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Silber M, Gilboa Y, Perlman S, Krispin E, Sukenik S, Shochat T, Hadar E, Bardin R. Accurate Diagnosis of Adnexal Torsion-Not Only for Expert Sonographers: A Retrospective Cohort Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:725-732. [PMID: 34013996 DOI: 10.1002/jum.15756] [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: 03/13/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of the study was to evaluate the clinical and sonographic parameters associated with a correct or incorrect diagnosis of adnexal torsion made by resident/attending physicians who are not expert sonographers. METHODS A retrospective study design included women who presented to the Emergency Department (ED) of a tertiary medical center between 2010 and 2019 with acute lower abdominal pain, who were subsequently diagnosed laparoscopically with adnexal torsion. Women who were correctly diagnosed in the ED by an obstetrician-gynecologist who was not an expert sonographer were compared for clinical and sonographic parameters with women who were initially incorrectly diagnosed and underwent a second ultrasound examination by an expert sonographer following admission. RESULTS Of 118 women with surgically proven adnexal torsion, 76 were correctly diagnosed in the ED and 42 were initially incorrectly diagnosed. The correctly diagnosed group was characterized by a significantly shorter mean time from admission to surgery, higher rate of vomiting, shorter duration of abdominal pain, and higher rate of prior torsion (P < .05). Physicians who made the correct diagnosis utilized more sonographic parameters than those who did not, namely ovarian size, ovarian edema, and Doppler flow. The correctly diagnosed group had a higher rate of bluish-black (ischemic) adnexa at laparoscopy, but a higher rate of recovery following detorsion. CONCLUSIONS Physicians in the ED should be alerted to the need to address some basic sonographic features when adnexal torsion is suspected. The diagnostic accuracy of adnexal torsion can be improved by utilizing simple sonographic markers, even in the ED setting.
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Affiliation(s)
- Michal Silber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Yinon Gilboa
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Sharon Perlman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Eyal Krispin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Shai Sukenik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Tzippy Shochat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Statistical Consulting Unit, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
| | - Ron Bardin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Helen Schneider Women's Hospital, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel
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2
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Ekici H, Okmen F, Imamoglu M, Hortu I, Akdemir A. Perioperative Outcomes in Pregnant Women Who Underwent Surgery for Adnexal Torsion. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:336-342. [PMID: 35139568 PMCID: PMC9948234 DOI: 10.1055/s-0042-1742403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate clinical characteristics, maternal and fetal outcomes in pregnant women who underwent surgery for adnexal torsion (AT). METHODS All patients, who underwent surgical operation due to AT during pregnancy at the Department of Obstetrics and Gynecology, School of Medicine, Ege University between 2005 and 2020 were retrospectively investigated. Main clinical and perioperative outcomes were evaluated. RESULTS A total of 21 patients who underwent surgery due to AT during pregnancy were included. Of all patients, 61.9% underwent laparoscopy and the remaining 38.1% underwent laparotomy. The most common surgical procedure was adnexal detorsion in both groups (48%). Mean gestational age at the time of diagnosis, duration of surgery and hospitalization were significantly lower in the laparoscopy group, when compared with the laparotomy group (p = 0.006, p = 0.001, and p = 0.001, respectively.) One of the patients had an infection during the postoperative period. Spontaneous abortion was only observed in one case. CONCLUSION It can be concluded that the surgical intervention implemented for the exact diagnosis and treatment of AT (laparotomy or laparoscopy) did not have an unfavorable effect on pregnancy outcomes such as abortion, preterm delivery, and fetal anomaly. However, laparoscopy may be superior to laparotomy in terms of advantages.
