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Wu M, Zhang M, Qu E, Sun X, Zhang R, Mu L, Xiao L, Wen H, Wang R, Liu T, Meng X, Wu S, Chen Y, Su M, Wang Y, Gu J, Zhang X. A modified CEUS risk stratification model for adnexal masses with solid components: prospective multicenter study and risk adjustment. Eur Radiol 2024:10.1007/s00330-024-10639-1. [PMID: 38374482 DOI: 10.1007/s00330-024-10639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To evaluate the additional advantages of integrating contrast-enhanced ultrasound (CEUS) into the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) for the characterization of adnexal lesions with solid components. MATERIALS AND METHODS This prospective multicenter study recruited women suspected of having adnexal lesions with solid components between September 2021 and December 2022. All patients scheduled for surgery underwent preoperative CEUS and US examinations. The lesions were categorized according to the O-RADS US system, and quantitative CEUS indexes were recorded. Pathological results served as the reference standard. Univariable and multivariable analyses were performed to identify risk factors for malignancy in adnexal lesions with solid components. Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance. RESULTS A total of 180 lesions in 175 women were included in the study. Among these masses, 80 were malignant and 100 were benign. Multivariable analysis revealed that serum CA-125, the presence of acoustic shadowing, and peak intensity (PI) ratio (PImass/PIuterus) of solid components on CEUS were independently associated with adnexal malignancy. The modified CEUS risk stratification model demonstrated superior diagnostic value in assessing adnexal lesions with solid components compared to O-RADS US (AUC: 0.91 vs 0.78, p < 0.001) and exhibited comparable performance to the Assessment of Different NEoplasias in the adnexa (ADNEX) model (AUC 0.91 vs 0.86, p = 0.07). CONCLUSION Our findings underscore the potential value of CEUS as an adjunctive tool for enhancing the precision of diagnostic evaluations of O-RADS US. CLINICAL RELEVANCE STATEMENT The promising performance of the modified CEUS risk stratification model suggests its potential to mitigate unnecessary surgeries in the characterization of adnexal lesions with solid components. KEY POINTS • The additional value of CEUS to O-RADS US in distinguishing between benign and malignant adnexal lesions with solid components requires further evaluation. • The modified CEUS risk stratification model displayed superior diagnostic value and specificity in characterizing adnexal lesions with solid components when compared to O-RADS US. • The inclusion of CEUS demonstrated potential in reducing the need for unnecessary surgeries in the characterization of adnexal lesions with solid components.
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Affiliation(s)
- Manli Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Enze Qu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Sun
- Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zhang
- Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China
| | - Liang Mu
- Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Xiao
- Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Hong Wen
- Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China
| | - Ruili Wang
- Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tingting Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, The Maternity Hospital Of Bao Tou, Baotou, China
| | - Shuangyu Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Chen
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Manting Su
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Wang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Gu
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Tian C, Wen SB, Zhao CY, Yan XN, Du JX. Comparative diagnostic accuracy of the IOTA SRR and LR2 scoring systems for discriminating between malignant and Benign Adnexal masses by junior physicians in Chinese patients: a retrospective observational study. BMC Womens Health 2023; 23:585. [PMID: 37940895 PMCID: PMC10633950 DOI: 10.1186/s12905-023-02719-z] [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: 03/03/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The accuracy of ultrasound in distinguishing benign from malignant adnexal masses is highly correlated with the experience of ultrasound physicians. In China, most of ultrasound differentiation is done by junior physicians. PURPOSE To compare the diagnostic performance of the International Ovarian Tumour Analysis (IOTA) Simple Rules Risk (SRR) and IOTA Logistic Regression Model 2 (LR2) scoring systems in Chinese patients with adnexal masses. METHODS Retrospective analysis of ovarian cancer tumor patients who underwent surgery at a hospital in China from January 2016 to December 2021. Screening patients with at least one adnexal mass on inclusion and exclusion criteria. Two trained junior physicians evaluated each mass using the two scoring systems. A receiver operating characteristic curve was used to test the diagnostic performance of each system. RESULTS A total of 144 adnexal masses were retrospectively collected. Forty masses were histologically diagnosed as malignant. Compared with premenopausal women, postmenopausal women had a much higher rate of malignant masses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the SRR was 97.5% (95% CI: 86.8 -99.9%), 82.7% (95% CI: 74.0 -89.4%), 68.4% (95% CI: 58.7 -76.8%) and 98.9% (95% CI: 92.5 -99.8%). The sensitivity, specificity, PPV, NPV of the LR2 were 90.0% (95% CI: 76.5 -97.2%), 89.4% (95% CI: 81.9 -94.6%), 76.6% (95% CI: 65.0 -85.2%), and 95.9% (95% CI: 90.2 -98.3%). There was good agreement between two scoring systems, with 84.03% total agreement and a kappa value of 0.783 (95% CI: 0.70-0.864). The areas under the curve for predicting malignant tumours using SRR and LR2 were similar for all patients (P > 0.05 ). CONCLUSION The two scoring systems can effectively distinguish benign from malignant adnexal masses. Both scoring systems have high diagnostic efficacy, and diagnostic efficacy is stable, which can provide an important reference for clinical decision making.
