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CC BY 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2025; 08(03): 180-187
DOI: 10.1055/s-0045-1809684
Original Article

Measure of Stage Migration Due to Significant Nodes Detected on Imaging in Patients with Uterocervical Cancer Using the FIGO 2018 Staging System

Authors

  • Renata Nappoly

    1   Department of Radiology, Christian Medical College Vellore, Tamil Nādu, India

  • Anuradha Chandramohan 

    2   Department of Radiology, Christian Medical College Vellore, Tamil Nādu, India

  • Vinotha Thomas

    3   Department of Obstetrics and Gynecology, Christian Medical College Vellore, Tamil Nādu, India

  • Sherin Daniel

    4   Department of General Pathology, Christian Medical College Vellore, Tamil Nādu, India
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Abstract

Background

While the earlier International Federation of Gynecology and Obstetrics (FIGO) staging guidelines for carcinoma cervix were only based on clinical examination findings, the revised guidelines published in 2018 incorporated imaging and pathological assessments to the staging system.

Aims and Objectives

This article compares the imaging-based new FIGO staging system with the old clinical staging and assesses the degree of stage migration.

Methods

In this institutional review board-approved retrospective study, consecutive patients who were diagnosed with uterocervical cancer and underwent imaging (i.e., computed tomography [CT]/magnetic resonance imaging [MRI]/positron emission tomography-CT [PET-CT]/ultrasound [USG]) between 2013 and 2017 were reviewed. Imaging findings were documented, and stage was assigned as per the revised 2018 FIGO staging system for cervical cancer and compared with the previous FIGO staging system. The degree of stage migration was compared between the new and the old FIGO staging systems. The degree of stage migration due to significant lymph nodes detected on different imaging modalities was assessed.

Results

274 patients with a mean age of 51 years and a range of 20 to 80 years were reviewed. The distribution as per the FIGO 2009 were: 0.3% (n = 1) in stage IA1 and IA2, 6.2% (n = 17) in stage IB1, 1% (n = 3) in stage IB2, 4% (n = 11) in stage IIA, 44.5% (n = 122) in stage IIB, 0.7% (n = 2) in stage IIIA, 27% (n = 74) in stage IIIB, 5.8% (n = 16) in stage IVA, and 7.2% (n = 20) in stage IVB. Among all these patients, 66.4% (n = 182) patients underwent USG, 53.6% (n = 147) underwent CT, 42.7% (n = 117) had MRI, and 3.6% (n = 10) underwent PET-CT. Only 4% (n = 8) and 0.5% (n = 1) patients who underwent USG at staging were detected to have significant parailiac and para-aortic nodes, respectively. On the other hand, 7.66% (n = 21) had significant para-aortic and 44.16% (n = 121) had significant parailiac nodes on other cross-sectional imaging modalities. There was stage migration in 36.86% of patients, with 23.72% upstaged to stage IIIC1.

Conclusion

Fewer lymph nodes were detected on USG than other cross-sectional imaging modalities. Adopting the new FIGO resulted in stage migration in 36.86% of patients, predominantly due to lymph node metastases detected on imaging.

Keywords

uterocervical cancer - carcinoma cervix - stage migration - FIGO 2018 - lymph node metastasis


Publication History

Article published online:
25 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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