Role of Imaging in Fertility-sparing Treatment of Gynecologic Malignancies.
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.
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Andrea G
AG
Rockall
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Mahrukh
M
Qureshi
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Ioanna
I
Papadopoulou
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Srdjan
S
Saso
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Nicholas
N
Butterfield
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Isabelle
I
Thomassin-Naggara
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Alan
A
Farthing
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
J Richard
JR
Smith
From the Department of Radiology, Hammersmith Hospital (A.G.R.), and Faculty of Medicine, Department of Surgery and Cancer (A.G.R., N. Bharwani), Imperial College London, England; Department of Radiology, Royal Free NHS Trust, London, England (M.Q.); Departments of Radiology (I.P., N. Butterfield, N. Bharwani), Surgery (S.S.), and Gynecology (A.F., J.R.S.), Imperial College Healthcare NHS Trust, London, England; and Department of Radiology, Université Pierre et Marie Curie, APHP, HUEP, Hôpital Tenon, Paris, France (I.T.N.).
Nishat
N
Bharwani
D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*