title: Percutaneous image-guided pelvic procedures in women with gynecologic cancers: utilization, complications, and impact on patient management.
abstract: Image-guided percutaneous pelvic procedures often play an important role in the management of women with gynecologic cancers. The purpose of this study is to evaluate the utilization of and indications for these procedures, and quantify their impact on patient management.
  
  
  
  IRB-approved retrospective record review of percutaneous pelvic procedures requested by gynecologic oncology, 2005 to 2015. Descriptive statistics and logistic regression were performed.
  
  
  
  392 pelvic procedures, including fluid aspiration, core biopsy, and fine needle aspiration, were performed in 225 women. Procedures were performed under sonographic guidance (303/392, 77.30%), CT guidance (87/392, 22.19%), or both (2/392, 0.51%). Pathology results included: no specimen sent (157/392, 40.05%), new cancer diagnosis (55/392, 14.03%), recurrence or metastasis of known primary cancer (107/392, 27.30%), benign tissue (67/392, 17.09%), and nondiagnostic (6/392, 1.53%). In terms of management, some procedures led to oncologic surgery, radiation, or chemotherapy (158/392, 40.31%), cessation of oncologic treatment (36/392, 9.18%), or treatment of infection (10/392, 2.55%). Many procedures were therapeutic (178/392, 45.41%), while a minority were performed for genomics (1/392, 0.26%) or did not impact clinical management (9/392, 2.30%). The number of procedures per year increased over time during the period of data collection. Date of service was a significant positive predictor of a purely therapeutic procedure (OR 1.69 [95 % CI 1.44-1.98], p < 0.0001) and a significant negative predictor of a malignant diagnosis (OR 0.72 [95 % CI 0.64-0.81], p < 0.0001), for each year later in the 10-year cycle.
  
  
  
  In this single institution study, we identified a trend toward increased utilization of image-guided percutaneous pelvic interventions in women with gynecologic cancers. The case mix has shifted over the past 10 years, with procedures for symptom management constituting a larger proportion and diagnostic procedures constituting a smaller proportion of procedures over time.
authors: Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA. Rubina.zahedi@gmail.com.
authors: Rubina
authors: 0000-0003-4566-7098
authors: R
authors: Zahedi
authors: Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
authors: Shitanshu
authors: S
authors: Uppal
authors: Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
authors: Mishal
authors: M
authors: Mendiratta-Lala
authors: Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
authors: Ellen J
authors: EJ
authors: Higgins
authors: Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
authors: Ashley N
authors: AN
authors: Nettles
authors: Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.|Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA.
authors: Katherine E
authors: KE
authors: Maturen
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects; D008875:Middle Aged; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D013396:Suction; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D018084:Ultrasonography, Interventional / Q000009:adverse effects
keywords: Gynecologic oncology; Lymph node biopsy; Paracentesis; Pelvic mass biopsy; Percutaneous intervention