Normal and abnormal MRI findings after abdominal radical trachelectomy (ART) for cervical cancer

Konstantinos Chatoupis, Charis Bourgioti, Aristeidis Antoniou, Evangelia Panourgias, Lia Angela Moulopoulos

Abstract


Purpose: To report MRI findings after abdominal radical trachelectomy (ART) for early-stage cervical cancer.

Material and Methods: During an 8-year period, 25 women (mean age: 32 years) with biopsy-proven cervical cancer stage ≤IB1, were treated with ART. Postoperative MRI was performed in 22/25 patients, 6 months after ART and every 6 months thereafter, for a total of 6-48 months (mean: 24 months). Normal MRI features of utero-vaginal anastomosis and post-ART complications were recorded by two expert radiologists.

Results: The utero-vaginal anastomosis was clearly depicted on all postoperative MRIs; a vaginal neo-fornix was observed in 17/22 patients. Magnetic susceptibility artefacts caused by the metallic cerclage suture placed at the anastomosis, were more prominent on gradient-echo sequences, partially degrading image quality. Baseline postoperative MRI showed diffuse vaginal wall thickening in 14/22 patients; this gradually resolved within a year from surgery. Asymptomatic lymphoceles occurred in 4/22 patients. Two/22 patients developed symptomatic isthmic stenosis and hematosalpinges, the first 2 years after surgery. In 4/22 patients, hydrosalpinges were discovered incidentally 6 months after ART; one of these patients was diagnosed with pelvic inflammatory disease a year after surgery. Follow-up MRI revealed local tumor relapse in two patients and nodal involvement in one patient, within 2 years after ART.

Conclusion: Post-ART complications observed on MR images of the pelvis include: vaginal wall thickening, lymphoceles, isthmic stenosis, hemato/hydrosalpinges and tumor recurrence. Familiarization of radiologists with the post-ART MRI appearance of utero-vaginal anastomosis is important to avoid misdiagnosis of tumor recurrence. 


Full Text:

PDF

References


SEER Data, 1973-2013: Surveillance, Epidemiology and End Results. Available via seer.cancer. gov/statfacts/html/cervix.html. Published April 15, 2016. Accessed June 20, 2016.

Frejka T, Sardon JP. First birth trends in developed countries: persisting parenthood postponement. Demogr Res 2006; 15(6): 147-180.

Loren A W, Mangu P B, Beck L N, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31(19): 2500-2510.

Denschlag D, Reed NS, Rodolakis A. Fertility-sparing approaches in gynecologic cancers: A review of ESGO task force activities. Curr Oncol Rep 2012; 14(6): 535-538.

Bourgioti C, Koutoulidis V, Chatoupis K, et al. MRI findings before and after abdominal radical trachelectomy (ART) for cervical cancer: A prospective study and review of the literature. Clin Radiol 2014; 69(7): 678-686.

Pecorelli S, Zigliani L, Odicino F. Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet 2009; 105(2): 107-108.

Balleyguier C, Sala E, Da Cunha T, et al. Staging of uterine cervical cancer with MRI: Guidelines of the European Society of Urogenital Radiology. Eur Radiol 2011; 21(5): 1102-1110.

Testa AC, Di Legge A, De Blasis I, et al. Imaging techniques for the evaluation cervical cancer. Best Pract Res Clin Obstet Gynaecol 2014; 28(5): 741-768.

Plante M, Gregoire J, Renaud MC, et al. The vaginal radical trachelectomy: An update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 2011; 121(2): 290-297.

Pareja R, Rendon GJ, Sanz-Lomana CM, et al. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy - a systematic literature review. Gynecol Oncol 2013; 131(1): 77-82.

Sahdev A, Jones J, Shepherd JH, et al. MR imaging appearances of the female pelvis after trachelectomy. Radiographics 2005; 25(1): 41-52.

Noël P, Dubé M, Plante M, et al. Early cervical carcinoma and fertility-sparing treatment options: MR imaging as a tool in patient selection and a follow-up modality. Radiographics 2014; 34(4): 1099-1119.

Li X, Li J, Wen H, et al. The survival rate and surgical morbidity of abdominal radical trachelectomy versus abdominal radical hysterectomy for stage IB1 cervical cancer. Ann Surg Oncol 2016; 23(9): 2953-2958.

Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (suppl 6): vi33-vi38.

Ajit D, Gavas S, Joseph S, et al. Identification of atypical glandular cells in pap smears: Is it a hit and miss scenario? Acta Cytol 2013; 57(1): 45-53.

Patel S, Liyanage SH, Sahdev A, et al. Imaging of endometrial and cervical cancer. Insights Imaging 2010; 1(5-6): 309-328.

Schneider A, Erdemoglu E, Chiantera V, et al. Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer. Int J Gynecol Cancer 2012; 22(4): 659-666.

Balleyguier C, Fournet C, Ben Hassen W, et al. Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging. Clin Imaging 2013; 37(1): 70-76.

Lakhman Y, Akin O, Park KJ, et al. Stage IB1 cervical cancer: Role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy. Radiology 2013; 269(1): 149-158.

Wethington SL, Cibula D, Duska LR, et al. An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies. Int J Gynecol Cancer 2012; 22(7): 1251-1257.




DOI: http://dx.doi.org/10.36162/hjr.v1i1.23

Refbacks

  • There are currently no refbacks.