title: Early cervical carcinoma and fertility-sparing treatment options: MR imaging as a tool in patient selection and a follow-up modality.
abstract: Because of the widespread use of cytologic screening programs in industrialized nations, cervical carcinoma is being diagnosed in younger patients and at an earlier stage. The traditional therapy for early-stage disease is radical hysterectomy with pelvic lymphadenectomy, which leads to infertility. In the past 20 years, fertility-sparing therapies, such as cervical conization and radical trachelectomy, have emerged and show good oncologic and obstetric outcomes. The selection criteria for vaginal radical trachelectomy include stages IA2 and IB1, a tumor that is smaller than 2 cm, distance from the internal os of at least 1 cm, limited stromal invasion, and no nodal or extracervical extension. Magnetic resonance (MR) imaging accurately depicts these criteria and is a necessary tool in the preoperative evaluation of patients with cervical carcinoma who are eligible for fertility-sparing surgery. The MR imaging report must provide the following pieces of information for adequate surgical planning: tridimensional diameters of the lesion, uterine and cervical lengths, the degree of stromal invasion, distance from the internal os, and the presence of extracervical or nodal involvement. Because patients also undergo follow-up MR imaging, radiologists must be familiar with the postoperative imaging appearance of the cervix. After trachelectomy, the uterovaginal anastomosis may appear end-to-end or with a neoposterior vaginal fornix. Vaginal wall thickening, hematomas, lymphoceles, and hematometra secondary to isthmic stenosis may be seen. The normal postoperative appearance must be differentiated from recurrent disease, which is seen as a mass with intermediate to high signal intensity in the vaginal vault or parametrium on T2-weighted images. Functional imaging, including diffusion-weighted and dynamic contrast-enhanced imaging, may help characterize recurrence.
authors.affiliation: From the Department of Medical Imaging (P.N., M.D., G.S.L.) and Gynecologic Oncology Division (M.P.), CHU de Québec, Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, QC, Canada G1R 2J6.
authors.forename: Patricia
authors.initials: P
authors.lastname: Noël
authors.forename: Mireille
authors.initials: M
authors.lastname: Dubé
authors.forename: Marie
authors.initials: M
authors.lastname: Plante
authors.forename: Guillaume
authors.initials: G
authors.lastname: St-Laurent
mesh_terms: D000328:Adult; D003663:Decision Trees; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D059351:Organ Sparing Treatments; D018579:Patient Selection; D000069339:Trachelectomy; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult