Preoperative evaluation of uterine isthmus-cervical infiltration in patient with cervical cancer using nuclear magnetic resonance

Abstract

www.onk.ns.ac.rs/Archive Vol 21, No. 3-4, December 2013 INTRODUCTION Cervical carcinoma represents one of the major problems in developing countries where the cervical population-screening program is still not developed (1). Approximately 45% of surgically treated stage IB cancers occur in women under the age of 40 years (2). However, in developed countries, screening enables the detection of cancer in its early phase, which suggests a new approach in comprehension and surgical treatment of early invasive cervical carcinoma. Radical trachelectomy is a surgical method, together with the pelvic lymphadenectomy, for treating invasive forms of cervical carcinoma in its early stage in women who are in their fertile ages and who want to keep their reproductive function (3-8). The general eligibility criteria for radical trachelectomy include the following: women less than 40 years of age who have a strong desire to preserve fertility, no clinical evidence of impaired fertility, lesion size less than 2 cm, International Federation of Gynecology and Obstetrics (FIGO) stages IA –IB-1, no involvement of the upper endocervical canal, and negative regional lymph nodes (9). The absence of metastatic disease in lymph nodes and parametrial involvement allow continuation of the procedure. Another crucial point of the procedure is the level where the cervix has to be incised. In the preservation of uterine corpus in fertility-sparing surgery, the most important factor is the absence of internal uterine ostium or uterine corpus tumor infiltration (10). When computed tomography (CT) and NMR are compared, NMR is signifycantly more accurate in the evaluation of tumor volume, local tumor stage, and parametrial invasion due to its distinctive tissue contrast and multiplanar capability (11). Cervical tumor is best shown in T2W sequence, which gives the most evident difference between normal structures in the body and cervix of the uterus. The same sequence is determined by the integrity of the stromal ring and its deficiency is explained by the penetration of the tumor to the parametrium. The aim was to evaluate the accuracy of NMR in detection of infiltration of uterine isthmus-cervical part in cervical cancer patients without fertility preservation.