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Yagur Y, Brisker K, Kveler K, Cohen G, Weitzner O, Schreiber H, Schonman R, Klein Z, Biron-Shental T. Can Natural Language Processing Improve Adnexal Torsion Predictions? J Minim Invasive Gynecol 2023; 30:672-677. [PMID: 37119990 DOI: 10.1016/j.jmig.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
STUDY OBJECTIVE To create a decision support tool based on machine learning algorithms and natural language processing (NLP) technology, to augment clinicians' ability to predict cases of suspected adnexal torsion. DESIGN Retrospective cohort study SETTING: Gynecology department, university-affiliated teaching medical center, 2014-2022. PATIENTS This study assessed risk-factors for adnexal torsion among women managed surgically for suspected adnexal torsion based on clinical and sonographic data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The dataset included demographic, clinical, sonographic, and surgical information obtained from electronic medical records. NLP was used to extract insights from unstructured free text and unlock them for automated reasoning. The machine learning model was a CatBoost classifier that utilizes gradient boosting on decision trees. The study cohort included 433 women who met inclusion criteria and underwent laparoscopy. Among them, 320 (74%) had adnexal torsion diagnosed during laparoscopy, and 113 (26%) did not. The model developed improved prediction of adnexal torsion to 84%, with a recall of 95%. The model ranked several parameters as important for prediction. Age, difference in size between ovaries, and the size of each ovary were the most significant. The precision for the "no torsion" class was 77%, with a recall of 45%. CONCLUSIONS Using machine learning algorithms and NLP technology as a decision-support tool for the diagnosis of adnexal torsion is feasible. It improved true prediction of adnexal torsion to 84% and decreased cases of unnecessary laparoscopy.
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Affiliation(s)
- Yael Yagur
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel.
| | - Karin Brisker
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Ksenya Kveler
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
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Garde I, Paredes C, Ventura L, Pascual MA, Ajossa S, Guerriero S, Vara J, Linares M, Alcázar JL. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:310-324. [PMID: 35751902 DOI: 10.1002/uog.24976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. METHODS This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. RESULTS The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. CONCLUSIONS The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Garde
- Department of Obstetrics and Gynecology, Hospital Universitario de Cruces, Bilbao, Spain
| | - C Paredes
- Department of Obstetrics and Gynecology, Hospital Materno-Infantil, Badajoz, Spain
| | - L Ventura
- School of Medicine, University of Navarra, Pamplona, Spain
| | - M A Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Institut Universitary Dexeus, Barcelona, Spain
| | - S Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - J Vara
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - M Linares
- Department of Obstetrics and Gynecology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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He Y, Ji C, Shen XC, Zhang KX, Wu YM, Wang Y. Rethinking ovary preservation by adnexal torsion reversal in adolescents: a case of delayed diagnosis. BMC Womens Health 2022; 22:421. [PMID: 36280816 PMCID: PMC9590186 DOI: 10.1186/s12905-022-02013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background This article discusses the management of an adolescent woman with a delayed diagnosis of adnexal torsion (AT) whose ovaries were successfully preserved. Case presentation The patient was a 14-year-old female teen admitted with the chief complaint of lower abdominal pain for 3 days and worsening pain for 2 days. Magnetic resonance imaging suggested a high possibility of torsion in the anterosuperior uterine mass and was accompanied by severe ovarian edema, bleeding, and enlargement. Intraoperatively, the left fallopian tube was characterized by thickening and torsion and appeared blackish purple. The left fallopian tube paraovarian cyst was about 20 cm in size, and the left adnexa was twisted 1080° along the left infundibulopelvic ligament (suspensory ligament of the left ovary). The left ovary appeared blackish purple, with an enlarged diameter of about 10 cm. At the request and with the informed consent of the patient’s parents, we preserved the left ovary and removed the left fallopian tube. The results of the endocrine, ultrasound, and tumor marker tests were normal 1 month after surgery. Follicles and blood flow signals seen in ultrasound examinations indirectly proved the successful preservation of the left ovary in the follow-up. Conclusions Our attempt to preserve the ovaries in an adolescent with a delayed diagnosis of AT was successful.
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Affiliation(s)
- Yue He
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
| | - Chen Ji
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
| | - Xiao-Chang Shen
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
| | - Ke-Xin Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
| | - Yu-Mei Wu
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
| | - Yan Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Dongcheng District, 17 Qihelou Street, Beijing, 100006 China
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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