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Affiliation(s)
- Cai Tian
- Department of gynecology, The second Hospital of Hebei Medical University, NO.215 of He ping West Road, Xinhua District, Shijiazhuang, 050000, China
| | - Shu-Bin Wen
- Department of gynecology, The second Hospital of Hebei Medical University, NO.215 of He ping West Road, Xinhua District, Shijiazhuang, 050000, China
| | - Cong-Ying Zhao
- Department of gynecology, The second Hospital of Hebei Medical University, NO.215 of He ping West Road, Xinhua District, Shijiazhuang, 050000, China
| | - Xiao-Nan Yan
- Department of gynecology, The second Hospital of Hebei Medical University, NO.215 of He ping West Road, Xinhua District, Shijiazhuang, 050000, China
| | - Jie-Xian Du
- Department of gynecology, The second Hospital of Hebei Medical University, NO.215 of He ping West Road, Xinhua District, Shijiazhuang, 050000, China.
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Sadowski EA, Rockall A, Thomassin-Naggara I, Barroilhet LM, Wallace SK, Jha P, Gupta A, Shinagare AB, Guo Y, Reinhold C. Adnexal Lesion Imaging: Past, Present, and Future. Radiology 2023; 307:e223281. [PMID: 37158725 DOI: 10.1148/radiol.223281] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, imaging is part of the standard of care for patients with adnexal lesions prior to definitive management. Imaging can identify a physiologic finding or classic benign lesion that can be followed up conservatively. When one of these entities is not present, imaging is used to determine the probability of ovarian cancer prior to surgical consultation. Since the inclusion of imaging in the evaluation of adnexal lesions in the 1970s, the rate of surgery for benign lesions has decreased. More recently, data-driven Ovarian-Adnexal Reporting and Data System (O-RADS) scoring systems for US and MRI with standardized lexicons have been developed to allow for assignment of a cancer risk score, with the goal of further decreasing unnecessary interventions while expediting the care of patients with ovarian cancer. US is used as the initial modality for the assessment of adnexal lesions, while MRI is used when there is a clinical need for increased specificity and positive predictive value for the diagnosis of cancer. This article will review how the treatment of adnexal lesions has changed due to imaging over the decades; the current data supporting the use of US, CT, and MRI to determine the likelihood of cancer; and future directions of adnexal imaging for the early detection of ovarian cancer.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Lisa M Barroilhet
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Sumer K Wallace
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Akshya Gupta
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Atul B Shinagare
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Yang Guo
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
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Wang Z, Cao L, Wang J, Wang H, Ma T, Yin Z, Cai W, Liu L, Liu T, Ma H, Zhang Y, Shen Z, Zheng H. A novel predictive model of microvascular invasion in hepatocellular carcinoma based on differential protein expression. BMC Gastroenterol 2023; 23:89. [PMID: 36973651 PMCID: PMC10041792 DOI: 10.1186/s12876-023-02729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND This study aims to construct and verify a nomogram model for microvascular invasion (MVI) based on hepatocellular carcinoma (HCC) tumor characteristics and differential protein expressions, and explore the clinical application value of the prediction model. METHODS The clinicopathological data of 200 HCC patients were collected and randomly divided into training set and validation set according to the ratio of 7:3. The correlation between MVI occurrence and primary disease, age, gender, tumor size, tumor stage, and immunohistochemical characteristics of 13 proteins, including GPC3, CK19 and vimentin, were statistically analyzed. Univariate and multivariate analyzes identified risk factors and independent risk factors, respectively. A nomogram model that can be used to predict the presence of MVI was subsequently constructed. Then, receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were conducted to assess the performance of the model. RESULTS Multivariate logistic regression analysis indicated that tumor size, GPC3, P53, RRM1, BRCA1, and ARG were independent risk factors for MVI. A nomogram was constructed based on the above six predictors. ROC curve, calibration, and DCA analysis demonstrated the good performance and the clinical application potential of the nomogram model. CONCLUSIONS The predictive model constructed based on the clinical characteristics of HCC tumors and differential protein expression patterns could be helpful to improve the accuracy of MVI diagnosis in HCC patients.
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Affiliation(s)
- Zhenglu Wang
- Biological Sample Resource Sharing Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Lei Cao
- Biological Sample Resource Sharing Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Jianxi Wang
- Biological Sample Resource Sharing Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Hanlin Wang
- Department of Pathology and Laboratory Medicine, University of California in Los Angeles (UCLA), Los Angeles, CA, USA
| | - Tingting Ma
- Biological Sample Resource Sharing Center, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Zhiqi Yin
- Pathology Department, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Wenjuan Cai
- Pathology Department, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Lei Liu
- Research Institute of Transplant Medicine, Nankai University, Tianjin, China
| | - Tao Liu
- Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, 24 Fukang Road, Nankai, Tianjin, 300192, China
| | - Hengde Ma
- HPS Gene Technology Co., Ltd., Tianjin, China
| | - Yamin Zhang
- Organ Transplant Department, Tianjin First Central Hospital, Nankai University, Tianjin, China
| | - Zhongyang Shen
- Research Institute of Transplant Medicine, Nankai University, Tianjin, China
- Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, 24 Fukang Road, Nankai, Tianjin, 300192, China
| | - Hong Zheng
- Key Laboratory of Transplant Medicine, Chinese Academy of Medical Sciences, 24 Fukang Road, Nankai, Tianjin, 300192, China.
- Tianjin Key Laboratory for Organ Transplantation, Tianjin First Central Hospital, Nankai University, Tianjin, China.
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Jurkovic D. Conservative management of adnexal tumors: how to tell good from bad. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:149-151. [PMID: 36722429 DOI: 10.1002/uog.26158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 05/27/2023]
Affiliation(s)
- D Jurkovic
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
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Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients with Adnexal Masses. Healthcare (Basel) 2022; 11:healthcare11010008. [PMID: 36611467 PMCID: PMC9818896 DOI: 10.3390/healthcare11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
This study compared the diagnostic performance of different ultrasound-based models in discriminating between benign and malignant ovarian masses in a Filipino population. This was a prospective cohort study in women with findings of an ovarian mass on ultrasound. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation using the different International Ovarian Tumor Analysis (IOTA) Group’s risk models. Serum CA-125 and a second-generation multivariate index assay (MIA2G) were also determined for all patients. The ovarian imaging and biomarker results were correlated with the histological findings. A total of 260 patients with completed ultrasound, CA-125, MIA2G, and histopathologic results was included in the study. The presence of papillae with blood flow and irregular cyst walls during the ultrasound were significantly associated with a 20-fold (OR: 20.13, CI: 8.69−46.67, p < 0.01) and 10-fold (OR: 10.11, CI: 5.30−19.28, p < 0.01) increase in the likelihood of a malignant lesion, respectively. All individual sonologic procedures performed well in discerning malignant and benign ovarian lesions. IOTA-LR1 showed the highest accuracy (82.6%, 95% CI: 77.5−87%) for identifying ovarian cancer. IOTA-ADNEX showed the highest sensitivity (93.3%, 95% CI: 87.2−97.1%) while IOTA-LR2 exhibited the highest specificity (84.4%, 95% CI: 77.3−90%). Among the different serial test combinations, IOTA-LR1 with MIA2G and IOTA-LR2 with MIA2G showed the highest diagnostic accuracy (AUROC = 0.82). This study showed that all individual ultrasound-based models performed well in discerning malignant and benign ovarian lesions, with IOTA-LR1 exhibiting the highest accuracy.
