Diagnostic Ultrasound - Abdomen and Pelvis

Cervical Carcinoma
Diagnoses: Female Pelvis
IMAGING
• Soft tissue mass: Hypoechoic or isoechoic ± necrosis
• Hydro- or hematometra from cervical obstruction
• MR is best modality for local staging and planning of
radiation therapy
○ Tumor: Intermediate to high signal mass replacing dark
cervical stroma on T2-weighted sequences
○ Accuracy superior to FIGO staging for size, parametrial
extension, lymph nodes
• In experienced hands, ultrasound may be superior to MR
for local staging and is more widely available than MR
• PET/CT best modality for overall staging: Nodal disease,
liver, bone, and lung metastases
• Revised FIGO staging uses information from CT or MR;
cystoscopy and sigmoidoscopy not mandatory
TOP DIFFERENTIAL DIAGNOSES
• Cervical fibroid
• Cervical polyp
KEY FACTS
• Endometrial cancer
• Primary cervical lymphoma
• Adenoma malignum/minimal deviation adenocarcinoma
• Neuroendocrine/small cell carcinoma
PATHOLOGY
• Approximately 80-90% are squamous carcinoma
• Arise at squamocolumnar junction
• Precursor lesions
○ Cervical intraepithelial neoplasia (CIN) grades I-III
CLINICAL ISSUES
• Abnormal bleeding, pain, or discharge
• Detected by screening cytology from Pap smear
○ ± testing for high-risk HPV
(Left) Sagittal transvaginal
ultrasound shows a bulky soft
tissue mass in the cervix ſt,
proven to be squamous cell
carcinoma. The body of the
uterus was unremarkable.
(Right) Parasagittal
transvaginal power Doppler
ultrasound shows abundant
vascularity within the anterior
portion of the cervical
carcinoma ſt.
(Left) Axial oblique T2 TSE MR
of the same patient shows a
large (7 cm) tumor with
intermediate signal intensity
ſt. The low signal intensity
cervical stroma st is thinned
but preserved. No parametrial
invasion was found at surgery.
(Right) Coronal T2 TSE parallel
to the endometrium in the
same patient confirms the lack
of parametrial invasion st
despite the large size of the
tumor.
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