Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies

Abstract

Treatments for gynecologic cancer usually result in loss of fertility due to surgery or radical radiation therapy in the pelvis. In countries with an established screening program for cervical cancer, the majority of gynecologic malignancies occur in postmenopausal women. However, a substantial number of affected women are of childbearing age and have not completed their families. In these younger women, consideration of fertility preservation may be important. This article describes the fertility-sparing treatment options that are currently available and outlines the role of imaging in the selection of eligible patients on the basis of a review of the literature. In the setting of cervical cancer, magnetic resonance (MR) imaging is used to delineate the size, position, and stage of the tumor for selection of patients who are suitable for radical trachelectomy. In patients with solitary complex adnexal masses, diffusion- and perfusion-weighted MR imaging sequences are used to categorize the likelihood of invasive or borderline malignancy for consideration of unilateral ovarian resection, with fertility preservation when possible. In patients with endometrial cancer, MR imaging is used to rule out signs of invasive disease before hormone therapy is considered. Imaging is also used at patient follow-up to detect recurrent disease; however, evidence to support this application is limited. In conclusion, imaging is an essential tool in the care of patients with gynecologic malignancies who are considering fertility-preserving treatment options. RSNA, 2016.

Fusion of T2 Weighted MRI and diffusion weighted imaging in the evaluation of myometrial invasion in endometrial cancer

“…The management of endometrial cancer is primarily operative. It has emerged over the years from radical hysterectomy to more conservative surgery or conservative hormone treatment for early-stage endometrial cancer (2)(3)(4)(5), with hysterectomy and surgical lymphadenectomy only performed in deep myometrial invasion cases (6)(7)(8).…”

The Value of Diffusion-Weighted Imaging in Combination With Conventional Magnetic Resonance Imaging for Improving Tumor Detection for Early Cervical Carcinoma Treated With Fertility-Sparing Surgery

“…16Y18 Finally, for the patients who undergo cone biopsy before MR examination, benign conditions, such as hemorrhage, inflammation, and edema caused by biopsy, may also increase signal intensity on T2-weighted images, which makes it very difficult for radiologist to identify the residual tumor. 19 Diffusion-weighted imaging is a functional tool that is based on the displacement of tissue water to create a contrasting image. This technique can add the valuable information on tissue at the cellular level to the information from conventional MRI.…”

Subfertility: What the Radiologist Needs to Know

“…With the development of fertility-sparing surgery/therapy, there is an increasing need for pretreatment stratification of suitable patients. Full discussion of this important topic is beyond the scope of this article and can be found elsewhere (73). Once the patient has completed her pregnancy, completion surgery (standard-of-care hysterectomy and bilateral salpingo-oophorectomy) is recommended (74,75).…”