An Update on the Role of MRI in Treatment Stratification of Patients with Cervical Cancer

SIMPLE SUMMARY: Magnetic resonance imaging (MRI) has a pivotal role in accurately staging cervical cancer and has been formally incorporated into the 2018 FIGO staging system. MRI can accurately assess tumour size and local and distant invasion as well as lymph node involvement, which is essential for triaging patients into surgical or chemotherapeutic management. In this review, we highlight key MRI findings and pitfalls pertaining to the updated FIGO stages and their implications for treatment selection into surgery or chemoradiation. ABSTRACT: Cervical cancer is the fourth most common cancer in women worldwide and the most common gynaecological malignancy. The FIGO staging system is the most commonly utilised classification system for cervical cancer worldwide. Prior to the most recent update in the FIGO staging in 2018, the staging was dependent upon clinical assessment alone. Concordance between the surgical and clinical FIGO staging decreases rapidly as the tumour becomes more advanced. MRI now plays a central role in patients diagnosed with cervical cancer and enables accurate staging, which is essential to determining the most appropriate treatment. MRI is the best imaging option for the assessment of tumour size, location, and parametrial and sidewall invasion. Notably, the presence of parametrial invasion precludes surgical options, and the patient will be triaged to chemoradiotherapy. As imaging is intrinsic to the new 2018 FIGO staging system, nodal metastases have been included within the classification as stage IIIC disease. The presence of lymph node metastases within the pelvis or abdomen is associated with a poorer prognosis, which previously could not be included in the staging classification as these could not be reliably detected on clinical examination. MRI findings corresponding to the 2018 revised FIGO staging of cervical cancers and their impact on treatment selection will be described.