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Affiliation(s)
- Huseyin Ekici
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Fırat Okmen
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey
| | - Metehan Imamoglu
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Obstetrics and Gynecology, School of Medicine, Yale University, New Haven, Connecticut, United States
| | - Ismet Hortu
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, Izmir, Turkey.,Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, School of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Institute of Health Sciences, Ege University, Izmir, Turkey
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Meller N, Meyer R, Cohen A, Abu-Bandora E, Amitai Komem D, Toussia-Cohen S, Mashiach R, Levin G, Orvieto R, Cohen SB. A validated predictive model for adnexal torsion pre-operative diagnosis. Arch Gynecol Obstet 2022; 305:1069-1077. [PMID: 35001184 DOI: 10.1007/s00404-021-06388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To develop a simple predictive model for pre-operative diagnosis of adnexal torsion (AT). METHODS A retrospective cohort study with a retrospective validation, including 669 separate episodes of women who underwent laparoscopy due to a suspected AT between January 2011 and June 2020. We compared the pre-operative characteristics between women with surgically confirmed AT and those without. RESULTS The derivation cohort included 615 episodes of suspected AT. AT was surgically confirmed in 445 episodes (72%). The retrospectively collected validation cohort included 54 episodes, with 31 (57.4%) surgically confirmed AT. In a multivariate regression analysis, vomiting, neutrophils to lymphocytes ratio > 3.5 and sonographic finding of enlarged ovary were independently associated with AT [OR 95% CI 2.78 (1.21-6.36), 3.15 (1.42-6.97) and 2.80 (1.33-5.88), respectively]. In the derivation cohort, the PPV for AT diagnosis was 69.7%, 84.5% and 93.1% if 1, 2 and 3 risk factors were present, respectively. Retrospective validation analysis underlined a PPV of 67.6%, 82.6 and 66.6% for 1, 2 and 3 risk factors, respectively. CONCLUSION We have developed and validated a simple predictive model for pre-operative diagnosis of AT, based on three parameters. Our model may assist clinicians while evaluating patients with suspected AT and improve pre-operative diagnosis.
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Affiliation(s)
- Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel. .,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | | | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomi Toussia-Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, 52621, Tel Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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4
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Hewitt MK. A diagnosis with a twist: Ultrasonographic sensitivity and predictors of pediatric ovarian torsion within a large pediatric hospital. World J Emerg Med 2022; 13:229-231. [DOI: 10.5847/wjem.j.1920-8642.2022.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
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5
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Meller N, Levin G, Cohen A, Abu-Bandora E, Amitai Komem D, Mashiach R, Meyer R. Surgically confirmed adnexal torsion during pregnancy: Does the trimester make a difference? J Obstet Gynaecol Res 2021; 47:4216-4223. [PMID: 34605118 DOI: 10.1111/jog.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the clinical and the sonographic characteristics of adnexal torsion (AT) during pregnancy and to underline differences in AT manifestation between pregnancy trimesters. METHODS This is a retrospective cohort study in a tertiary medical center. The study included all pregnant women with surgically confirmed AT between March 2011 and April 2020. The patients were divided into three groups according to pregnancy trimesters, and the clinical and sonographic characteristics were compared between the groups. RESULTS The study cohort included 140 cases of AT. Ninety-nine (70.7%) of the cases occurred during the 1st trimester, and 31 (22.1%) and 10 (7.1%) occurred during the 2nd and the 3rd trimesters, respectively. Conception by assisted-reproductive technologies (ART), nausea, and finding of enlarged ovary on ultrasound scan were all more common among patients in the 1st trimester group as compared to the 3rd trimester group (p = 0.001, 0.015, and 0.024, respectively). The mean time from admission to surgery was significantly shorter in the 1st trimester group as compared to late pregnancy (p = 0.001). The majority of cases were right-sided. There was a significant difference in the organs involved in every trimester of pregnancy-ovary only, ovary and fallopian tube, and fallopian tube only (p = 0.023). CONCLUSIONS Most AT cases during pregnancy occurred during the 1st trimester. Conception by ART and enlarged ovary on ultrasound scan were also more common in AT cases during early pregnancy. Time from admission to surgery was longer as pregnancy progressed and organs involved differed between trimesters. Understanding the difference in manifestation of AT in every trimester might improve the preoperative evaluation of AT in pregnancy.
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Affiliation(s)
- Nir Meller
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adiel Cohen
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel-Aviv, Israel.,The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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6
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Adu-Bredu TK, Arkorful J, Appiah-Denkyira K, Wiafe YA. Diagnostic value of the sonographic whirlpool sign in the diagnosis of ovarian torsion: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:746-753. [PMID: 34021602 DOI: 10.1002/jcu.23021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/05/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
In this review, we investigated the diagnostic value of the sonographic "whirlpool sign" in identifying ovarian torsion. This was done by performing a search in PubMed, Scopus, Embase, Web of Science, CINAHL, and Google scholar. Additional search for the grey literature was made in EThOS.bl.uk, explore.bl.uk, opengrey.eu, greylit.org, and clinicaltrials.org. A total of eight studies were included in this meta-analysis. Sensitivity and specificity of whirlpool sign were extracted from the studies and computed into the Metadisc statistical software for pooled analysis. The whirlpool sign showed a high sensitivity and specificity for the diagnosis of ovarian torsion.
