CT-Based Contouring Recommendations for Image-Guided Adaptive Brachytherapy in Cervical Cancer

Imaging Modalities and Diagnostic Performance

MRI remains the gold standard for soft tissue assessment in cervical cancer, with 86% agreement with surgical pathology for tumor size and local extent, and demonstrates superior diagnostic performance with 71-88% sensitivity and 86-95% specificity for assessing invasion extent 1
MRI shows 71% sensitivity and 91% specificity for parametrial invasion, significantly better than CT, and enhanced performance with diffusion-weighted imaging (DWI) increases parametrial assessment to 82% sensitivity and 97% specificity 1

The National Comprehensive Cancer Network recommends that traditional point A dosing must not be abandoned when implementing image-guided approaches, and current 3D image-guided techniques should optimize tumor coverage and reduce organ-at-risk doses while ensuring total point A doses reach at least 80 Gy for small tumors and ≥85 Gy for larger tumors (combining external beam and brachytherapy) 2, 3, 4, 5, 6