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Imaging in Cervical Cancer from Screening, Diagnosis to Management.

January 25 2022 – Imaging Endpoints (IE) is a global leader in performing imaging services for clinical trials with vast experience in cervical cancer. CT, MRI, PET/CT, DCE and DWI MRI, as well as PET/MRI and PET tracers, are playing an important role in the evaluation of new diagnostic and treatment agents for cervical cancer being evaluated in clinical trials.

Worldwide, uterine cervical carcinoma is the second most common gynecologic malignancy. Squamous cell carcinoma (SCC) accounts for 85% of all cervical cancers followed by, non-squamous cervical carcinomas, which are far less common (15%) and carry a poorer prognosis. The main risk factor for developing cervical cancer is infection with the human papilloma virus (HPV). Other predisposing factors include immunosuppression and smoking.

Recently, due to the global implementation of routine cervical cancer screening, PAP smear and HPV testing, as part of women’s health care, the incidence of advanced invasive cervical cancer has dropped significantly especially in the developed countries. However, limited access to such screening testing in under-resourced communities and the disproportionate variation seen among different race, age, and ethnicities are contributing to maintaining advanced cervical carcinoma as a highly lethal disease without any significant improvement in survival rates.

The International Federation of Gynecology and Obstetrics (FIGO) clinical classification is the most used staging system for uterine cervical cancer. In 2018, they recommended including cross-sectional imaging (CT, MRI, PET-CT) in the staging guidelines, as it provides more accurate evaluation of local disease and extrauterine spread.

Because of the accuracy of MR imaging in the evaluation of cervical tumor morphology and its local extent, and its ability to assess the size, endocervical growth, the possible presence of uterine wall infiltration and involvement of pelvic sidewall or adjacent organ (e.g. bladder, rectum), the clinical staging and identification of prognostic factors have been significantly improved.

In patients with clinical evidence of tumor recurrence, PET-CT is the preferred imaging modality as it is more reliable than CT and MRI. It can more accurately evaluate lymph node status and extra pelvic spread of the disease. Therefore, a combination of MRI and PET-CT is preferred for the diagnosis of cervical cancer relapse.

Recently, novel functional imaging methods including dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI), texture imaging analysis, PET- MRI, as well as the use of various radiotracers for PET imaging demonstrated their ability to visualize and quantify functional and microstructural aspects of cervical tumor characteristics preoperatively, which have been shown to be closely associated with clinical phenotype, FIGO stage, lymph node metastases, prognostic histological tumor markers, treatment response, and ultimately patient outcome.

Thus, both conventional and functional imaging may be considered as important non-invasive imaging.

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