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Pregnancy Staging Safety — SCE Medical Oncology MCQ

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HardBreast CancerPregnancy Staging SafetySCE Medical Oncology

A woman at 24 weeks of pregnancy has a persistent breast mass and biopsy-proven cancer. The MDT needs to define local extent and investigate possible liver metastases without delaying treatment. Which imaging principle is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Prefer ultrasound and non-contrast MRI; use other clinically essential imaging after expert dose-risk assessment

Explanation lettering: B = shown as A · C = shown as B · A = shown as C · E = shown as D · D = shown as E

C is correct. Ultrasound and non-contrast MRI avoid ionising radiation and are preferred when they can answer the clinical question. Pregnancy, however, is not a reason to leave a potentially management-changing maternal diagnosis unstaged: a necessary radiograph or CT can be justified after optimisation and informed multidisciplinary discussion. PET-CT is not a routine first staging test in pregnancy, and gadolinium crosses the placenta and is not used routinely. The goal is proportionality and diagnostic adequacy, not the incorrect absolute claim that CT can never be performed.

Reference: RCOG Green-top Guideline 12 pregnancy and breast cancer: https://pubmed.ncbi.nlm.nih.gov/40855616/