Diagnostic Ultrasound - Abdomen and Pelvis

Cervical Carcinoma
IMAGING
General Features
• Best diagnostic clue
○ Mass involving cervical stroma
Ultrasonographic Findings
• Grayscale ultrasound
○ Soft tissue mass, hypoechoic or isoechoic ± necrosis, less
commonly hyperechoic
○ Mass extending into upper vagina
○ Invasion of posterior bladder wall
○ Invasion of anterior rectal wall
○ Enlarged lymph nodes
○ Hydro- or hematometra from cervical obstruction
○ Hydronephrosis implies stage IIIB disease
• 3D
○ May be used to assess tumor volume before/after
therapy
• Color/power Doppler
○ Abundant internal color flow
○ Vascularity may predict response to therapy
○ Useful for detection of isoechoic tumors
• Ultrasound to guide treatment
○ Placement of interstitial radiation therapy devices
○ Guidance for dilatation of postradiation cervical/vaginal
stenosis
CT Findings
• CECT
○ For whole body staging: Nodal disease, liver, bone, and
lung metastases
○ Less sensitive for local staging
– Soft tissue mass ± necrosis
MR Findings
• T2WI
○ Tumor: Intermediate to high signal mass replacing dark
cervical stroma
– Look for disruption of dark stromal "ring" on true axial
images of cervix
• DWI
○ Tumor and lymphadenopathy: High signal on DWI with
low ADC
• T1WI C+
○ Variable, smaller tumors enhance more than larger
tumors
• Study of choice for identification of disease beyond cervix
• Accuracy for tumor size: 93%
• Parametrial invasion: Accuracy: 88-97%, specificity: 93%,
negative predictive value (NPV): 94-100%
• High negative predictive value for bladder and rectal
invasion: 100%
• Essential for patients being considered for trachelectomy
• Ideal for radiation planning
Nuclear Medicine Findings
• PET/CT
○ Study of choice for whole body staging, especially lymph
nodes
○ May reduce unnecessary surgical interventions/change
therapeutic approach
○ For restaging after therapy and follow-up
Imaging Recommendations
• Best imaging tool
○ MR is best modality for local staging and planning of
radiation therapy
○ Accuracy superior to FIGO staging for size, parametrial
extension, lymph nodes
○ PET/CT best modality for overall staging
○ In experienced hands, ultrasound may be superior to MR
for local staging and is more widely available than MR
• Protocol advice
○ Optimize MR study by
– Obtaining images perpendicular to cervix
– Distending vagina with water soluble gel
DIFFERENTIAL DIAGNOSIS
Cervical Fibroid
• Similar appearance to myometrium
• Prolapsed endocavitary fibroid may mimic cervical mass
• Fibroid may arise from cervical stroma, producing
subserosal or submucosal mass
Cervical Polyp
• May originate in cervical canal or prolapse from
endometrial cavity
• Similar echogenicity to endometrium and cervical mucosa
• Feeding vessel and internal cysts may be visible
Endometrial Cancer
• Direct extension to cervix
• Epicenter of mass will be in uterus
Primary Cervical Lymphoma
• Solid mass with relative preservation of cervical canal
• Aggressive surgery not required
• Responds to chemotherapy/radiation therapy
Adenoma Malignum/Minimal Deviation
Adenocarcinoma
• Rare well-differentiated adenocarcinoma of cervix
• Early dissemination/poor prognosis
• Arises from columnar epithelium
• Barrel-shaped multicystic lesion deep in cervical stroma
with solid components
○ May be mistaken for nabothian cysts (more superficial)
Neuroendocrine/Small Cell Carcinoma
• More aggressive
• Lymphadenopathy and metastases more extensive
• Related to smoking
Cervical Metastasis
• Fallopian tube, ovary, primary peritoneal carcinoma
• Differentiate by histology and presence of other tumor
PATHOLOGY
General Features
• Precursor lesions
Diagnoses: Female Pelvis
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