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Velayo CL, Reforma KN, Sicam RVG, Diwa MH, Sy ADR, Tantengco OAG. Improving diagnostic strategies for ovarian cancer in Filipino women using ultrasound imaging and a multivariate index assay. Cancer Epidemiol 2022; 81:102253. [PMID: 36179631 DOI: 10.1016/j.canep.2022.102253] [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: 06/22/2022] [Revised: 08/27/2022] [Accepted: 09/10/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the clinical performance and overall utility of imaging and biomarker assays in discriminating between benign and malignant ovarian masses in a Filipino population. METHODS This is a prospective cohort study among Filipino women undergoing assessment for an ovarian mass in a tertiary center. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation, multivariate index assay (MIA2G), and surgery for an adnexal mass. Ovarian tumors were classified as high-risk for malignancy based on the International Ovarian Tumour Analysis (IOTA) - Logistic Regression 2 (LR2) score. The ovarian imaging and biomarker results were correlated with the reference standard: histological findings. RESULTS Among the 379 women with adnexal masses enrolled in this study, 291 were evaluable with ultrasound imaging, biomarker assays, and histopathological results. The risk of malignancy was higher for women classified as high-risk based on IOTA-LR2 (≥10%). The sensitivity, specificity, and diagnostic accuracy for the prediction of malignancy were 81.2%, 81%, and 0.81 (95% CI: 0.77-0.86) for IOTA-LR2; 77.5%, 66.7%, and 0.72 (95% CI: 0.67-0.77) for CA-125; and 91.3%, 41.2%, and 0.66 (95% CI: 0.62-0.71) for MIA2G. A combination of IOTA-LR2 and MIA2G significantly influenced the diagnostic performance and the result. When MIA2G was combined with IOTA-LR2 in parallel, the sensitivity (94.2%) and NPV (87.7%) increased, but the specificity (37.3%) decreased. When combined with IOTA-LR2 in series, there were fewer false positives, which resulted in improved specificity (85%). CONCLUSION This study determined the utility of ovarian imaging and a second-generation multivariate index assay in predicting the risk of ovarian malignancy. IOTA-LR2 and MIA2G were useful in classifying patients with a high risk for ovarian malignancy.
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Affiliation(s)
- Clarissa L Velayo
- Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines.
| | - Kareen N Reforma
- Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Renee Vina G Sicam
- Department of Obstetrics and Gynecology, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Michele H Diwa
- Department of Pathology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Alvin Duke R Sy
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Philippines
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Jha P, Gupta A, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski EA. Diagnostic Performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) Ultrasound Risk Score in Women in the United States. JAMA Netw Open 2022; 5:e2216370. [PMID: 35679042 PMCID: PMC9185186 DOI: 10.1001/jamanetworkopen.2022.16370] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk scoring system has been studied in a selected population of women referred for suspected or known adnexal lesions. This population has a higher frequency of malignant neoplasms than women presenting to radiology departments for pelvic ultrasonography for a variety of indications, potentially impacting the diagnostic performance of the risk scoring system. OBJECTIVE To evaluate the risk of malignant neoplasm and diagnostic performance of O-RADS US risk scoring system in a multi-institutional, nonselected cohort. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional cohort study included a population of nonselected women in the United States who presented to radiology departments for routine pelvic ultrasonography between 2011 and 2014, with pathology confirmation imaging follow up or 2 years of clinical follow up. EXPOSURE Analysis of 1014 adnexal lesions using the O-RADS US risk stratification system. MAIN OUTCOMES AND MEASURES Frequency of ovarian cancer and diagnostic performance of the O-RADS US risk stratification system. RESULTS This study included 913 women with 1014 adnexal lesions. The mean (SD) age of the patients was 42.4 (13.9 years), and 674 of 913 (73.8%) were premenopausal. The overall frequency of malignant neoplasm was 8.4% (85 of 1014 adnexal lesions). The frequency of malignant neoplasm for O-RADS US 2 was 0.5% (3 of 657 lesions; <1% expected); O-RADS US 3, 4.5% (5 of 112 lesions; <10% expected); O-RADS US 4, 11.6% (18 of 155; 10%-50% expected); and O-RADS 5, 65.6% (59 of 90 lesions; >50% expected). O-RADS US 4 was the optimum cutoff for diagnosing cancer with sensitivity of 90.6% (95% CI, 82.3%-95.9%), specificity of 81.9% (95% CI, 79.3%-84.3%), positive predictive value of 31.4% (95% CI, 25.7%-37.7%) and negative predictive value of 99.0% (95% CI, 98.0%-99.6%). CONCLUSIONS AND RELEVANCE In this cohort study of a nonselected patient population, the O-RADS US risk stratification system performed within the expected range as published by the ACR O-RADS US committee. The frequency of malignant neoplasm was at the lower end of the published range, partially because of the lower prevalence of cancer in a nonselected population. However, a high negative predictive value was maintained, and when a lesion can be classified as an O-RADS US 2, the risk of cancer is low, which is reassuring for both clinician and patient.
