The FIGO 2018 staging of cervical carcinoma introduced major changes from the 2009 version. Which of the following was a new addition in FIGO 2018 that allows imaging and pathological findings to upstage the tumor?

• A Parametrial invasion now diagnosed only by MRI, not clinical examination
• B Vaginal involvement added as a new staging criterion
• C Lymphovascular space invasion now used as a staging criterion
• D Lymph node metastasis now upstages tumor to stage IIIC (IIIC1: pelvic LN; IIIC2: para-aortic LN) ✓

Explanation

The FIGO 2018 cervical carcinoma staging revision was landmark because it incorporated imaging and pathological findings for the first time. A major addition was Stage IIIC, defined by lymph node involvement regardless of tumor size: Stage IIIC1 indicates pelvic lymph node metastasis, and Stage IIIC2 indicates para-aortic lymph node metastasis. These are subclassified as 'r' (imaging-based) or 'p' (pathological) depending on how the nodes were identified. This change significantly impacted staging because previously lymph node metastasis was not part of clinical FIGO staging. Parametrial invasion by imaging is now acceptable but that was incorporated for earlier stages (IIB). LVSI is a prognostic factor but not a staging criterion.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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