Masselli Gabriele, Bourgioti Charis
Radiology Department, Umberto I Hospital, Sapienza University, Via del Policlinico 155, 00161 Rome, Italy.
School of Medicine, National and Kapodistrian University of Athens, Aretaieon Hospital, 11527 Athens, Greece.
Cancers (Basel). 2025 Feb 28;17(5):838. doi: 10.3390/cancers17050838.
The aim of this review is to provide an update on the imaging triage, safety considerations, and cancer-imaging features of common and uncommon gynecological tumors during pregnancy. Clinical examination can be inconclusive, especially for the evaluation of intra-abdominal diseases since symptoms related to cancer such as fatigue, vomiting, or nausea overlap with common pregnancy-associated symptoms. Delayed pregnancy, advanced maternal age, and improvements in diagnostic imaging in developed countries have increased the incidence of cancer diagnosis in gravid populations. Non-invasive diagnostic imaging has a central role in the initial diagnosis and management of pregnancy tumors. Sonography is the first modality for the abdominal evaluation of gravid patients because it is widely available, low cost, and lacks adverse effects on the mother and fetus. MR imaging is considered the imaging modality of choice for diagnosis and staging of gynecologic cancer during pregnancy due to its larger imaging field of view, better reproducibility, and excellent soft tissue contrast. Moreover, whole-body diffusion-weighted imaging (DWI) has been proposed for the oncologic staging of pregnant patients; however, large prospective studies are needed to support its clinical implementation. Gynecological cancer diagnosed during pregnancy requires accurate diagnosis and staging to determine optimal treatment based on gestational age, and therefore multidisciplinary team collaboration is pivotal.
本综述的目的是更新孕期常见和罕见妇科肿瘤的影像分诊、安全考量及癌症影像特征。临床检查可能无法得出明确结论，尤其是对于腹内疾病的评估，因为与癌症相关的症状，如疲劳、呕吐或恶心，与常见的妊娠相关症状重叠。发达国家中，妊娠延迟、产妇年龄增大以及诊断性影像学的进步，增加了孕期人群中癌症诊断的发生率。非侵入性诊断性影像学在孕期肿瘤的初始诊断和管理中起着核心作用。超声检查是对妊娠患者进行腹部评估的首选方式，因为它广泛可用、成本低，且对母体和胎儿无不良影响。由于磁共振成像（MR成像）具有更大的成像视野、更好的可重复性和出色的软组织对比度，它被认为是孕期妇科癌症诊断和分期的首选成像方式。此外，全身扩散加权成像（DWI）已被提议用于妊娠患者的肿瘤分期；然而，需要大型前瞻性研究来支持其临床应用。孕期诊断出的妇科癌症需要准确的诊断和分期，以便根据孕周确定最佳治疗方案，因此多学科团队合作至关重要。
