E2039. Multimodality Imaging of Trachelectomy in Cervical Cancer
  1. Meng Hao; Hospital of the University of Pennsylvania
  2. Kalpana Suresh; Hospital of the University of Pennsylvania
  3. Joanie Garratt; Hospital of the University of Pennsylvania
While cervical cancer is the third most common gynecologic malignancy, it affects a younger population and is most frequently diagnosed in women between the ages of 35-44. With increasing public awareness and routine screening, cervical cancer is being diagnosed at an earlier age. At the same time, more women are choosing to delay childbearing leading to increasing number of patients seeking fertility preserving treatments. While radical hysterectomy is the usual course of treatment, women diagnosed with low stage cervical cancer may opt for trachelectomy, an alternative fertility sparing surgery with neoadjuvant chemotherapy and/or pelvic lymphadenectomy. This alternative allows women to conceive with or without the assistance of in-vitro fertilization and the capability to carry the pregnancy to term. Radiologists play a crucial role in the staging of cervical cancer as FIGO gynecologic oncology committee revised guidelines to allow staging based on imaging and pathologic findings in 2018.

Educational Goals / Teaching Points
In this exhibit, we will review the 2018 FIGO staging of cervical cancer and inclusion and exclusion criteria for trachelectomy candidates. We will also discuss key information to include in radiologic reports to help surgeons identify this subgroup of patients. This exhibit will review the various surgical procedures and imaging appearance of trachelectomy with common appearances such as end-to-end anastomoses and vaginal neo-fornix. This education exhibit will also describe and present cases of common post-surgical findings including vaginal wall thickening, lymphoceles, isthmic stenosis, and hematosalphinx. We will also include a brief discussion with case examples of some of the unique fertility challenges and pregnancy complications these patients face. Most importantly, this exhibit will review imaging findings that are suspicious for recurrent disease and common locations for recurrence including the vaginal vault, parametrium, pelvic side wall, and pelvic and para-aortic lymph nodes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A case-based multimodality review (US, CT, PET-CT, MRI) of the appearance the female pelvis after trachelectomy will be presented with a focus on MRI, including a discussion on artifacts and pitfalls.

Familiarity and knowledge of the post-trachelectomy imaging appearances will be essential in helping radiologists identify benign post-surgical variations and recurrent disease.