Precision Imaging in Cervical Cancer: A Comprehensive Approach to Diagnosis and Pre-treatment Evaluation

Objectives: Until 2018, cervical cancer (CC) was clinically staged; however, it was frequently under-staged. For this reason, in 2018, the International Federation of Gynecology and Obstetrics (FIGO) incorporated the imaging assessment into the staging of this malignancy. The aim of this review is to discuss available data regarding the role of imaging in the diagnosis, pretreatment staging, and how an adequate radiological evaluation could assist in the treatment planning for CC. Mechanism: An extensive literature search was conducted to identify relevant studies across various databases, including articles addressing topics related to imaging used in CC. The selected articles underwent thorough examination and evaluation to identify studies that met the objectives of this review, taking into account the specified inclusion and exclusion criteria. Subsequently, relevant data were extracted and analyzed for each article. Findings in Brief: Transvaginal ultrasound (TVS) and transrectal ultrasound (TRUS) have been shown to be accurate diagnostic tools to assessing the local spread of CC disease. Currently, magnetic resonance imaging (MRI) appears to offer the highest sensitivity, specificity, and accuracy in detecting parametrial and stromal invasion, as well as tumor size. Computed tomography (CT) and contrast-enhanced (CE)-CT are considered the best imaging modalities for the detection of lymph node metastases. However, positron emission tomography (PET) has demonstrated notable precision and exhibited high negative predictive value in predicting the pelvic nodal status during the early-stage diagnosis of CC diagnosis. Radiomics represents a newly introduced field of translational research with the potential to predict several clinically and pathological relevant variables in cervical carcinoma patients. These variables include disease staging, histological type, lymph node status, probability of recurrence, and estimated survival. Conclusions: Imaging plays an indispensable role in diagnosis, tumor staging, and monitoring the evolution of pathology in response to therapies over time. It provides physicians with the indispensable tool for optimal regulation of therapeutic strategy.