2a - Inspection visuelle pour la détection des lésions du col de l'utérus. Am J Obstet Gynecol. ■ The 2018 International Federation of Gynecology and Obstetrics (FIGO) uterine cervical cancer staging system introduces a new primary tumor size cutoff value of 2 cm (ie, stage IB1 vs IB2), used to evaluate patients for fertility-sparing radical trachelectomy and to estimate prognosis. a Imaging and pathology can be used, where available, to supplement clinical findings with respect to tumor size and extent, in all stages. On ne doit pas prendre en compte l’extension au corps utérin. Tumeur du col < 3 mm Lorsque la tumeur est < 3 mm, il s’agit d’un stade FIGO IA1, le risque d’envahissement du paramètre et des ganglions est < 1 %. The derived apparent diffusion coefficients offer an opportunity for quantitative imaging but have yet to be incorporated into clinical examination protocols (45). Additionally, the revision calls for a more precise description of primary tumor size, which should be measured with MRI, especially for trachelectomy planning. DU CANCER DU COL DE L’UTÉRUS DÈS ˜˚ ANS, UN TEST À RÉALISER TOUS LES ˛ ANS – Ne pas jeter sur la voie publique – INCa – SIREN : 187 512 777 – Juillet 2018 – DEPCCU18. 28, No. In patients suspected of having advanced disease, transabdominal US can be used to evaluate for hydronephrosis (stage IIIB) if cross-sectional imaging with CT, MRI, or PET/CT—usually performed for retroperitoneal nodal evaluation—is not performed. Épreuves corrigées par l'auteur. Figure 4a: Images show uterine cervical cancer lymphadenopathy at fluorodeoxyglucose PET/CT versus CT. (a) Coronal maximum intensity projection PET image in a patient clinically staged as IB shows hypermetabolic foci in pelvis (arrowheads) and abdomen (arrows), which at fusion PET/CT (not shown) correspond to retroperitoneal lymphadenopathy. Dr. Alexandre Ladoux Preceding versions of the staging system included imaging with chest and skeletal radiography, intravenous pyelography, and barium enema (4–6). Enter your email address below and we will send you the reset instructions. 114 Routine pathologic screening of mismatch repair deficiencies in the endometrial cancer specimen, similar to colorectal cancer, has been advocated and is increasingly being introduced in practice. Insinga et al. *Complete description is available in reference 53. Ainsi la chirurgie peut dans certains cas ne pas faire partie de l’arsenal thérapeutique. Dans le cas du cancer du col de l’utérus, il y a 4 stades. Instead, they are triaged to one or the other curative, and far less morbid, options (12). 1 More than 85% of these … Brockbank E, Kokka F, Bryant A, Pomel C, Reynolds K. Cochrane Database Syst Rev. Imaging plays a central role in the 2018 International Federation of Gynecology and Obstetrics staging system for uterine cervical cancer. 115 However, in most women with mismatch repair deficiency this is caused by … Int J Gynaecol Obstet 105, 103-104 (2009). Figure 5b: Images show uterine cervical cancer with thoracic metastases. Patients with tumors less than 2 cm (ie, stage IB1) demonstrate a nearly twofold lower risk of cervical cancer death compared with patients with tumors measuring 2–4 cm (ie, stage IB2). Tumeur T4aN1M1) il s'agissait d'un "carcinome épidermoîde du col utérin avec envahissement vésical." Le dépistage du cancer du col de l’utérus est recommandé à toutes les femmes de 25 à 65 ans, ayant ou ayant eu des rapports sexuels, et après la ménopause. Pour les stades 1 à 4, on utilise souvent les chiffres romains I, II, III et IV. ... 31 /01/2018 COURS POUR EXTERNE 5éme ANNEE Dépistage du cancer du col These should be routinely acquired if a PET/CT or an abdominopelvic CT is not planned. To compensate for these shortfalls, treatment planning for invasive cervical cancer in much of the developed world has included modern cross-sectional and functional imaging such as CT, MRI, and fluorine 18 fluorodeoxyglucose, or FDG, PET (10,11). 2b - La cytologie dans le dépistage des cancers du col de l’utérus. Introduction. Navigation des articles. Trachélectomie radicale. Correlation between FIGO staging, MR imaging staging, and treatment is summarized in , Table 1. Moreover, stage IB1 tumors are more likely to be adenocarcinoma with low-grade histologic features, whereas stage IB2 tumors are more likely to be squamous cell carcinoma with high-grade histologic features (14). Par ailleurs, la capsule qui entoure l’ovaire est intacte et ne s’est pas rompue. Following the attenuation-correction CT, we acquire the PET images in the caudocranial direction to minimize the interval for bladder filling and bowel peristalsis that could cause misregistration between the CT and PET images (47). 