Magnetic resonance imaging of cervical cancer in pregnancy

Abstract

Zanetta G, Pellegrino A, Vanzulli A, Di Lelio A, Milani R, Mangioni C. Magnetic resonance imaging of cervical cancer in pregnancy. Int J Gynecol Cancer 1998; 8: 265–269. Six subjects with cervical cancer in pregnancy underwent magnetic resonance imaging (MRI) for the evaluation of the tumoral invasion. Three subjects with early stage IB tumors had no evidene of parametrial invasion or lymph nodal metastases. Two were followed until term and underwent cesarean section/radical hysterectomy. One subject underwent an excision of the tumor during pregnancy and delivered vaginally. Three subjects had locally advanced tumors with macroscopic lymph node metastases. Two of them received neoadjuvant chemotherapy followed by radical surgery, whereas one underwent radical hysterectomy after maturation of the pulmonary function of the fetus. Five of the subjects had an interval of more than two months between diagnosis and delivery and underwent a repeat MRI. In all but one subject a good correlation was observed between the staging based on the final MRI and the histopathological findings. All three subjects with a diagnosis of lymph node metastases at MRI had confirmed metastases at surgery. MRI allowed for tailored treatment planning. With a median follow-up of 42 months (range 23–57) from definitive treatment, four women are alive without tumor and one is alive with distant recurrence. Five infants were born without handicaps or malformations. One fetus died during pregnancy. MRI provides important information for the management of cervical cancer in pregnancy, either when an aggressive or an expectant policy is chosen. An expectant management, consisting of simple observation, of early cervical cancer does not seem to affect progression. Neoadjuvant chemotherapy in pregnancy deserves further investigation.