The Role of Interventional Radiology in Management of Benign and Malignant Gynecologic Diseases

Abstract

This article focuses on the role of interventional radiology in the therapeutic and diagnostic management of benign and malignant gynecologic conditions. The subspecialty of interventional radiology utilizes minimally invasive advanced image-guided percutaneous techniques in gynecology that include central venous catheter placement, fluid aspiration, drainage catheter placement, tissue biopsy, inferior vena cava filter placement, and pelvic arterial embolization. Central venous catheters, such as ports, peripherally inserted central catheters, and tunneled catheters, are placed for intermediate to long-term intravenous chemotherapy or total parental nutrition or antibiotics. Patients with refractory malignant ascites or pleural effusion from seeding of advanced gynecologic cancers may benefit by percutaneous aspiration of fluid collections or placement of drainage catheters. Postoperative fluid collections including abscess, seroma, or lymphocele are managed by percutaneous drainage catheter insertion. Pelvic, peritoneal, or retroperitoneal masses can be sampled by image-guided percutaneous biopsy or aspiration of fluid to determine a pathologic diagnosis. Certain patients are at risk for deep venous thrombosis with pulmonary embolism and may benefit from an inferior vena cava filter. Patients with uncontrolled postoperative or postpartum bleeding can be effectively managed with emergent transarterial pelvic embolization. Each of the aforementioned interventions with indications, expected benefits, and complications is described including a published literature.

Comparison of image quality assessments between interventional radiographers and interventional radiologists using digital subtraction angiography

“…36,37 This study recognizes the qualities of interventional radiographers as expert observers and skilled clinicians who assist the interventional radiologist during procedures, especially for complex interventions including embolizations of gastrointestinal bleeds, gynecological hemorrhages, and malignancy complications. [38][39][40][41] This study had certain limitations. The Interventional Radiology Department was limited by the number of observers who were able to participate in the VGC-ratings task.…”

“…Interventional radiology differs from other largely pathology detection-based modalities, such as general x-ray, CT, and MRI, as the imaging is primarily used for the purpose of guiding percutaneous devices for therapeutic management through vascular and nonvascular interventions 36 , 37 . This study recognizes the qualities of interventional radiographers as expert observers and skilled clinicians who assist the interventional radiologist during procedures, especially for complex interventions including embolizations of gastrointestinal bleeds, gynecological hemorrhages, and malignancy complications 38 – 41 …”