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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

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  • Published:
European Radiology Aims and scope Submit manuscript

A Correction to this article was published on 17 June 2021

This article has been updated

Abstract

Objectives

The recommendations cover indications for MRI examination including acquisition planes, patient preparation, imaging protocol including multi-parametric approaches such as diffusion-weighted imaging (DWI-MR),  dynamic contrast-enhanced imaging (DCE-MR) and standardised reporting. The document also underscores the value of whole-body 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) and highlights potential future methods.

Methods

In 2019, the ESUR female pelvic imaging working group reviewed the revised 2018 FIGO staging system, the up-to-date clinical management guidelines, and the recent imaging literature. The RAND-UCLA Appropriateness Method (RAM) was followed to develop the current ESUR consensus guidelines following methodological steps: literature research, questionnaire developments, panel selection, survey, data extraction and analysis.

Results

The updated ESUR guidelines are recommendations based on ≥ 80% consensus among experts. If ≥ 80% agreement was not reached, the action was indicated as optional.

Conclusions

The present ESUR guidelines focus on the main role of MRI in the initial staging, response monitoring and evaluation of disease recurrence. Whole-body FDG-PET plays an important role in the detection of lymph nodes (LNs) and distant metastases.

Key Points

• T2WI and DWI-MR are now recommended for initial staging, monitoring of response and evaluation of recurrence.

• DCE-MR is optional; its primary role remains in the research setting.

• T2WI, DWI-MRI and whole-body FDG-PET/CT enable comprehensive assessment of treatment response and recurrence

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Change history

Abbreviations

2D:

Two dimensional

3D:

Three dimensional

ADC:

Apparent diffusion coefficient

CCRT:

Concurrent chemoradiotherapy

CT:

Computed tomography

DCE-MRI:

Dynamic contrast-enhanced imaging

DWI-MR:

Diffusion-weighted imaging

EBRT:

External beam radiation

ESUR:

European Society of Urogenital Radiology

FDG-PET/CT:

18-Fluorodeoxyglucose positron emission tomography/computed tomography

FIGO:

International Federation of Gynaecology and Obstetrics

LN:

Lymph node

LNM:

Lymph node metastases

MRI:

Magnetic resonance imaging

PET/MRI:

18-Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging

PMI:

Parametrial invasion

rFOV:

Reduced field-of-view

T2WI:

T2-weighted imaging

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Acknowledgements

The statistical analysis was carried out by Alessandro Sindoni MD, Department of Public Health and Infectious Diseases Sapienza University of Rome. The Committee would like to thank the members of ESUR Female Pelvic Imaging Working Group who contributed to the survey.

Yulia Lakhman was supported by the National Cancer Institute Grant N0 P30CA008748 (paid to Institution).

Author information

Authors and Affiliations

  1. Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161, Rome, Italy

    Lucia Manganaro

  2. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Yulia Lakhman

  3. Department of Surgery and Cancer, Imperial College, London, UK

    Nishat Bharwani

  4. Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, Department of Surgery and Cancer, Imperial College, London, 3rd Floor, Queen Elizabeth the Queen Mother Building, Praed St., London, W21NY, UK

    Nishat Bharwani

  5. Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia Generale ed Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy

    Benedetta Gui

  6. Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini, 385, 00157, Rome, Italy

    Silvia Gigli

  7. Department of Radiology, Aerospace Medical Institute, Viale Piero Gobetti, Rome, Italy

    Valeria Vinci

  8. Department of Radiology, Università della Svizzera Italiana (USI), EOC via Tesserete 46, Lugano, 6900, Switzerland

    Stefania Rizzo

  9. Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan

    Aki Kido

  10. Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon Codex, Portugal

    Teresa Margarida Cunha

  11. Department of Radiology, Cambridge Biomedical Campus Cambridge, Box 218, Cambridge, CB2 0QQ, UK

    Evis Sala

  12. Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK

    Andrea Rockall

  13. Department of Radiology, Imperial College Healthcare NHS Trust, London, UK

    Andrea Rockall

  14. Department of Radiology, PMU, Müllner Hauptstr, 48 Universitätsklinikum, 5020, Salzburg, Austria

    Rosemarie Forstner

  15. Department of Radiology, University of Montpellier, Montpellier, France

    Stephanie Nougaret

  16. INSERM, Montpellier Cancer Research Institute, U1194, University of Montpellier, 208 Avenue des Apothicaires, 34295, Montpellier, France

    Stephanie Nougaret

Authors
  1. Lucia Manganaro
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  2. Yulia Lakhman
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  3. Nishat Bharwani
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  4. Benedetta Gui
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  6. Valeria Vinci
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  7. Stefania Rizzo
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  8. Aki Kido
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  11. Andrea Rockall
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  12. Rosemarie Forstner
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Corresponding author

Correspondence to Lucia Manganaro.

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Guarantor

The scientific guarantor of this publication is Lucia Manganaro MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Alessandro Sindoni kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because this manuscript is a special report regarding Staging, recurrence and follow up of uterine cervical cancer using MRI.

Ethical approval

Institutional Review Board approval was not required because this is a special report on Staging, recurrence and follow up of uterine cervical cancer using MRI.

Study subjects or cohorts overlap

N/A

This document represents an update of ESUR guidelines on the basis of new FIGO Classification (2018).

Methodology

• Retrospective

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The original online version of this article was revised: Affiliation 1 was incorrect.

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Manganaro, L., Lakhman, Y., Bharwani, N. 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 31, 7802–7816 (2021). https://doi.org/10.1007/s00330-020-07632-9

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  • DOI: https://doi.org/10.1007/s00330-020-07632-9

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