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IB3 … Careers. Dissemination of the advantages of imaging for cervical cancer staging lies within the domain of global health development efforts. 2e - Classification des cancers du col de l'utérus. † Stage IIIC should be annotated with r (radiology) or p (pathologic analysis) to indicate the method used to allocate this stage. This variability is reader specific and attributable to the preference for minimizing false-negative or false-positive findings. Although surgery is more sensitive, imaging is less morbid in avoiding the short- and long-term complications of lymphadenectomy (57). doi: 10.1097/MD.0000000000019714. Additionally, patients gave consent for data collection and publication. 2015 Apr 7;(4):CD010260. Le cancer du col de l'utérus est la deuxième forme la plus fréquente de cancer chez les Femmes à l'échelle mondiale après le cancer du sein. Yang X, An J, Zhang Y, Yang Y, Chen S, Huang M, Wu L. Front Oncol. Globocan 2002: IARC Cancer Base No.5. 4, Magnetic Resonance Imaging Clinics of North America, Vol. In this context, PET/CT is preferred as the imaging modality because it also enables depiction of occult distant metastases, another factor in staging. Although a parallel TNM system for gynecologic cancers has been described by the American Joint Committee on Cancer, the FIGO system continues to predominate worldwide in clinical practice and for cancer database reporting (2). Figure 1c: Images show uterine cervical cancer at CT versus MRI. FIGO staging of cancer of the cervix uteri (2018) When in doubt, the lower staging should be assigned. Please enable it to take advantage of the complete set of features! On ne doit pas prendre en compte l’extension au corps utérin. Ce cancer est en partie lié a l'activité sexuelle. 2b - La cytologie dans le dépistage des cancers du col de l’utérus. Early stage of disease was defined as FIGO stage IA2, IB1 (with tumor diameter < 20 mm) and IB2 (with tumor diameter between 20 and 40 mm) according to the new FIGO 2018 staging system . Stage I: Tumor confined to ovaries or fallopian tube(s) T1-N0-M0 IA: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings T1a-N0-M0 International Federation of Gynecology and Obstetrics, Revised FIGO staging for carcinoma of the cervix, FIGO staging for carcinoma of the vulva, cervix, and corpus uteri, Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183, The staging of cervical cancer: inevitable discrepancies between clinical staging and pathologic findinges, Tumor size evaluated by pelvic examination compared with 3-D quantitative analysis in the prediction of outcome for cervical cancer, ACR Appropriateness Criteria® pretreatment planning of invasive cancer of the cervix, Clinical Practice Guideline in Oncology. Chapitre 3 - Le rôle des virus HPV (a) Contrast--enhanced CT, (b) axial fast spin-echo T2-weighted MRI, and (c) axial T1 images after gadolinium-based contrast agent administration through pelvis of a woman with stage IB2 cervical cancer (arrows). Il représente 12,5% de tous les cancers féminins. La tumeur de stade IA est située uniquement dans un seul des deux ovaires. Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage. Clinical staging (FIGO) should also be documented (Table 1). Chest CT findings of metastases are pulmonary nodules or involvement of the supraclavicular nodes, a station in the drainage pathway of the primary tumor (31). 1 It is thus a major cause of morbidity and mortality from cancer. Classification FIGO 2009 FIGO I : cancer strictement limité au col IA : diag histologique profond invasion ≤5 mm et extension en largeur ≤7 mm IA1 invasion stroma ≤3.0 mm prof et ext lat ≤7.0 mm IA2 invasion stroma >3.0 mm et ≤5.0 mm et extension en largeur non ≤7.0 mm IB : lésion visible visible limitée au col … The size and extent of local spread of the primary tumor in the central pelvis can now be assessed by using clinical examination, imaging, or pathologic measurement. (b) Sagittal MRI after gadolinium-based contrast agent administartion shows that tumor (arrows) extends into uterine corpus and measures 4.8 cm, corresponding to stage IB3. Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. 2c - Colposcopie (pour les notes du présentateur, cliquer ici) 2d - Recherche et identification des virus VPH. (a) Coronal maximal intensity projection PET image in a patient staged as IB following clinical examination and normal chest x-ray (not shown) shows hypermetabolic foci in left upper (arrow) and right middle (arrowhead) thorax corresponding to (b) left supraclavicular lymphadenopathy (arrow) and (c) cavitary right lung nodule (arrowhead), respectively. The standards for image acquisition and interpretation are summarized with cases illustrating potential pitfalls. Role of PET/MRI in Staging of Cervical Cancer Under the Newly Updated FIGO Staging System, The International Federation of Gynecology and Obstetrics (FIGO) Cancer Report 2019: An Imaging Update on Cervical Cancer Staging and Beyond, Pseudoprogression with Immunotherapy Treatment, Locally advanced, metastatic prostate adenocarcinoma. The revision calls for a more precise measurement of primary tumor size, best assessed with imaging. Figure 4b: Images show uterine cervical cancer lymphadenopathy at fluorodeoxyglucose PET/CT versus CT. (a) Coronal maximum intensity projection PET image in a patient clinically staged as IB shows hypermetabolic foci in pelvis (arrowheads) and abdomen (arrows), which at fusion PET/CT (not shown) correspond to retroperitoneal lymphadenopathy. FIGO – Cancer de l’ovaire . doi: 10.1002/14651858.CD008217.pub3. Wright JD, Matsuo K, Huang Y, Tergas AI, Hou JY, Khoury-Collado F, St Clair CM, Ananth CV, Neugut AI, Hershman DL. ... Basé sur FIGO Cancer Report 2018 (Neerja Bhatla N, Aoki D, Sharma DN, Sankaranarayanan, R, et al: Cancer of the cervix uteri. First Published: 11 October 2018. Multiplanar fast spin-echo T2 images help evaluate for tumor invasion into the parametria (stage IIB) and pelvic sidewall (stage IIIB), and images after gadolinium-based contrast agent administration help assess for peritoneal, nodal, and bone metastases (10,32). Elle est maximum entre 60 et 70 ans. La classification et le pronostic du cancer de l'utérus dépend du grade et du stade de la tumeur. Clipboard, Search History, and several other advanced features are temporarily unavailable. Cancer du col de l’utérus ... Les performances de l’IRM abdomino-pelvienne permettent l’évaluation précise du stade de la tumeur (classification FIGO), l’examen sous anesthésie n’est plus indiqué. To compensate for these shortfalls, treatment planning for invasive cervical cancer in much of the developed world has included modern cross-sectional and functional imaging such as CT, MRI, and fluorine 18 fluorodeoxyglucose, or FDG, PET (10,11). Imaging routinely encompasses the skull base through the proximal thighs. Stages. Medicine (Baltimore). Le dépistage du cancer du col de l’utérus est recommandé à toutes les femmes de 25 à 65 ans, ayant ou ayant eu des rapports sexuels, et après la ménopause. The new system introduces retroperitoneal lymphadenopathy as a factor and specifies that cross-sectional imaging, ideally PET/CT, be used to assess nodal status. Chest radiography in posterior-anterior and lateral views is performed in patients with local-regionally advanced disease to evaluate for pulmonary metastases. FIGO et TNM – Cancer de l’endomètre. Classification 2018 du cancer du col de l’utérus selon la Fédération internationale de gynécologie obtétrique (FIGO), d’après Bhatla et al. Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer. Endovaginal or endorectal US with a high-frequency (eg, 7–9 MHz) transducer is used to measure the primary tumor and to assess for local spread into the uterine cervical stroma (stage IB) or parametria (stage IIB) in patients suspected of having early stage disease. Thus, early detection of stage IVB disease significantly impacts patient treatment and represents an opportunity to decrease treatment-related morbidity. It is usually performed as part of a PET/CT examination or as an alternative to abdominopelvic MRI if the latter examination is contraindicated or unavailable. At the end of the year 2018, the International Federation of Gynecology and Obstetrics (FIGO) published a new classification for cervical cancer. In 2018, there were an estimated 569 847 new cases and 311 365 deaths worldwide annually. The treatment of cervical cancers according to FIGO staging is well defined. Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. Figure 4c: Images show uterine cervical cancer lymphadenopathy at fluorodeoxyglucose PET/CT versus CT. (a) Coronal maximum intensity projection PET image in a patient clinically staged as IB shows hypermetabolic foci in pelvis (arrowheads) and abdomen (arrows), which at fusion PET/CT (not shown) correspond to retroperitoneal lymphadenopathy. 