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Affiliation(s)
- Theophilus Kofi Adu-Bredu
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Arkorful
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Appiah-Denkyira
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Yaw Amo Wiafe
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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7
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Kinay T, Akgul MA, Kiykac Altinbas S, Tapisiz OL, Kayikcioglu F, Moraloglu Tekin O. Diagnostic value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in adnexal torsion cases. J Obstet Gynaecol Res 2021; 47:1846-1853. [PMID: 33650213 DOI: 10.1111/jog.14715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/26/2020] [Accepted: 01/29/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate if the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) could be used to diagnose adnexal torsion. METHODS A retrospective study reviewed medical records of women who underwent surgery due to an adnexal mass between January 2012 and December 2017 at a tertiary referral center in Turkey. According to the surgical findings, the women were divided into a torsion group and a control group. NLR and PLR were compared between women who had adnexal torsion and those who did not. RESULTS A total of 201 women were included in the study: 67 in the torsion group and 134 in the control group. Mean WBC count (9584.0 ± 3080.8 vs. 6678.2 ± 1886.1 h/mm3 ), mean NLR (5.9 ± 4.3 vs. 2.1 ± 0.8), and mean PLR (210.5 ± 132.7 vs. 147.9 ± 48.7) were higher in the torsion group than in the control group (p < 0.001). According to the ROC curve analyses, the optimal cut-off value for NLR and PLR were 2.51 (sensitivity, 72%; specificity, 78%) and 154.4 (sensitivity, 61%; specificity, 64%) in the diagnosis of adnexal torsion, respectively. CONCLUSION NLR and PLR have been found useful hematological markers for the diagnosis of adnexal torsion. NLR and PLR could be helpful in cases, which is difficult to make a definitive diagnosis with patients' symptom and the ultrasonographic examination.
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Affiliation(s)
- Tugba Kinay
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Mehmet A Akgul
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Sadiman Kiykac Altinbas
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Omer L Tapisiz
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Fulya Kayikcioglu
- Department of Obstetrics and Gynaecology, University of Health Sciences Turkey, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynaecology, Ministry of Health Ankara City Hospital, Ankara, Turkey
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8
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Meyer R, Meller N, Mohr-Sasson A, Abu-Bandora E, Cohen A, Tamir M, Mashiach R, Levin G. Prediction score for recurrent adnexal torsion in women with a previous adnexal torsion. Int J Gynaecol Obstet 2021; 155:411-416. [PMID: 33629355 DOI: 10.1002/ijgo.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop a risk score for preoperative prediction of recurrent adnexal torsion (rAT) among women with a history of previous adnexal torsion (AT). METHODS A retrospective cohort study. We included women with a history of AT, presenting with suspected rAT who underwent diagnostic laparoscopy between March 2011 and March 2020. We compared women with rAT to those without. We constructed a prediction score and validated it in a prospectively collected cohort between April 2020 and June 2020. RESULTS One hundred and fifteen women composed the study cohort. Recurrent AT was confirmed laparoscopically in 86 (74.8%) cases. A risk score for rAT was developed, based on three associated factors: enlarged ovary, no previous oophoropexy and current IVF treatment. In the construction cohort, the rate of torsion was 44.4%, 67.9%, 82.9% and 100% if none, one, two, or three risk factors were present, respectively. In the prospective validation of the risk score, the prediction of one and two risk factors was 60.0% and 100% respectively. CONCLUSION Enlarged ovary is independently associated with preoperative rAT diagnosis. Coupled with information regarding the previous surgical approach in previous AT and current IVF use, these factors could be used to efficiently predict rAT among women with a previous AT.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aya Mohr-Sasson
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Mordechai Tamir
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of medicine, Hebrew University, Jerusalem, Israel
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9
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Bardin R, Perl N, Mashiach R, Ram E, Orbach-Zinger S, Shmueli A, Wiznitzer A, Hadar E. Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:688-694. [PMID: 31703238 DOI: 10.1055/a-1014-2593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. MATERIALS AND METHODS Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. RESULTS The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). CONCLUSION Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.
