Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guidelines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update of the ESGO-ESTRO-ESP recommendations was performed, further confirming this statement. Transvaginal/transrectal ultrasound (TRS/TVS) or pelvic magnetic resonance (MRI) enables tumor delineation and precise assessment of its local extent, including the evaluation of the depth of infiltration in the bladder- or rectal wall. Additionally, both techniques have very high specificity to confirm the presence of metastatic pelvic lymph nodes but fail to exclude them due to insufficient sensitivity to detect small-volume metastases, as in any other currently available imaging modality. In early-stage disease (T1a to T2a1, except T1b3) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging should be performed. In all other situations, contrast-enhanced computed tomography (CECT) or 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET-CT) is recommended to assess extrapelvic spread. This paper aims to review the evidence supporting the implementation of diagnostic imaging with a focus on ultrasound at primary diagnostic workup of cervical cancer.
依据欧洲妇科肿瘤学会（ESGO）、欧洲放射治疗与肿瘤学会（ESTRO）及欧洲病理学会（ESP）联合发布的宫颈癌患者管理指南（2018版），治疗决策应以现代影像学技术为指导。五年后（2023年），ESGO-ESTRO-ESP建议进行了更新，进一步确认了这一原则。经阴道/经直肠超声（TRS/TVS）或盆腔磁共振成像（MRI）能够实现肿瘤轮廓勾画并精确评估其局部侵犯范围，包括对膀胱或直肠壁浸润深度的评估。此外，这两种技术在确认盆腔淋巴结转移方面具有极高的特异性，但由于对微小转移灶检测的敏感性不足（与当前其他可用影像学方法类似），无法完全排除淋巴结转移。对于早期病例（T1a至T2a1期，T1b3除外）且TVS/TRS或MRI显示淋巴结阴性者，应进行手术病理分期。在所有其他情况下，建议采用对比增强计算机断层扫描（CECT）或18F-氟代脱氧葡萄糖正电子发射断层扫描联合CT（PET-CT）评估盆腔外扩散情况。本文旨在综述支持诊断影像学应用的证据，重点关注宫颈癌初次诊断检查中超声的应用价值。
The Role of Imaging in Cervical Cancer Staging: ESGO/ESTRO/ESP Guidelines (Update 2023)
肿瘤(癌症)患者之家