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Percutaneous image-guided pelvic procedures in women with gynecologic cancers: utilization, complications, and impact on patient management

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Abstract

Purpose

Image-guided percutaneous pelvic procedures often play an important role in the management of women with gynecologic cancers. The purpose of this study is to evaluate the utilization of and indications for these procedures, and quantify their impact on patient management.

Methods

IRB-approved retrospective record review of percutaneous pelvic procedures requested by gynecologic oncology, 2005 to 2015. Descriptive statistics and logistic regression were performed.

Results

392 pelvic procedures, including fluid aspiration, core biopsy, and fine needle aspiration, were performed in 225 women. Procedures were performed under sonographic guidance (303/392, 77.30%), CT guidance (87/392, 22.19%), or both (2/392, 0.51%). Pathology results included: no specimen sent (157/392, 40.05%), new cancer diagnosis (55/392, 14.03%), recurrence or metastasis of known primary cancer (107/392, 27.30%), benign tissue (67/392, 17.09%), and nondiagnostic (6/392, 1.53%). In terms of management, some procedures led to oncologic surgery, radiation, or chemotherapy (158/392, 40.31%), cessation of oncologic treatment (36/392, 9.18%), or treatment of infection (10/392, 2.55%). Many procedures were therapeutic (178/392, 45.41%), while a minority were performed for genomics (1/392, 0.26%) or did not impact clinical management (9/392, 2.30%). The number of procedures per year increased over time during the period of data collection. Date of service was a significant positive predictor of a purely therapeutic procedure (OR 1.69 [95 % CI 1.44–1.98], p < 0.0001) and a significant negative predictor of a malignant diagnosis (OR 0.72 [95 % CI 0.64–0.81], p < 0.0001), for each year later in the 10-year cycle.

Conclusion

In this single institution study, we identified a trend toward increased utilization of image-guided percutaneous pelvic interventions in women with gynecologic cancers. The case mix has shifted over the past 10 years, with procedures for symptom management constituting a larger proportion and diagnostic procedures constituting a smaller proportion of procedures over time.

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Authors and Affiliations

  1. Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA

    Rubina Zahedi, Mishal Mendiratta-Lala, Ellen J. Higgins, Ashley N. Nettles & Katherine E. Maturen

  2. Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5030, USA

    Shitanshu Uppal & Katherine E. Maturen

Authors
  1. Rubina Zahedi
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  2. Shitanshu Uppal
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  3. Mishal Mendiratta-Lala
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  4. Ellen J. Higgins
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  5. Ashley N. Nettles
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  6. Katherine E. Maturen
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Corresponding author

Correspondence to Rubina Zahedi.

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The authors have no relevant financial disclosures or other conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent is not required.

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Zahedi, R., Uppal, S., Mendiratta-Lala, M. et al. Percutaneous image-guided pelvic procedures in women with gynecologic cancers: utilization, complications, and impact on patient management. Abdom Radiol 41, 2460–2465 (2016). https://doi.org/10.1007/s00261-016-0882-9

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  • DOI: https://doi.org/10.1007/s00261-016-0882-9

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