2.1 Stade de la tumeur. Référentiel e l’AP-HP Cancer e la ulve ui 016 3 Sommaire Préambule3 Classification FIGO 2009 du cancer la vulve 4 Classification TNM du cancer de la vulve (7ème édition 2009) 5 I. Anatomopathologie 9 II. Dr. Alexandre Ladoux However, because tumor is usually homogeneously enhancing similar to normal cervical tissue, CT is usually suboptimal for assessing tumor extent of central pelvic spread and accurate measurement of the tumor (Fig 1) (28). Cancer staging is a fundamental principle and one of the first and most important steps used to predict patient outcome as well as to plan the most appropriate treatment. Cancer Today (powered by GLOBOCAN 2018) IARC CancerBase No. Cancers gynécologiques - Retrouvez les recommandations de bonne pratique liées à la prise en charge des cancers gynécologiques (ovaire, endomètre, col utérin). In the stage III cohort (n = 11,733), stage IIIC1 was independently associated with improved cause-specific survival compared to stage IIIB disease (adjusted-HR 0.79, 95%CI 0.74-0.85, P < 0.001). Deux cas particuliers seront précisés : Keywords: Patient was staged as IVB based on PET/CT and lymph node biopsy that showed metastases at pathologic analysis. However, in patients with lymphadenopathy, surgery alone does not cure and 10%–30% of patients with early stage disease harbor lymph node metastases (22). These should be routinely acquired if a PET/CT or an abdominopelvic CT is not planned. Abdominopelvic CT is performed to evaluate for retroperitoneal lymphadenopathy (stage IIIC). Int J Gynaecol Obstet 105, 103-104 (2009). Stage predicts patient prognosis and guides treatment planning. 15 Edited by Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F In a prospective cohort study of 560 patients at a single center, the risk of recurrent disease was shown to increase incrementally on the basis of the most distant level of lymph node involvement at PET, with a hazard ratio of 2.40 (95% confidence interval: 1.63, 3.52) for pelvic, 5.88 (95% confidence interval: 3.80, 9.09) for para-aortic, and 30.27 (95% confidence interval: 16.56, 55.34) for supraclavicular involvement (63). Dans sa récente Déclaration mondiale sur l'élimination du cancer du col utérin, la FIGO a souligné notre engagement à collaborer à l'effort mondial. Preceding versions of the staging system included imaging with chest and skeletal radiography, intravenous pyelography, and barium enema (4–6). Data in parentheses are 95% confidence intervals. Stratégie diagnostique Dans l’évaluation diagnostique d’un frottis anormal, la colposcopie est … Consequently, we routinely include diffusion-weighted imaging with b values of 0 and 1000 sec/mm2 to facilitate lesion detection (42). Objective To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer, with a particular focus on stage IB and stage III disease. - À l'opposé, devant un col macroscopiquement anormal, un résultat de frottis normal ne suffit pas à exclure le diagnostic de cancer du col. 3.1. Surgery is the preferred choice for less advanced tumors. PET/CT is best used to evaluate for hydronephrosis (stage IIIB), retroperitoneal lymphadenopathy (stage IIIC), and distant metastases (stage IVB). Cervical cancer can manifest with tumor beyond the pelvic soft tissues and the retroperitoneal lymph nodes. 2019 Jul;134(1):49-57. doi: 10.1097/AOG.0000000000003311. The 2018 FIGO staging system for cervical cancer is useful to distinguish survival groups; stage IB1 and stage IB2 disease have distinct characteristics and survival outcomes, while survival in stage IIIC1 varies depending on local tumor factors. (b) Sagittal MRI after gadolinium-based contrast agent administartion shows that tumor (arrows) extends into uterine corpus and measures 4.8 cm, corresponding to stage IB3. Publié dans: Cancéro, Pelvis | Tagué: Cancer du col utérin, FIGO, Ladoux. In this trial, 647 patients with advanced ovarian cancer (FIGO IIB‐IV) who underwent macroscopically complete resection and clinically negative pelvic and para‐aortic lymph nodes were randomized to systematic pelvic and para‐aortic lymphadenectomy or no … To be considered a candidate for this procedure, the woman must be considered to have stage I (ie, tumor confined to the cervix) and not stage II (ie, tumor growth into the upper third of the vagina or the parametria) disease. L’évaluation du stade d’évolution d’un cancer demande un ensemble de tests de diagnostic et d’examens permettant d’évaluer la nature précise et l’étendue de la maladie. Axial oblique fast spin-echo T2-weighted image in a woman clinically staged as IB shows tumor that extends beyond dark stromal ring of cervix into adjacent parametria (arrows) corresponding to stage IIB. Source.—References 8 and 9. Survival of stage IIIC1 disease significantly differed based on T = stage, (5-year rates: 74.8% for T1, 58.7% for T2, and 39.3% for T3) with a 35.3% difference in absolute survival (P < 0.001). About . If PET/CT is unavailable, then chest radiography is recommended as first-line imaging modality for thoracic imaging. Bethesda, MD 20894, Copyright Ainsi la chirurgie peut dans certains cas ne pas faire partie de l’arsenal thérapeutique. In high-resource settings, pelvic MRI (to assess tumor size and central pelvic spread) and torso fluorodeoxyglucose PET/CT (to assess lymphadenopathy and distant metastases) are used to assign stage and to plan therapy. 2020 Oct 20;10:591700. doi: 10.3389/fonc.2020.591700. 114 Routine pathologic screening of mismatch repair deficiencies in the endometrial cancer specimen, similar to colorectal cancer, has been advocated and is increasingly being introduced in practice. The stage IB cohort consisted of node-negative FIGO stage IB1 (tumor size <2 cm), IB2 (2-3.9 cm), and IB3 (≥4 cm) cervical cancer. Figure 4a: Images show uterine cervical cancer lymphadenopathy at fluorodeoxyglucose PET/CT versus CT. (a) Coronal maximum intensity projection PET image in a patient clinically staged as IB shows hypermetabolic foci in pelvis (arrowheads) and abdomen (arrows), which at fusion PET/CT (not shown) correspond to retroperitoneal lymphadenopathy. L'édition 2018 du FIGO Cancer Report a permis à nos membres d'actualiser leurs connaissances, d'identifier les lacunes dans leurs compétences et de rechercher des opportunités de formation continue afin de garantir que toutes les femmes reçoivent les soins dont elles ont besoin. Seront abordés, avec des questions posées par les patient(e)s et avec un chat : ... Honolulu : Friday, November 9th 2018 from 06am to 07:30am (GMT-10) San Francisco : Friday, November 9th 2018 from 08am to 09:30am (GMT-8) Le cancer du col utérin est le deuxième cancer gynécologique en Algérie, avec une incidence de 8,7 pour 100 000 femmes. ║ Abnormalities should be confirmed with pathologic analysis. Cervical cancer, MRI and PET/CT for triaging stage IB clinically operable cervical cancer to appropriate therapy: decision analysis to assess patient outcomes, Multidisciplinary perspectives on newly revised 2018 FIGO staging of cancer of the cervix uteri, Validation of the 2018 FIGO cervical cancer staging system, Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer—a series of 50 pregnancies and review of the literature, Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women, The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience, Fertility-sparing surgery in early-stage cervical cancer: indications and applications, Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer, FDG-PET-based prognostic nomograms for locally advanced cervical cancer, PET/CT imaging to guide cervical cancer therapy. From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 (S.I.L. It is usually performed as part of a PET/CT examination or to follow-up abnormalities seen at chest x-ray. Note.—Adapted, with permission, from reference 59. La fréquence du cancer du corps de l´utérus augmente avec l´âge. Most common are lung nodules, although pleural effusions or masses can also be seen. Obstet Gynecol. Choice of modality depends on the technology available within the practice setting. † Examination should include small field-of-view images tailored for soft-tissue evaluation of the central pelvis and large field-of-view images of the abdomen and pelvis to evaluate retroperitoneal lymph nodes and the renal collecting system. The patient is asked to void before scanning to decrease bladder volume. A prospective multicenter trial of 208 women demonstrated that MRI correlated more closely with pathologic measurements than did CT or physical examination (28). Viewer, https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf, https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html, 2018 FIGO Staging Classification for Cervical Cancer: Added Benefits of Imaging, Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies, MRI for Radiation Therapy Planning in Human Papillomavirus–associated Gynecologic Cancers, Utility of PET/CT to Evaluate Retroperitoneal Lymph Node Metastasis in High-Risk Endometrial Cancer: Results of ACRIN 6671/GOG 0233 Trial, FDG PET/CT Pitfalls in Gynecologic and Genitourinary Oncologic Imaging. Patient was staged as IIIC2 based on PET/CT. Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. CT should be of diagnostic quality but use of iodinated contrast material is optional. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer, The role of ultrasound in the assessment of uterine cervical cancer, Comparison of MRI and high-resolution transvaginal sonography for the local staging of cervical cancer, Three-dimensional transvaginal sonography and magnetic resonance imaging for local staging of cervical cancer: an agreement study, Transrectal ultrasound and magnetic resonance imaging in staging of early cervical cancer, 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, Normal pelvic lymph nodes: evaluation with CT after bipedal lymphangiography, New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1), Supraclavicular lymph node metastases in cervical cancer, Staging of uterine cervical cancer with MRI: guidelines of the European Society of Urogenital Radiology, Preoperative magnetic resonance imaging staging of uterine cervical carcinoma: results of prospective study, MRI for pretreatment lymph node staging in uterine cervical cancer, Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging, Diffusion-weighted magnetic resonance imaging of uterine cervical cancer, Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T, Relative apparent diffusion coefficient: determination of reference site and validation of benefit for detecting metastatic lymph nodes in uterine cervical cancer, Discrimination of metastatic from hyperplastic pelvic lymph nodes in patients with cervical cancer by diffusion-weighted magnetic resonance imaging, Differentiation of metastatic from non-metastatic lymph nodes in patients with uterine cervical cancer using diffusion-weighted imaging, Diagnostic accuracy of whole-body MRI/DWI image fusion for detection of malignant tumours: a comparison with PET/CT, Evaluation of gynecologic cancer with MR imaging, 18F-FDG PET/CT, and PET/MR imaging, Detection of peritoneal dissemination in gynecological malignancy: evaluation by diffusion-weighted MR imaging, Diagnostic significance of diffusion-weighted MRI in patients with cervical cancer: a meta-analysis, Value of apparent diffusion coefficient (ADC) in assessing radiotherapy and chemotherapy success in cervical cancer, Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0, FDG PET-CT of genitourinary and gynecologic tumors: overcoming the challenges of evaluating the abdomen and pelvis, FDG PET-CT of gynecologic cancers: pearls and pitfalls, Predictors of survival in patients with FIGO stage IVB cervical cancer, Management and care of women with invasive cervical cancer: American Society of Clinical Oncology resource-stratified clinical practice guideline, Early-stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound - a European multicenter trial, 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, Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer, Lymphatic mapping and sentinel node identification in patients with cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy, Sentinel lymph node detection in early stage uterine cervix carcinoma: a systematic review, Complications of lymphadenectomy for gynecologic cancer, 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, Utility of PET-CT to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: results of ACRIN6671/GOG0233 trial, Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis, Identification of distant metastatic disease in uterine cervical and endometrial cancers with FDG PET/CT: analysis from the ACRIN 6671/GOG 0233 Multicenter Trial, Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases, Lymph node staging by positron emission tomography in cervical cancer: relationship to prognosis, Pulmonary nodules in patients with primary malignancy: comparison of hybrid PET/MR and PET/CT imaging, Global health and radiology: a new paradigm for US radiology resident training, https://doi.org/10.1148/radiol.2019190088, Open in Image La détermination précise du stade d’un cancer est l’un des facteurs déterminant pour le choix du type de traitement. Stade I du cancer de l’ovaire. Imaging modality or pathologic technique should also be documented. PET/CT is the most sensitive imaging examination for detection of lymphadenopathy. Distant metastases noted at PET/CT should be confirmed with pathologic analysis, because this finding significantly impacts patient prognosis and treatment (49,50). The maximal cross-sectional tumor diameter visualized in any plane is measured both at imaging and at pathologic analysis. 