DOI: 10.1148/rg.234035054
(Radiographics. 2003;23:981.)
© RSNA, 2003
Invited Commentary
Evan S. Siegelman, MD
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
In the United States this year, 12,200 women will develop cervical carcinoma and 4,000 will die of the disease (1). Cervical infection with human papilloma virus (HPV) contributes to the development of most cases of dysplasia and carcinoma of the cervix (2). Screening for HPV infection may become incorporated into screening protocols for cervical cancer (3–5). Development and implementation of an HPV vaccine may help prevent the development of cervical carcinoma in the future (6,7).
Until HPV infection is eliminated in both men (8) and women, cervical carcinoma shall remain a common tumor and radiologists shall continue to be involved in the imaging and treatment of affected women. Prior articles published in RadioGraphics have focused on the CT and MR imaging appearances of cervical carcinoma both before and after therapy (9,10). In the preceding article, Jeong and colleagues show the normal pelvic imaging findings in women who have been treated with surgery or radiation therapy and provide representative imaging examples of recurrent local disease, malignant adenopathy, and metastatic disease.
It is important for radiologists to recognize the spectrum of posttreatment findings in women with cervical carcinoma to distinguish those women who are cured of their disease from those who have recurrent-metastatic disease and those who have nonneoplastic complications of prior therapy. For example, sacral insufficiency fracture and radiation osteonecrosis can mimic metastatic disease at CT and MR imaging (11,12). Radiologists should consider reading a moving narrative concerning the emotions one patient experiences when she is told that her images may or may not show metastatic tumor to a vertebral body (12). It was the physician who took the time to obtain a history and perform a physical examination who was able to establish a diagnosis of radiation osteonecrosis, and thus an unnecessary biopsy was avoided.
Characterization of lymph nodes in patients with cancer is a challenging task. Jeong and colleagues advise us to evaluate nodes in part on the basis of morphology and to categorize nodes larger than 1 cm as malignant and those smaller than 1 cm as benign. Contrast-enhanced CT or MR imaging may be helpful for further characterization of nodes, as squamous cell cancers (the most common subtype of cervical carcinoma) tend to show central necrosis as revealed by nonenhancement, whereas reactive nodes do not (13). MR spectroscopy (14) and lymph node–specific contrast agents (15) may play a future role in the characterization of lymph nodes in selected cancer patients.
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References
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Uterine Cervical Carcinoma after Therapy: CT and MR Imaging Findings
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RadioGraphics 2003 23: 969-981.
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