2.1 Stade de la tumeur. Radial spread of tumor out of the uterine cervix into the parametria correlates with stage IIB disease and triages the patient away from primary surgery to concurrent chemotherapy and radiation therapy (Fig 3). Epub 2019 Jul 6. Radiologists, among other physicians, should continue to participate in ongoing efforts to improve access to advances in medical technology and expertise in low-resource settings (65,66). PET/CT is indicated and is the preferred examination for whole-body staging in patients with local-regionally advanced cancer at pelvic examination (ie, clinical stage IB3, IIA2, >IIB) and in patients in whom radiography, CT, or MRI indicates extrauterine spread of the primary tumor. Deux cas particuliers seront précisés : Le cancer du col utérin est le deuxième cancer gynécologique en Algérie, avec une incidence de 8,7 pour 100 000 femmes. (1). Eur J Obstet Gynecol Reprod Biol. CLASSIFICATION PRONOSTIC ESMO /INCA FIGO Type histologique Grade 1/2/3 Emboles lymphatiques 90% des cancers de l’endomètre sont découverts à un stade précoce: stade I ESMO 2009 . La fréquence de ce cancer et ses conséquences a régressé depuis 40 ans dans les pays développés grâce au dépistage par frottis. Accolib. Objective: To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer, with a particular focus on stage IB and stage III disease. In this article, we review the 2018 FIGO staging system for cervical cancer and the new additions relevant to radiologists. Patients with cervical cancer should be staged according to the TNM classifi cation. The 2018 FIGO cervical cancer staging system now enables identification and upstaging of these patients based on pretreatment lymph node imaging, thereby sparing them unnecessary surgery and long-term morbidity (12,23). It was first published on 11 th October, 2018. † Stage IIIC should be annotated with r (radiology) or p (pathologic analysis) to indicate the method used to allocate this stage. IB2 invasive carcinoma ≥2 cm and <4 cm in greatest dimension. Administration of intravenous iodinated contrast material is optional but can aid in the evaluation of solid organs (eg, uterine corpus, liver, kidneys). La détermination précise du stade d’un cancer est l’un des facteurs déterminant pour le choix du type de traitement. Reported accuracies of MR imaging staging of cervical carcinoma are shown in , Table 2 . The revisions introduced in the 2018 FIGO staging system are intended to address the gap between the staging formalism and ongoing clinical practice and to explicitly acknowledge the role that advanced imaging has come to play in the care of women with invasive uterine cervical cancer (13). For diagnosing lymphadenopathy based on morphology, there is variability in the literature on the acceptable size of cutoff value, which ranges between 0.8 cm and 1.0 cm in short-axis measurements (29,30). For oncologists, the use of modern imaging will enable them to stage more accurately, to counsel on prognosis with greater certainty, and to tailor treatment to be curative but less morbid. Often, large field-of-view anatomic images (eg, gradient-echo T1-weighted or echo planar T2-weighted images) from the level of the renal hilum through the pelvic floor are also obtained in the axial plane to evaluate for hydronephrosis (stage IIIB) and lymphadenopathy (stage IIIC). Figure 1b: Images show uterine cervical cancer at CT versus MRI. porteuse d’un cancer du col utérin. Rated Best Pet Insurance in 2017, 2018, 2019 and Best Technology in 2020 by Reviews.com *Reference standard is pathologic analysis. Role of PET/MRI in Staging of Cervical Cancer Under the Newly Updated FIGO Staging System, The International Federation of Gynecology and Obstetrics (FIGO) Cancer Report 2019: An Imaging Update on Cervical Cancer Staging and Beyond, Pseudoprogression with Immunotherapy Treatment, Locally advanced, metastatic prostate adenocarcinoma. (b, c), On concurrent contrast-enhanced CT images, hypermetabolic abdominal lymph nodes measure less than 1 cm in short axis and are morphologically normal. ). However, clinical implementation of PET/MRI would require that the challenges posed by attenuation correction be better solved, especially in the abdomen and pelvis. . Imagerie de la Femme - Sous presse. Figure 4b: Images show uterine cervical cancer lymphadenopathy at fluorodeoxyglucose