Imaging Cancer in Pregnancy

被引:23
作者
Jha, Priyanka [1 ]
Poder, Liina [1 ]
Glanc, Phyllis [2 ]
Patel-Lippmann, Krupa [3 ]
McGettigan, Melissa [3 ,4 ,5 ]
Moshiri, Mariam
Nougaret, Stephanie [6 ,7 ]
Revzin, Margarita V. [8 ]
Javitt, Marcia C. [9 ,10 ]
机构
[1] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, 505 Parnassus Ave,Box 0628, San Francisco, CA 94143 USA
[2] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Radiol Obstet & Gynecol, Toronto, ON, Canada
[3] Vanderbilt Univ, Dept Radiol & Radiol Sci, Med Ctr, Nashville, TN USA
[4] Univ S Florida, Moffitt Canc Ctr, Dept Diagnost Imaging & Intervent Radiol, Coll Med, Tampa, FL USA
[5] Univ S Florida, Dept Oncol Sci, Coll Med, Tampa, FL USA
[6] Univ Montpellier, Inst Reg Canc Montpellier, Dept Radiol, Montpellier, France
[7] Univ Montpellier, Montpellier Canc Res Inst, Montpellier, France
[8] Yale Univ, Dept Radiol & Biomed Imaging, Sch Med, New Haven, CT USA
[9] George Washington Univ, Dept Radiol, Med Ctr, Washington, DC USA
[10] Rambam Hlth Care Campus, Dept Med Imaging, Haifa, Israel
关键词
BREAST-CANCER; FERTILITY PRESERVATION; OVARIAN-CANCER; MANAGEMENT; GUIDELINES; EXPOSURE; MELANOMA; WOMEN; FETAL; RECOMMENDATIONS;
D O I
10.1148/rg.220005
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (& SIM;1:1000 pregnancies), PAC is increasing owing to postponed childbearing and advanced maternal age at conception. Cancer -related symptoms masked by physiologic gestational changes may delay diagnosis. Imaging, clinical management, and treatment require a carefully choreographed multidisciplinary team approach. The risk-benefit of every imaging modality, the strategies to balance the safety of mother and fetus, and the support of the patient and family at every step are crucial. US and MRI are preferred imaging modalities that lack ionizing radiation. Radiation dose concerns should be addressed, noting that most imaging examinations (including mammography, radiography, CT, and technetium 99m-labeled sulfur colloid sentinel lymph node staging) are performed at radiation levels below thresholds at which deterministic side effects are seen. Dose estimates should be provided after each examination. The use of iodinated intravenous contrast material is safe during pregnancy, but gadolinium-based contrast material should be avoided. Accurate diagnosis and staging combined with gestational age affect decisions about surgery and chemotherapy. Whole-body MRI with diffusion-weighted sequences is ideal to screen for primary and metastatic sites, determine disease stage, identify biopsy targets, and guide further cancer site-specific imaging. The authors provide an update of the imaging triage, safety considerations, cancer-specific imaging, and treatment options for cancer in pregnancy.
引用
收藏
页码:1494 / 1513
页数:20
相关论文
共 86 条
[1]   Pregnancy- and lactation-associated breast cancer - Mammographic and sonographic findings [J].
Ahn, BY ;
Kim, HH ;
Moon, WK ;
Pisano, ED ;
Kim, HS ;
Cha, ES ;
Kim, JS ;
Oh, KK ;
Park, SH .
JOURNAL OF ULTRASOUND IN MEDICINE, 2003, 22 (05) :491-497
[2]   Metastatic melanoma in pregnancy: Risk of transplacental metastases in the infant [J].
Alexander, A ;
Samlowski, WE ;
Grossman, D ;
Bruggers, CS ;
Harris, RM ;
Zone, JJ ;
Noyes, RD ;
Bowen, GM ;
Leachman, SA .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (11) :2179-2186
[3]   2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum [J].
Alexander, Erik K. ;
Pearce, Elizabeth N. ;
Brent, Gregory A. ;
Brown, Rosalind S. ;
Chen, Herbert ;
Dosiou, Chrysoula ;
Grobman, William A. ;
Laurberg, Peter ;
Lazarus, John H. ;
Mandel, Susan J. ;
Peeters, Robin P. ;
Sullivan, Scott .
THYROID, 2017, 27 (03) :315-+
[4]   Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting [J].
Amant, F. ;
Berveiller, P. ;
Boere, I. A. ;
Cardonick, E. ;
Fruscio, R. ;
Fumagalli, M. ;
Halaska, M. J. ;
Hasenburg, A. ;
Johansson, A. L. V. ;
Lambertini, M. ;
Lok, C. A. R. ;
Maggen, C. ;
Morice, P. ;
Peccatori, F. ;
Poortmans, P. ;
Van Calsteren, K. ;
Vandenbroucke, T. ;
van Gerwen, M. ;
van den Heuvel-Eibrink, M. ;
Zagouri, F. ;
Zapardiel, I. .
ANNALS OF ONCOLOGY, 2019, 30 (10) :1601-1612
[5]   Breast cancer in pregnancy [J].
Amant, Frederic ;
Loibl, Sibylle ;
Neven, Patrick ;
Van Calsteren, Kristel .
LANCET, 2012, 379 (9815) :570-579
[6]  
American College of Radiology, 2020, AM COLL RAD MAN CONT
[7]  
[Anonymous], 2017, Obstet Gynecol, V130, P933, DOI 10.1097/AOG.0000000000002350
[8]  
[Anonymous], 2020, RAD PREGN FACT SHEET
[9]  
[Anonymous], 2013, 174 NAT COUNC RAD PR
[10]  
[Anonymous], 2023, ACR-SPR Practice Parameters for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation