ABSTRACT
Pelvic imaging has seen a revolution in recent times, with increasing availability and utilization at almost all levels, from initial assessment of tumors to its role in management and disease response evaluation. Various classification systems are in use for staging gynecological malignancies, but the International Federation of Gynaecology and Obstetrics (FIGO) is currently widely used in this regard. Although FIGO does not take into account the role of cross-sectional imaging for staging of gynecological malignancies, CT and MRI have become the mainstay for assessment and staging in developed countries. However, FIGO manual and surgicopathological staging is vital for full international comparison of incidence and results of treatment. The role of imaging is valuable in the initial assessment of indeterminate adnexal masses and endometrial assessment but not in diagnosing cervical and endometrial cancers. These tumors are diagnosed by clinical examination supplemented by examination under anesthesia, biopsy, and hysteroscopy. The gold standard for staging of endometrial cancer remains histopathological. CT and MRI also have a vital role in radiotherapy treatment planning. Following treatment, cross-sectional imaging plays an important role in assessing response to treatment and also for evaluating for any recurrence. 2-(F-18) fluor-2-deoxy-D-glucose positron emission tomography (18 FGD PET) is also now part of the mainstay of imaging for staging locally advanced cervical cancer or disease recurrence, and prior to pelvic exenteration. It also has an increasing role in radiotherapy planning and response assessment.