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Affiliation(s)
- Ron Bardin
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Noga Perl
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Reuven Mashiach
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eitan Ram
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | | | - Anat Shmueli
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Arnon Wiznitzer
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Hadar
- Helen-Schneider-Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
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10
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Yao F, Wang Q. Letter to "Ovarian size as a risk factor for recurrent adnexal torsion: Smaller is not better". J Obstet Gynaecol Res 2020; 46:1928. [PMID: 32648997 DOI: 10.1111/jog.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- FengXiang Yao
- Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Qiong Wang
- Department of Obstetrics and Gynecology, Ningbo First Hospital, Ningbo, Zhejiang, China
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11
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Wattar B, Rimmer M, Rogozinska E, Macmillian M, Khan KS, Al Wattar BH. Accuracy of imaging modalities for adnexal torsion: a systematic review and meta-analysis. BJOG 2020; 128:37-44. [PMID: 32570294 DOI: 10.1111/1471-0528.16371] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Adnexal torsion (AT), a serious gynaecological emergency, often presents with non-specific symptoms leading to delayed diagnosis. OBJECTIVE To compare the test accuracy of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) to diagnose AT. SEARCH STRATEGY We searched EMBASE, MEDLINE and Cochrane CENTRAL until December 2019. SELECTION CRITERIA Studies reporting on the accuracy of any imaging modality (Index Test) in female patients (paediatric and adult) suspected of AT compared with surgical diagnosis and/or standard clinical/radiological follow-up period until resolution of symptoms (Reference Standard). DATA COLLECTION AND ANALYSIS We assessed study quality using QUADAS-2. We conducted test accuracy meta-analysis using a univariate model or a hierarchical model. MAIN RESULTS We screened 3836 citations, included 18 studies (1654 women, 665 cases), and included 15 in the meta-analyses. Ultrasound pooled sensitivity (n = 12, 1187 women) was 0.79 (95% CI 0.63-0.92) and specificity was 0.76 (95% CI 0.54-0.93), with negative and positive likelihood ratios of 0.29 (95% CI 0.13-0.66) and 4.35 (95% CI 2.03-9.32), respectively. Using Doppler with ultrasound (n = 7, 845 women) yielded similar sensitivity (0.80, 95% CI 0.67-0.93) and specificity (0.88, 95% CI 0.72-1.00). For MRI (n = 3, 99 women), the pooled sensitivity was 0.81 (95% CI 0.63-0.91) and specificity was 0.91 (95% CI 0.80-0.96). A meta-analysis for CT was not possible with two case-control studies and one cohort study (n = 3, 232 women). Its sensitivity range was 0.74-0.95 and specificity was 0.80-0.90. CONCLUSIONS Ultrasound has good performance as a first-line diagnostic test for suspected AT. Magnetic resonance imaging could offer improved specificity to investigate complex ovarian morphology, but more evidence is needed. TWEETABLE ABSTRACT To investigate adnexal torsion, ultrasound is a good first-line diagnostic test with a pooled sensitivity of 0.79 and specificity of 0.76.
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Affiliation(s)
- B Wattar
- West Suffolk NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | - M Rimmer
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - E Rogozinska
- MRC Clinical Trials Unit, University College London, London, UK
| | - M Macmillian
- MRC Centre for Regenerative Medicine, The University of Edinburgh, Edinburgh, UK
| | - K S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - B H Al Wattar
- Warwick Medical School, University of Warwick, Coventry, UK
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12
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Feng JL, Zheng J, Lei T, Xu YJ, Pang H, Xie HN. Comparison of ovarian torsion between pregnant and non-pregnant women at reproductive ages: sonographic and pathological findings. Quant Imaging Med Surg 2020; 10:137-147. [PMID: 31956537 DOI: 10.21037/qims.2019.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differences in the ultrasonographic features and histological diagnosis of ovarian torsion in pregnant and non-pregnant women have not been defined. A better characterization of these features may help improve the accuracy of preoperative diagnosis. The present study aimed to compare the clinical characteristics, sonographic findings, operative procedures, and histological spectrum of ovarian torsion in pregnant and non-pregnant women. Methods This was a retrospective investigation of female patients at reproductive age with ovarian torsion between January 2010 and May 2017. Each patient received a detailed preoperative ultrasound, and the diagnosis was confirmed by surgery. The clinical characteristics, ultrasonic features, operative procedures, and histological diagnosis of ovarian torsion were retrieved from medical records and were compared in non-pregnant and pregnant patients according to the method of conception. Results The overall preoperative ultrasonic detection rate of ovarian torsion was 0.84, which was significantly different between pregnant and non-pregnant women. The presence of ovarian edema and abnormal adnexal positions also differed between pregnant and non-pregnant women. The ultrasonic features were not significantly different between the two pregnant sub-groups. The most common histologic diagnoses in the pregnant group and the non-pregnant group were a normal ovary and teratoma, respectively. The incidence of ovarian neoplasm was significantly lower in pregnant women. There were significant differences in the surgical procedures between the groups based on neoplastic or non-neoplastic lesions. Conclusions Ovarian edema, absence/decreased blood flow in the ovary, and the whirlpool sign were reliable ultrasonic markers for ovarian torsion at reproductive ages. The preoperative ultrasonic detection rate of ovarian torsion was higher in pregnant women, and ovarian edema was more common. The clinical features of ovarian torsion in pregnant women were similar, independent of the method of conception. In women with ovarian torsion, the incidence of non-neoplastic lesions was more frequent in pregnant women, whereas neoplastic lesions were more common in non-pregnant women. Ultrasonography provides useful parameters for the preclinical diagnosis of ovarian torsion to improve patient management.
