Elastography of the uterine cervix in gynecology: normal appearance, cervical intraepithelial neoplasia and cancer. A systematic review

AIMS: To revise the current literature about the usefulness of elastography in cervical cancer (CC) and cervical intraepithelial neoplasia (CIN), from methods and technical limitations, to diagnosis, staging and the ability of predicting the response to oncologic treatment. METHODS: An electronic database search was performed (PubMed, EMBASE, Web of Science) with the data range from January 2000 until May 2020. All studies, fully-available in English, assessing elastography of the uterine cervix in CC and CIN were selected. Studies were reviewed and discussed according to the elastographic technique and to the purpose of the research. RESULTS: Twenty-three articles were found: 11 articles regarding strain elastography, 4 articles assessing shear wave elastography and 8 papers with matter-related information. Elastography was used in the study of normal variants of the uterine cervix as well as: the positive diagnosis of CC and CIN, clinical staging and the prediction of therapeutic response in CC. Comparison of the elastographic techniques was also performed. CONCLUSIONS: Elastography has multiple applications in the gynecological pathology of the cervix. The methods used to assess the cervix are diverse, and none have become universally accepted. With regard to CC and CIN, elastography is still an ongoing research field.