Department of Radiodiagnosis, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Department of Obstetrics & Gynaecology, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Indian J Med Res. 2021 Aug;154(2):383-390. doi: 10.4103/ijmr.IJMR_212_21.
BACKGROUND & OBJECTIVES: Imaging has been added to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system of cervical carcinoma. This study was performed to assess the impact of imaging in staging and to ascertain the prevalence and pattern of nodal metastasis on contrast-enhanced computed tomography (CECT) in patients with cervical carcinoma who were treated based on FIGO 2009 staging system.
This retrospective study was conducted to evaluate all patients with biopsy-proven cervical carcinoma who underwent CECT of abdomen at a tertiary cancer centre in north India from April 2017 to April 2019 and for whom either baseline or follow up scans were available. In patients with enlarged or necrotic lymph nodes, the location, size and pattern of infiltration of adjacent organs were recorded.
A total of 602 patients of cervical carcinoma had undergone CT during the study period, of whom 138 (22.9%) underwent CT at baseline and 464 (77.1%) patients during follow up. The FIGO (2009) stage distribution at the time of presentation was stage IB: 109 (18.1%); stage IIA: 14 (2.3%), stage IIB: 118 (19.6%), stage IIIA: 12 (2%), stage IIIB: 277 (46%), stage IVA: 20 (3.3%) and stage IVB: 52 (8.6%). Ninety of the 138 (65.22%) patients underwent a stage shift according to the FIGO 2018 because of the presence of enlarged lymph nodes at baseline scan. Sixteen (2.7%) patients had infiltrative nodal masses most commonly involving the blood vessels (n=14) followed by ureter (n=8), bones (n=5), muscle and bowel (n=3, each). The majority (14/16) of these patients presented with vague abdominal pain, discomfort and vomiting, while two had bone pain.
INTERPRETATION & CONCLUSIONS: CECT at baseline helps in accurately assessing the stage in cervical carcinoma. It helps in the identification of lymph node metastasis in cervical carcinoma, which is crucial for guiding accurate management.
影像学检查已被纳入国际妇产科联合会（FIGO）2018 年宫颈癌分期系统。本研究旨在评估影像学检查在分期中的作用，并确定基于 FIGO 2009 分期系统治疗的宫颈癌患者增强 CT（CECT）上淋巴结转移的发生率和模式。
本回顾性研究评估了 2017 年 4 月至 2019 年 4 月在印度北部一家三级癌症中心接受 CECT 检查且活检证实为宫颈癌的所有患者，并且基线或随访时均有扫描结果。对有增大或坏死淋巴结的患者，记录淋巴结的位置、大小和邻近器官浸润模式。
研究期间共有 602 例宫颈癌患者接受了 CT 检查，其中 138 例（22.9%）在基线时接受 CT 检查，464 例（77.1%）在随访时接受 CT 检查。就诊时 FIGO（2009）分期分布为：IB 期 109 例（18.1%）；IIA 期 14 例（2.3%）；IIB 期 118 例（19.6%）；IIIA 期 12 例（2.0%）；IIIB 期 277 例（46.0%）；IVA 期 20 例（3.3%）；IVB 期 52 例（8.6%）。由于基线扫描时存在淋巴结肿大，138 例（65.22%）患者根据 FIGO 2018 进行了分期转移。16 例（2.7%）患者有浸润性淋巴结肿块，最常见的累及血管（n=14），其次是输尿管（n=8）、骨骼（n=5）、肌肉和肠（n=3，各 1 例）。这些患者多数（14/16）表现为模糊的腹痛、不适和呕吐，2 例有骨痛。
基线 CECT 有助于准确评估宫颈癌分期。它有助于识别宫颈癌淋巴结转移，这对于指导准确的管理至关重要。
