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

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

Objective: 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.

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

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

Data collection and analysis: 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.

Main results: 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.

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