PET/CT versus CT. (a) Coronal maximum intensity projection PET image in a patient clinically staged as IB shows hypermetabolic foci in pelvis (arrowheads) and abdomen (arrows), which at fusion PET/CT (not shown) correspond to retroperitoneal lymphadenopathy. Bilan initial 10 A - L’examen clinique B - Bilan paraclinique C - Bilan d’opérabilité III. Thus, early detection of stage IVB disease significantly impacts patient treatment and represents an opportunity to decrease treatment-related morbidity. IB clinically visible lesion limited to the cervix uteri or preclinical cancers ≥5 mm in depth ( greater than stage IA) IB1 invasive carcinoma ≥5 mm depth of stromal invasion, and <2 cm in greatest dimension. COVID-19 is an emerging, rapidly evolving situation. 2015 Apr 7;(4):CD010260. outils pour les professionnels de santé assurant le suivi gynécologique (INCa). A meta-analysis of 72 studies involving 5042 women found that PET demonstrates a higher sensitivity (75%) and comparable specificity (98%) to MRI (sensitivity of 56% and specificity of 93%) and CT (sensitivity of 58% and specificity of 92%) (58). See our plans and coverages. Version 2.0. Classification 2018 du cancer du col de l’utérus selon la Fédération internationale de gynécologie obtétrique (FIGO), d’après Bhatla et al. Stage I: Tumor confined to ovaries or fallopian tube(s) T1-N0-M0 IA: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings T1a-N0-M0 For instance, the estimated incidence rate of Lynch syndrome in an unselected endometrial cancer population is 3%–6%. 10 regras para pés adoráveis e saudáveis e equilibrados. *PET and CT images acquired in a hybrid scanner and interpreted with inclusion of fusion imaging. The treatment of cervical cancers according to FIGO staging is well defined. Objective: A prospective trial of 189 women with FIGO stage IA2–IIA cervical cancer (ie, invasive tumors <4 cm) showed that maximal tumor dimension measured with US agreed with those obtained with MRI or pathologic analysis (Table 3) (52). If PET/CT is unavailable, then CT or MRI is a second-line alternative with both modalities demonstrating similar diagnostic performance (28,60). Accurate tracer localization to avoid both false-positive and false-negative errors requires that the PET and CT data be acquired in the same sitting and that the CT be performed with sufficient beam energy to be anatomically interpretable (48). Stade I du cancer de l’ovaire. doi: 10.1097/MD.0000000000019714. To be considered a candidate for this procedure, the woman must be considered to have stage I (ie, tumor confined to the cervix) and not stage II (ie, tumor growth into the upper third of the vagina or the parametria) disease. (a) Coronal maximal intensity projection PET image in a patient staged as IB following clinical examination and normal chest x-ray (not shown) shows hypermetabolic foci in left upper (arrow) and right middle (arrowhead) thorax corresponding to (b) left supraclavicular lymphadenopathy (arrow) and (c) cavitary right lung nodule (arrowhead), respectively. One of the major changes in the updated staging system is that stage IB disease (ie, invasive carcinoma limited to the cervix) now includes three, rather than two, subgroups based on tumor size measured in its maximal dimension. 8th edition of the UICC TNM classifi cation of malignant tumours (2016). Other option for nodal evaluation is surgical and includes lymphadenectomy or sentinel node biopsy, the latter limited to sites where the necessary surgical and pathologic expertise are available (55,56). Written informed consent was obtained from every patient. Cancer incidence and mortality data. Patient was staged as IVB based on PET/CT and lymph node biopsy that showed metastases at pathologic analysis. The choice of imaging for staging is modified based on the availability of the technology and expertise (Table 2). 4 Pecorelli, S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. ║ Abnormalities should be confirmed with pathologic analysis. 2013 Mar 28;2013(3):CD008217. The false-positive rate was also low, but was higher for MRI (8%) than for US (2%; P < .001) (Table 3) (52). (a) Sagittal endovaginal US image in a woman presenting with abnormal uterine bleeding shows 2.3-cm solid mass (arrows), pathologically diagnosed as invasive adenocarcinoma and initially staged as IB2. In 2018, there were an estimated 569 847 new cases and 311 365 deaths worldwide annually. Dernières données mondiales sur le cancer : le fardeau du cancer atteint 18,1 millions de nouveaux cas et 9,6 millions de décès par cancer en 2018 . However, the limited field of view and soft-tissue contrast of US can impede accurate assessment of bulky tumors (Fig 2) and precludes evaluation of retroperitoneal lymph nodes. Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. Although surgery is more sensitive, imaging is less morbid in avoiding the short- and long-term complications of lymphadenectomy (57). Although imaging is already a part of pretreatment planning in some high-resource settings, its incorporation into assigning stage is a new development. The examination offers “one-stop staging” by assessing the pelvic tumor with MRI and evaluating the entire body for retroperitoneal nodal and distant metastases. The stage IB cohort consisted of node-negative FIGO stage IB1 (tumor size <2 cm), IB2 (2-3.9 cm), and IB3 (≥4 cm) cervical cancer. 2020 Oct 20;10:591700. doi: 10.3389/fonc.2020.591700. Multivariable analysis was performed for cause-specific survival based on cancer stage. 2021 Jan;21(1):54. doi: 10.3892/ol.2020.12316. Balaya V, Guani B, Magaud L, Bonsang-Kitzis H, Ngô C, Mathevet P, Lécuru F, On Behalf Of The Senticol Group. With the 2018 International Federation of Gynecology and Obstetrics staging system for uterine cervical cancer, imaging is formally incorporated as a source of staging information and as a supplement to clinical examination (ie, pelvic examination, cystoscopy and colposcopy) to obtain an accurate description of tumor spread. Obstet Gynecol. IV - Cas particulier : cancer du col et grossesse 15 A - Bilan pré-thérapeutique et diagnostic positif B - Traitements 1- Si la découverte est à plus de 28 SA 2- Si la découverte est à moins de 20 – 24 SA 3- Si la découverte se situe entre 20 – 24 SA Annexes 17 Annexe 1 : Classification FIGO Worldwide, cervical cancer is both the fourth-most common cause of cancer and deaths from cancer in women. Cancer staging is a fundamental principle and one of the first and most important steps used to predict patient outcome as well as to plan the most appropriate treatment. Methods: Two retrospective cohort studies were conducted using The Surveillance, Epidemiology, and End Results Program between 1988 and 2014. Disponible en ligne depuis le samedi 23 novembre 2019 - Nouvelle classification et recommandation de prise en charge du cancer du col de l’utérus selon la Fédération internationale de gynécologie obstétrique (FIGO) - EM consulte Cervical cancer prevention by vaccination and screening, and management by surgery and radiation according to the revised FIGO staging, can reduce cancer incidence and mortality. Stage predicts patient prognosis and guides treatment planning. When compared with the conventional T1- or T2-weighted sequences, the diffusion-restricted tumor is more conspicuous against the normal tissue and is especially useful when gadolinium-based contrast agent cannot be administered. In the stage IB cohort (n = 8909), stage IB1 tumors were more likely to be adenocarcinoma and low-grade compared to other the groups (P < 0.001). Table 2: Choice of Imaging Based on Resource Availability for Staging of Patients with Uterine Cervical Cancer. Patient is clinically suspected to have low-stage disease (ie, less than International Federation of Gynecology and Obstetrics [FIGO] stage IIA). Figure 5c: Images show uterine cervical cancer with thoracic metastases. International Federation of Gynecology and Obstetrics, Revised FIGO staging for carcinoma of the cervix, FIGO staging for carcinoma of the vulva, cervix, and corpus uteri, Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: results of intergroup protocol ACRIN 6651/GOG 183, The staging of cervical cancer: inevitable discrepancies between clinical staging and pathologic findinges, Tumor size evaluated by pelvic examination compared with 3-D quantitative analysis in the prediction of outcome for cervical cancer, ACR Appropriateness Criteria® pretreatment planning of invasive cancer of the cervix, Clinical Practice Guideline in Oncology. Data in parentheses are 95% confidence intervals. Unable to load your collection due to an error, Unable to load your delegates due to an error, Kaplan-Meier curves based on 2018 FIGO cancer staging system. ■ Torso (chest, abdomen, and pelvis) PET CT reveals unsuspected distant metastases (eg, chest, peritoneum, bone, etc) that changes the stage, prognosis, and treatment plan in 14% of women with local-regionally advanced (ie, clinically suspected FIGO stage IB3, IIA2, ≥IIB) cervical cancer. If the address matches an existing account you will receive an email with instructions to reset your password. Multiplanar fast spin-echo T2 images help evaluate for tumor invasion into the parametria (stage IIB) and pelvic sidewall (stage IIIB), and images after gadolinium-based contrast agent administration help assess for peritoneal, nodal, and bone metastases (10,32). Although the choice of b values for nodal detection for gynecologic cancer has not been standardized, most studies use maximum b values of 800–1000 sec/mm2 (35–41). Additionally, patients gave consent for data collection and publication. Note.