6, © 2021 Radiological Society of North America, History of the FIGO cancer staging system, FIGO staging of gynecologic cancer. Fluorine 18 FDG PET/MRI, in which MRI and PET data are acquired simultaneously in a single scanner, demonstrates promise to be an important tool in FIGO cervical cancer staging (42). ... 31 /01/2018 COURS POUR EXTERNE 5éme ANNEE Dépistage du cancer du col 2018; Cervical cancer; FIGO; International Federation of Gynecology and Obstetrics; Staging; Validation. 8600 Rockville Pike Finally, we describe how the recommended imaging choices can be directly applied to the new staging system. For patients suspected of having stage IB (invasive cancer ≥5 mm) disease or greater, imaging is indicated to assign stage (see Fig E1 [online]). The 2018 FIGO cervical cancer staging system now enables identification and upstaging of these patients based on pretreatment lymph node imaging, thereby sparing them unnecessary surgery and long-term morbidity (12,23). Radiologists, among other physicians, should continue to participate in ongoing efforts to improve access to advances in medical technology and expertise in low-resource settings (65,66). If MRI is unavailable, then US with an endovaginal or endorectal probe is an alternative in women when the clinical examination suggests early stage disease. This revision is based on observational data that define two clinically distinct patient populations (14). ). Ferlay et al, editors. Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. 89.5% of females survive uterine cancer for at least one year, this falls to 75.6% surviving for five years or more, as shown by age-standardised net survival for patients diagnosed with uterine cancer during 2013-2017 in England. The first staging system put forth by FIGO around the turn of the 20th century applied to carcinoma of the uterine cervix, at the time the most common cancer among women in the developed world (3). Surgery is the treatment of choice for stages lower than IIA, except for lesions over 4 cm in diameter (stage IB2 or IIA). One of the major changes in the updated staging system is that stage IB disease (ie, invasive carcinoma limited to the cervix) now includes three, rather than two, subgroups based on tumor size measured in its maximal dimension. A prospective trial of 189 women with FIGO stage IA2–IIA cervical cancer (ie, invasive tumors <4 cm) showed that maximal tumor dimension measured with US agreed with those obtained with MRI or pathologic analysis (Table 3) (52). outils pour les professionnels de santé assurant le suivi gynécologique (INCa). A lymph node is considered positive for metastasis when it is within the anatomic nodal drainage pathway for the primary tumor and demonstrates tracer uptake greater than that of a clearly a normal node elsewhere on the scan (48). Prognostic Nomograms Predicting Survival in Patients With Locally Advanced Cervical Squamous Cell Carcinoma: The First Nomogram Compared With Revised FIGO 2018 Staging System. MRI is preferred over CT or pelvic examination for measuring primary tumor size. The choice of imaging for staging is modified based on the availability of the technology and expertise (Table 2). In lower-resource settings, analogous modalities are pelvic US and chest radiography. FIGO is dedicated to the improvement of women's health and rights and to the reduction of disparities in healthcare available to women and newborns, as well as to advancing the science and practice of obstetrics and gynecology. On multivariable analysis, stage IB2 disease was independently associated with a nearly two-fold increased risk of cervical cancer mortality compared to stage IB1 disease (adjusted-hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.62-2.41, P < 0.001).

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