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Affiliation(s)
- Jie-Ling Feng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ting Lei
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yong-Jian Xu
- Center for Information Technology & Statistics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Pang
- Department of Medical Records Management, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Bromley B. Gynecologic Ultrasound Evaluation of the Nongravid Woman with Pelvic Pain. Obstet Gynecol Clin North Am 2019; 46:581-594. [PMID: 31677743 DOI: 10.1016/j.ogc.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pelvic pain is a common condition. Many underlying gynecologic and nongynecologic conditions can contribute to this symptom. Pelvic ultrasound using comprehensive 2-dimensional interactive imaging techniques as well as color Doppler and 3-dimensional imaging optimizes the detection of inciting etiologies.
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Affiliation(s)
- Bryann Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Diagnostic Ultrasound Associates, One Brookline Place, Suite 506, Brookline, MA 02445, USA
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15
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Isolated Tubal Torsion after Tubal Ligation. J Minim Invasive Gynecol 2019; 26:595-596. [DOI: 10.1016/j.jmig.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022]
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16
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Budhram G, Elia T, Dan J, Schroeder M, Safain G, Schlech W, Friderici J, Knee A, Anthouard M, Schoenfeld E. A Case-Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain. Acad Emerg Med 2019; 26:152-159. [PMID: 30044031 DOI: 10.1111/acem.13523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/20/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Color and power Doppler ultrasound are commonly used in the evaluation of ovarian torsion but are unreliable. Because normal-sized ovaries are unlikely to cause torsion, maximum ovarian diameter (MOD) could theoretically be used as a screening test in the ED. Identification of MOD values below which torsion is unlikely would be of benefit to providers interpreting radiology department or point-of-care pelvic ultrasound. OBJECTIVES The objective was to determine if sonographic MOD can be used as a screening tool to rule out torsion in selected patients. METHODS Via a retrospective case-control study spanning a 14-year period, we examined the ultrasound characteristics of patients with torsion and age-matched controls, all presenting to the emergency department with lower abdominal pain and receiving a radiology department pelvic ultrasound for "rule-out torsion." Standardized data collection forms were utilized. Distributions of MOD were compared and sensitivity, specificity, and likelihood ratios were calculated for multiple cutoffs. RESULTS We identified 92 cases of surgically confirmed ovarian torsion and selected 92 age-matched controls. In postmenarchal patients the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 3- and 5-cm MODs were 100% (96%-100%), 30% (20%-41%), 1.4 (1.3-1.7), and 0 and 91% (83%-97%), 92% (83%-97%), 11.2 (5.5-22.9), and 0.09 (0.04-0.19), respectively. The 5-cm MOD, however, excluded an additional 52 of 84 (62%) postmenarchal patients. CONCLUSIONS A threshold MOD of 5 cm on pelvic ultrasound may be useful to rule out ovarian torsion in postmenarchal females presenting with lower abdominal and pelvic pain.
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Affiliation(s)
- Gavin Budhram
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Tala Elia
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Jeff Dan
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Michele Schroeder
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Golien Safain
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Cambridge Health Alliance Cambridge MA
| | - Walter Schlech
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Berkshire Medical Center Pittsfield MA
| | - Jennifer Friderici
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Alex Knee
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
| | - Magalie Anthouard
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
- Department of Emergency Medicine Manatee Memorial Hospital Bradenton FL
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine University of Massachusetts Medical Center–Baystate Springfield MA
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Melcer Y, Maymon R, Pekar-Zlotin M, Vaknin Z, Pansky M, Smorgick N. Does she have adnexal torsion? Prediction of adnexal torsion in reproductive age women. Arch Gynecol Obstet 2017; 297:685-690. [DOI: 10.1007/s00404-017-4628-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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