Optimal Staging of Lymphoma during Pregnancy is Crucial

We have read with great interest the review by Lavi et al. [1] on the management of hematological malignancies in pregnancy. The authors recommended chest X-ray with abdominal shielding and ultrasonography as preferred staging method. However, they also advised not to perform MRI during the first trimester and only in the second and third trimester, if results would significantly alter clinical management, because of the theoretical risk to the fetus. Although we agree with the authors that careful deliberation of any medical intervention during pregnancy is necessary, we also want to emphasize that in an oncologic setting, correct staging does alter clinical management and helps to optimize long-term survival [2].

MRI is commonly used during pregnancy for evaluation of fetal anomalies and other obstetric and nonobstetric indications. As stated by the American College of Radiology [3], present data have not documented any deleterious effects of MRI exposure on the developing fetus in any trimester of pregnancy. Furthermore, it is well documented that MRI is safe at 3.0 tesla or less during the second and third trimester [4]. MRI is an excellent alternative to the radioactive ionizing gold standard of computed tomography with ¹⁸F-fuoro-2-deoxy-D-glucose positron emission tomography. The recent study by Kwee et al. [5] reported that MRI staging without gadolinium-based contrast equals computed tomography staging in the majority of patients with newly diagnosed lymphoma. The fetal risks of gadolinium during pregnancy are still unclear at the present time. In case of lymphoma during pregnancy, maternal benefit of correct staging clearly outweighs theoretical fetal risks. MRI plays a crucial role in accurate staging of pregnant women. Accurate staging enables optimal treatment planning. This is of major importance for maternal outcome and must not be disregarded [2].