Department of Radiology, Box 218, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Hills Rd, Cambridge CB2 0QQ, England.
Radiographics. 2012 Oct;32(6):1805-27. doi: 10.1148/rg.326125519.
Cancers of the uterine corpus and cervix are the most common gynecologic malignancies worldwide. The International Federation of Gynecology and Obstetrics (FIGO) staging system was first established in 1958, when it was recognized that the recurrence rate and patient outcomes were directly related to the degree of tumor spread at the patient's initial presentation. Changes in understanding of tumor biology led to a recent update in the FIGO staging system that reflects the variation in treatment strategies between endometrial and cervical cancer. Patients with endometrial cancer are primarily treated with hysterectomy; thus, staging is done at surgery and histologic analysis. Magnetic resonance (MR) imaging may accurately depict the extent of endometrial cancer at diagnosis and, in conjunction with the tumor grade and histologic subtype, help stratify risk, which determines the therapeutic course. Cervical carcinoma is staged at clinical examination because many tumors are inoperable at the time of patient presentation. Preoperative MR imaging criteria are not formally included in the revised FIGO staging system because cervical carcinoma is most prevalent in developing countries, where imaging resources are limited. However, MR imaging is highly sensitive and specific for depicting important prognostic factors and, when available, is recommended as an adjunct to clinical examination. The MR imaging findings of uterine carcinoma should be discussed in a multidisciplinary setting in conjunction with clinical and histologic findings, an approach that provides accurate staging and risk stratification and allows for individualized treatment.
子宫体和子宫颈癌症是全球最常见的妇科恶性肿瘤。国际妇产科联合会（FIGO）分期系统于 1958 年首次建立，当时人们认识到肿瘤的复发率和患者预后与患者初次就诊时肿瘤的扩散程度直接相关。对肿瘤生物学的认识的变化导致了最近对 FIGO 分期系统的更新，该系统反映了子宫内膜癌和宫颈癌之间治疗策略的变化。子宫内膜癌患者主要接受子宫切除术治疗；因此，分期是在手术和组织学分析时进行的。磁共振成像（MR）可以准确描述诊断时子宫内膜癌的范围，并且结合肿瘤分级和组织学亚型，有助于分层风险，从而确定治疗方案。宫颈癌在临床检查时进行分期，因为许多肿瘤在患者就诊时已经无法手术。术前 MR 成像标准并未正式纳入修订后的 FIGO 分期系统，因为宫颈癌在发展中国家更为普遍，这些国家的影像学资源有限。然而，MR 成像对于描绘重要的预后因素具有高度的敏感性和特异性，并且在有条件的情况下，推荐将其作为临床检查的辅助手段。子宫癌的 MR 成像结果应结合临床和组织学结果在多学科环境中进行讨论，这种方法可以提供准确的分期和风险分层，并允许个体化治疗。
