Accuracy | Pros | Cons | ||
Physical examination | 47–70% | Necessary step in the initial evaluation of cervical cancer patients | Depends on examiner’s experience High interobserver variability Impacted by patient’s anxiety, body habitus, discomfort Inaccurate for endocervical tumors Tumor size often described as a range rather than a value | |
Imaging methods | Ultrasound | 80–89% | Low cost Widely available Short scan time Requires minimal patient preparation Detailed images of tumor Tumor detection not impacted by prior conization High accuracy in determining depth of stromal invasion | Requires expert radiologist |
CT scan | 50–73% | Widely available High spatial resolution images Short scanning times | Poor soft tissue contrast resolution Tumors are isodense (same density) as adjacent normal tissue Large tumors may appear as a non-specific cervical enlargement Iodinated contrast agent is an additional risk to patients | |
MRI | 79–90% | High-tissue contrast resolution Effective delineating tumor boundaries and measuring tumor size Lack of ionizing radiation Ideal method to evaluate fertility-sparing surgical candidates | High cost Lower spatial resolution More frequently degraded by artifact. Requires an antiperistaltic agent to reduce bowel motion artifacts Difficulty in discriminating between T2-hyperintensity due to peritumoral edema vs neoplastic infiltration (risk of overstaging) | |
PET/CT | – | Tumors ≥1 cm show intense FDG uptake | High cost Poor special resolution with limited value in tumor stage Not ideal to determine tumor size |
CT, computed tomography; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; PET, positron emission tomography.