Ultrasound-based preoperative assessment for cervical cancer: a pragmatic staging and treatment-planning strategy adaptable to diverse resource settings

Cervical cancer remains a major global health burden, particularly in low- and middle-income countries, where access to advanced imaging and treatment is often limited. While magnetic resonance imaging is considered the gold standard for loco-regional staging, recent evidence supports transvaginal/transrectal ultrasound as an accurate and cost-effective alternative when performed by trained sonographers and clinicians. Its portability and affordability make ultrasound particularly valuable in resource-constrained settings. In this paper, we present a pragmatic diagnostic and clinical strategy for managing cervical cancer in contexts where magnetic resonance imaging, sentinel lymph node mapping, and radiotherapy are not available. Building on a structured checklist of ultrasound-based parameters, we propose simple, tailored pathways to guide decisions regarding upfront surgery, neoadjuvant chemotherapy, pelvic exenteration, or palliative chemotherapy and supportive care. The approach emphasizes accurate staging through transvaginal/transrectal ultrasound combined with transabdominal scanning, allowing identification of tumor size, local extension, lymph node status, and clear contraindications to surgery. By promoting ultrasound as a reliable tool for loco-regional staging and treatment planning, we aim to improve access to cervical cancer care in low- and middle-income countries and to lay the groundwork for future prospective multi-center studies.