Table 1

Accuracy of physical examination and imaging methods in measuring tumor size

AccuracyProsCons
Physical examination47–70%Necessary step in the initial evaluation of cervical cancer patientsDepends 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 methodsUltrasound80–89%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 scan50–73%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
MRI79–90%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/CTTumors ≥1 cm show intense FDG uptakeHigh 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.