— Data in parentheses are primary ratios. 2020 Nov 28;12(12):3554. doi: 10.3390/cancers12123554. A prospective multicenter trial of 208 women demonstrated that MRI correlated more closely with pathologic measurements than did CT or physical examination (28). (1). ‡ Abnormalities should be further evaluated with chest CT. § PET and CT images should be acquired with hybrid scanner and analysis should include fusion imaging. As with CT, lymph nodes are evaluated not only based on size, but also for abnormal signal and/or shape. If PET/CT is unavailable, then chest radiography is recommended as first-line imaging modality for thoracic imaging. Presence of distant metastases (stage IVB) confers a substantially poorer prognosis and indicates that local-regionally–directed therapies, such as surgery and radiation therapy, will not be sufficient for cure (49,50). Most cervical cancers are diagnosed in low-resource settings where options such as modern cross-sectional and functional imaging (eg, CT, MRI, PET/CT), brachytherapy, and on-site pathologic analysis are either constrained or not accessible at all. L'édition 2018 du FIGO Cancer Report a permis à nos membres d'actualiser leurs connaissances, d'identifier les lacunes dans leurs compétences et de rechercher des opportunités de formation continue afin de garantir que toutes les femmes reçoivent les soins dont elles ont besoin. Source.—References 8 and 9. Cancer du col de l’utérus ... Les performances de l’IRM abdomino-pelvienne permettent l’évaluation précise du stade de la tumeur (classification FIGO), l’examen sous anesthésie n’est plus indiqué. Another prospective multicenter trial showed that the false-negative rate with US and MRI for parametrial extension was comparable and very low (ie, <3%). Stades Critères 52, No. Accessibility Cancer invasif du col de l’utérus Dysplasie de bas grade CIN 1 Infection persistante >2 ans ~1 an 2 à 5 ans ans 4 à 5 9 à 15 ans Pagliusi and Aguado. Dr. Alexandre Ladoux Accolib. Pre-treatment surgical para-aortic lymph node assessment in locally advanced cervical cancer. Our International Journal of Gynecology & Obstetrics (IJGO) published a range of open access research: - FIGO 2018 Cancer Report- Institutionalization of postpartum IUDs- Abstracts presented at FIGO's XXII World Congress Join us in 2021 Tumor size (stage IB and IIA), cervical stromal invasion (stage IA), and lack of parametrial spread (stage IIB) are assessed well with MRI but poorly with CT. Breast cancer may include lump in the breast, a change in breast or red scaly patch on skin. The list of cancer sites, however, has been extended to 36 cancer types in GLOBOCAN 2018, with one of the major additions being estimates of the incidence of, and mortality from, nonmelanoma skin cancer (NMSC) (excluding basal‐cell carcinomas). Ceci est un vidéo expliquant la classification du cancer du col utérin. Choice of modality depends on the technology available within the practice setting. 2004;191:105–113. Cervical Carcinoma and Updated FIGO Staging: What Should Radiologists Know in 2019? The stage III cohort consisted of FIGO stage IIIA, IIIB, and stage IIIC1 (any pelvic nodal metastasis) cervical cancer. The 5-year overall survival of cervical cancer in stage IIIC-r was little different to stage I and II: a retrospective analysis from a single center. 