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Affiliation(s)
- Priyanka Jha
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | - Aya Kamaya
- Stanford University, Stanford, California
| | - Neha Antil
- Stanford University, Stanford, California
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Gupta A, Jha P, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski E. Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US. Radiology 2022; 303:603-610. [PMID: 35315722 DOI: 10.1148/radiol.212338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Several US risk stratification schemas for assessing adnexal lesions exist. These multiple-subcategory systems may be more multifaceted than necessary for isolated adnexal lesions in average-risk women. Purpose To explore whether a US-based classification scheme of classic versus nonclassic appearance can be used to help appropriately triage women at average risk of ovarian cancer without compromising diagnostic performance. Materials and Methods This retrospective multicenter study included isolated ovarian lesions identified at pelvic US performed between January 2011 and June 2014, reviewed between September 2019 and September 2020. Lesions were considered isolated in the absence of ascites or peritoneal implants. Lesions were classified as classic or nonclassic based on sonographic appearance. Classic lesions included simple cysts, hemorrhagic cysts, endometriomas, and dermoids. Otherwise, lesions were considered nonclassic. Outcomes based on histopathologic results or clinical or imaging follow-up were recorded. Diagnostic performance and frequency of malignancy were calculated. Frequency of malignancy between age groups was compared using the χ2 test, and Poisson regression was used to explore relationships between imaging features and malignancy. Results A total of 970 isolated lesions in 878 women (mean age, 42 years ± 14 [SD]) were included. The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant. The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow (P < .001). For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow (P = .004). The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema was 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy. Conclusion Using a US classification schema of classic- or nonclassic-appearing adnexal lesions resulted in high sensitivity and specificity in the diagnosis of malignancy in ovarian cancer. The highest risk of cancer was in isolated nonclassic lesions with blood flow in women older than 60 years. © RSNA, 2022 See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Akshya Gupta
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Priyanka Jha
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Timothy M Baran
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Katherine E Maturen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Krupa Patel-Lippmann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Hanna M Zafar
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Aya Kamaya
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Neha Antil
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Lisa Barroilhet
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Elizabeth Sadowski
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
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Guo Y, Zhao B, Zhou S, Wen L, Liu J, Fu Y, Xu F, Liu M. A comparison of the diagnostic performance of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems by senior and junior doctors. Ultrasonography 2022; 41:511-518. [PMID: 35196832 PMCID: PMC9262660 DOI: 10.14366/usg.21237] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/31/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose This study compared the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the Risk of Malignancy Index 4 (RMI4), the International Ovarian of Tumor Analysis Logistic Regression Model 2 (IOTA LR2), and the IOTA Simple Rules (IOTA SR) in predicting the malignancy of adnexal masses (AMs). Methods This retrospective study included 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (group I) and two junior doctors (group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. A receiver operating characteristic curve was used to test the diagnostic performance. The interrater agreement between the two groups was tested using kappa values. Results Of all 592 AMs, 447 (75.5%) were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68, and 0.77 for the O-RADS, RMI4, IOTA LR2, and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems were 0.90, 0.89, 0.90, and 0.86 for group I and 0.89, 0.87, 0.88, and 0.84 for group II, respectively. The O-RADS had the highest sensitivity (91.0% in group I and 84.8% in group II). Conclusion The four diagnostic systems could compensate for junior doctors’ inexperience in predicting malignant adnexal lesions. The O-RADS performed best and showed the highest sensitivity.
