Transvaginal Ultrasound: beware the cervical cancer

Harriet Bowles, Peter Cantin, Ann MM Jones, Radiology, University Hospitals Plymouth NHS Trust

Cervical cancer is a preventable disease; around 3000 cases are diagnosed each year in the UK.  Approximately 75% of cervical carcinomas are diagnosed following an abnormal cervical smear, with subsequent clinical examination and biopsy. However, with the advent of one-stop clinics for abnormal per vaginal bleeding, patients can present for a transvaginal ultrasound (TVS) prior to clinical examination, and a recent smear may not have necessarily been performed.

When performing TVS for abnormal bleeding, the sonographer is correctly concentrating on the endometrial appearances, which will not be apparent clinically. However, cervical abnormalities should not be overlooked. 

We propose that it is of paramount importance to ensure that the cervix is routinely adequately imaged on all pelvic ultrasounds (both transabdominal or transvaginal) for all clinical presentations. The sonographer should be aware of assessment of the cervix, and be familiar with the normal appearances, as well as the ultrasound findings in the context of carcinoma of the cervix. The reporter should then be able to signpost the referrer to the next appropriate step in investigation.

We present the normal appearances of the cervix on TVS and four cases of histology-proven carcinoma of the cervix, three with initial presentation at ultrasound. Two cases were thought to have endocervical polyps, the third was suspected on ultrasound and the fourth seen in retrospect on ultrasound. Transvaginal ultrasound and MRI images are demonstrated to illustrate both normality and the varying appearances of cervical cancer.

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