chen M.D., Paley P.J., Carson L.F., Twiggs L.B. Pretreatment surgical staging of patients with cervical carcinoma. Cancer. 1998;82:2241–2248. doi: 10.1002/(SICI)1097-0142(19980601)82:11<2241::AID-CNCR20>3.0.CO;2-T. PubMed DOI

Marnitz S., Köhler C., Roth C., Füller J., Hinkelbein W., Schneider A. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol. Oncol. 2005;99:536–544. doi: 10.1016/j.ygyno.2005.07.005. PubMed DOI

Leblanc E., Narducci F., Frumovitz M., Lesoin A., Castelain B., Baranzelli M.C., Taieb S., Fournier C., Querleu D. Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. Gynecol. Oncol. 2007;105:304–311. doi: 10.1016/j.ygyno.2006.12.012. PubMed DOI

Tsunoda A.T., Marnitz S., Nunes J.S., Andrade C.E.M.d.C., Neto C.S., Blohmer J.-U., Herrmann J., Kerr L.M., Martus P., Schneider A., et al. Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial. Oncology. 2017;92:213–220. doi: 10.1159/000453666. PubMed DOI

Marnitz S., Tsunoda A.T., Martus P., Vieira M., Junior R.J.A., Nunes J., Budach V., Hertel H., Mustea A., Sehouli J., et al. Surgical versus clinical staging prior to primary chemoradiation in patients with cervical cancer FIGO stages IIB–IVA: Oncologic results of a prospective randomized international multicenter (Uterus-11) intergroup study. Int. J. Gynecol. Cancer. 2020;30:1855–1861. doi: 10.1136/ijgc-2020-001973. PubMed DOI PMC

Marnitz-Schulze S., Tsunoda A., Martus P., Vieira M.V., Affonso R., Nunes J.S., Budach V., Schneider A., Hertel H., Mustea A., et al. UTERUS-11 STUDY: A randomized clinical trial on surgical staging versus ct-staging prior to primary chemoradiation in patients with FIGO2009 stages IIB-IVA cervical cancer. Int. J. Gynecol. Cancer Off. J. Int. Gynecol. Cancer Soc. 2019;29:A1–A197.

Dabi Y., Francogyn F.T.G.d.R., Simon V., Carcopino X., Bendifallah S., Ouldamer L., Lavoue V., Canlorbe G., Raimond E., Coutant C., et al. Therapeutic value of surgical paraaortic staging in locally advanced cervical cancer: A multicenter cohort analysis from the FRANCOGYN study group. J. Transl. Med. 2018;16:326. doi: 10.1186/s12967-018-1703-4. PubMed DOI PMC

Fischerova D., Cibula D., Dundr P., Zikan M., Calda P., Freitag P., Slama J. Ultrasound-guided tru-cut biopsy in the management of advanced abdomino-pelvic tumors. Int. J. Gynecol. Cancer. 2008;18:833–837. doi: 10.1111/j.1525-1438.2007.01015.x. PubMed DOI

Meva J., Chaudhary R.K., Bhaduri D., Bhatia M., Hatti S., Ba R. Lacunae in International Federation of Gynecology and Obstetrics (FIGO) classification for cervical carcinoma: Observational study using TNM classification as comparator. Int. J. Gynecol. Cancer. 2013;23:1071–1077. doi: 10.1097/IGC.0b013e31829783c4. PubMed DOI

Luo Q., Luo L., Tang L. A Network Meta-Analysis on the Diagnostic Value of Different Imaging Methods for Lymph Node Metastases in Patients with Cervical Cancer. Technol. Cancer Res. Treat. 2018;17:1533034617742311. doi: 10.1177/1533034617742311. PubMed DOI PMC