15 Edited by Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F Prevention and treatment information (HHS). eCollection 2020. According to the latest data from GLOBOCAN 2018, cervical cancer is the fourth most common cancer in women worldwide, and the second most common in low‐ and middle‐income countries (LMICs). Cancer micro invasif du col utérin sur pièce de conisation –stade Ia2 9 Cancer invasif du col utérin chez la femme en dehors de la grossesse 10 Cancer invasif du col utérin –stades Ib1 et IIa1 11 Cancer invasif du col utérin –stades Ib2, IIa2 à IVa 12 Cancer invasif du col utérin –stades IVb 13 … Le dépistage systématique est beaucoup plus difficile que pour le cancer du col de l´utérus. Dissemination of the advantages of imaging for cervical cancer staging lies within the domain of global health development efforts. Yes, we know, pet insurance is confusing—but it doesn’t have to be. Such pretreatment imaging spared many women the particularly toxic combination of surgery, followed by concurrent chemotherapy and radiation therapy. The International Federation of Gynecology and Obstetrics (FIGO) ovarian cancer staging system was first published in 1973 and was revised in 1988 and 2014 [1, 2]. Référentiel e l’AP-HP Cancer e la ulve ui 016 3 Sommaire Préambule3 Classification FIGO 2009 du cancer la vulve 4 Classification TNM du cancer de la vulve (7ème édition 2009) 5 I. Anatomopathologie 9 II. Publié dans: Cancéro, Pelvis | Tagué: Cancer du col utérin, FIGO, Ladoux. Chest CT without or with contrast enhancement is performed to evaluate for distant metastases (stage IVB). For FIGO stage IB2 or more, chemoradiotherapy followed by uterovaginal brachytherapy boost is the standard treatment. (a) Sagittal endovaginal US image in a woman presenting with abnormal uterine bleeding shows 2.3-cm solid mass (arrows), pathologically diagnosed as invasive adenocarcinoma and initially staged as IB2. La classification et le pronostic du cancer de l'utérus dépend du grade et du stade de la tumeur. Table E1 (online) is a representative protocol for image acquisition. (b, c), On concurrent contrast-enhanced CT images, hypermetabolic abdominal lymph nodes measure less than 1 cm in short axis and are morphologically normal. Axial oblique fast spin-echo T2-weighted image in a woman clinically staged as IB shows tumor that extends beyond dark stromal ring of cervix into adjacent parametria (arrows) corresponding to stage IIB. Il représente 12,5% de tous les cancers féminins. Evaluation for abdominopelvic retroperitoneal lymphadenopathy, either with imaging alone or with pathologic analysis, is now also part of staging. On multivariable analysis, stage IB2 disease was independently associated with a nearly two-fold increased risk of cervical cancer mortality compared to stage IB1 disease (adjusted-hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.62-2.41, P < 0.001). []Uterine Cancer Age-Standardised One-, Five- and Ten-Year Net Survival, Adults (Aged 15-99), England, 2013-2017 Cervical cancer can manifest with tumor beyond the pelvic soft tissues and the retroperitoneal lymph nodes. If performed as an alternative to pelvic MRI, then intravenous contrast material should be administered for soft-tissue contrast to aid in distinguishing tumor from the normal uterine and other pelvic tissues. ); and Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (M.A. Medicine (Baltimore). It is usually performed as part of a PET/CT examination or as an alternative to abdominopelvic MRI if the latter examination is contraindicated or unavailable. The patient is asked to void before scanning to decrease bladder volume. FOIA 2018; Cervical cancer; FIGO; International Federation of Gynecology and Obstetrics; Staging; Validation. Le stade est un classement histopathologique qui décrit le degré d'extension de la tumeur. Stages. Clipboard, Search History, and several other advanced features are temporarily unavailable. Careers. Imaging modality or pathologic technique should also be documented. Lymph node status is to be assigned based on imaging and/or pathologic analysis and the methodology is to be recorded. IV - Cas particulier : cancer du col et grossesse 15 A - Bilan pré-thérapeutique et diagnostic positif B - Traitements 1- Si la découverte est à plus de 28 SA 2- Si la découverte est à moins de 20 – 24 SA 3- Si la découverte se situe entre 20 – 24 SA Annexes 17 Annexe 1 : Classification FIGO CT should be of diagnostic quality but use of iodinated contrast material is optional. Classification clinique par stades du cancer du col de l'utérus FIGO* Classification clinique par stades du cancer du col de l'utérus FIGO* Stade. At US, tumor is typically homogeneously solid and hypoechoic relative to the uterine cervical stroma (24–27). Mediastinal lymphadenopathy, unlike retroperitoneal or supraclavicular lymphadenopathy, does not result from direct drainage of the primary tumor; instead, it would suggest underlying pulmonary metastases. TNM should be based on a correlation of various modalities (integrating physical examination, imaging and pathology) after discussion in a multidisciplinary forum.