title: Cancer in pregnancy: cross-sectional oncologic imaging utilization at a tertiary care center with an algorithmic approach to imaging.
abstract: OBJECTIVE
  To review utilization of imaging in pregnant patients with malignancies and define an imaging algorithm in this patient population.
  
  
  METHODS
  Pregnant patients with concurrent diagnoses of malignancy from January 2002 to January 2011 were identified using an institutional electronic medical record system. Patients with history of malignancy concurrent with pregnancy who had documented cross-sectional imaging studies were included. Clinical charts were reviewed, and patient demographics, diagnoses, indication for imaging, imaging findings, and oncologic stage were recorded. Descriptive statistics were performed.
  
  
  RESULTS
  Thirty-eight women were identified with malignancy concurrent with pregnancy. Twenty-seven patients had cross-sectional imaging studies during their pregnancy. There were 20 new diagnoses of malignancy and 7 with recurrent tumor. The most common new malignancies were lymphoma (5/27, 19%) and breast cancer (4/27, 15%). Two thirds (18/27, 66%) of the patients underwent at least one imaging study associated with ionizing radiation. CT imaging was utilized in 13 (48%) of 27 patients and MRI was used in 14 (52%) of 27 patients. Fifteen (75%) of the 20 patients with new diagnoses underwent oncologic staging with imaging that meets the standard of care based on National Comprehensive Cancer Network guidelines. An imaging algorithm was created as a guideline for the most common malignancies in pregnancy.
  
  
  CONCLUSIONS
  Cross-sectional oncologic imaging in the pregnant patient involves a variety of imaging modalities including those with ionizing radiation. This imaging largely follows standard of care for the nonpregnant patient and is tailored to specific patient complaints. A generalized algorithm is offered here for imaging pregnant oncology patients.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Carly S
authors.initials: CS
authors.lastname: Gardner
authors.forename: Avinash S
authors.initials: AS
authors.lastname: Patil
authors.forename: Chad M
authors.initials: CM
authors.lastname: Miller
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Jaffe
mesh_terms: D000328:Adult; D000465:Algorithms; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology*; D009657:North Carolina / Q000453:epidemiology; D011247:Pregnancy / Q000706:statistics & numerical data*; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D062606:Tertiary Care Centers