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Affiliation(s)
- Yuyang Guo
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Baihua Zhao
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shan Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lieming Wen
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jieyu Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yaqian Fu
- Health Management Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Xu
- Department of Ultrasonography, The First Hospital of Changsha, Changsha, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
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11
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Sadowski EA, Thomassin-Naggara I, Rockall A, Maturen KE, Forstner R, Jha P, Nougaret S, Siegelman ES, Reinhold C. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022; 303:35-47. [PMID: 35040672 PMCID: PMC8962917 DOI: 10.1148/radiol.204371] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
MRI plays an important role as a secondary test or problem-solving modality in the evaluation of adnexal lesions depicted at US. MRI has increased specificity compared with US, decreasing the number of false-positive diagnoses for malignancy and thereby avoiding unnecessary or over-extensive surgery in patients with benign lesions or borderline tumors, while women with possible malignancies can be expeditiously referred for oncologic surgical evaluation. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee is an international collaborative effort formed under the direction of the American College of Radiology and includes a diverse group of experts on adnexal imaging and management who developed the O-RADS MRI risk stratification system. This scoring system assigns a probability of malignancy based on the MRI features of an adnexal lesion and provides information to facilitate optimal patient management. The widespread implementation of a codified reporting system will lead to improved interpretation agreement and standardized communication between radiologists and referring physicians. In addition, it will allow for high-quality multi-institutional collaborations-an important unmet need that has hampered the performance of high-quality research in this area in the past. This article provides guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Katherine E Maturen
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Rosemarie Forstner
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Stephanie Nougaret
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Evan S Siegelman
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
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12
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Gorski JW, Dietrich CS, Davis C, Erol L, Dietrich H, Per NJ, Ferrell EL, McDowell AB, Riggs MJ, Hutchcraft ML, Baldwin-Branch LA, Miller RW, DeSimone CP, Gallion HH, Ueland FR, van Nagell JR, Pavlik EJ. Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram. Diagnostics (Basel) 2022; 12:diagnostics12010144. [PMID: 35054310 PMCID: PMC8774702 DOI: 10.3390/diagnostics12010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1–19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5–29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2–93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7–178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration.
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Affiliation(s)
- Justin W. Gorski
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Charles S. Dietrich
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Caeli Davis
- Denison University, Granville, OH 43023, USA;
| | - Lindsay Erol
- Tripler Army Medical Center, Honolulu, HI 96859, USA;
| | | | - Nicholas J. Per
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Emily Lenk Ferrell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Anthony B. McDowell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - McKayla J. Riggs
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Megan L. Hutchcraft
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Lauren A. Baldwin-Branch
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Rachel W. Miller
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Christopher P. DeSimone
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Holly H. Gallion
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Frederick R. Ueland
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - John R. van Nagell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Edward J. Pavlik
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Correspondence:
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13
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Ultrasonographic ovarian mass scoring system for predicting malignancy in pregnant women with ovarian mass. Obstet Gynecol Sci 2021; 65:1-13. [PMID: 34902893 PMCID: PMC8784942 DOI: 10.5468/ogs.21212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022] Open
Abstract
During routine antenatal ultrasound examinations, an ovarian mass can be found incidentally. In clinical practice, the differential diagnosis between benign and malignant ovarian masses is essential for planning further management. Ultrasound imaging has become the most popular diagnostic tool during pregnancy, with the recent development of ultrasonography. In non-pregnant women, several methods have been used to predict malignant ovarian masses before surgery. The International Ovarian Tumor Analysis (IOTA) group reported several scoring systems, such as the IOTA simple rules, IOTA logistic regression models, and IOTA assessment of different NEoplasias in the adneXa. Other researchers have also evaluated the malignancy of ovarian masses before surgery using scoring systems such as the Sassone score, pelvic mass score, DePriest score, Lerner score, and Ovarian-Adnexal Reporting and Data System. These researchers suggested specific features of ovarian masses that can be used for differential diagnosis, including size, proportion of solid tissue, papillary projections, inner wall structure, locules, wall thickness, septa, echogenicity, acoustic shadows, and presence of ascites. Although these factors can also be measured in pregnant women using ultrasound, only a few studies have applied ovarian scoring systems in pregnant women. In this article, we reviewed various scoring systems for predicting malignant tumors of the ovary and determined whether they can be applied to pregnant women.
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Thomassin-Naggara I, Sadowski E, Rockall A, Reinhold C. Correspondence on "ESGO/ISUOG/IOTA/ESGE consensus statement on pre-operative diagnosis of ovarian tumors" by Timmerman et al. Int J Gynecol Cancer 2021; 31:1394-1395. [PMID: 34417255 DOI: 10.1136/ijgc-2021-002910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Elizabeth Sadowski
- Department of Radiology and Obstetrics and Gynecology, Madison, Wisconsin, USA
| | - Andrea Rockall
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline Reinhold
- Department of Radiology, Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Centre, Montreal, Québec, Canada
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Shen H, Hsu HC, Tai YJ, Kuo KT, Wu CY, Lai YL, Chiang YC, Chen YL, Cheng WF. Factors Influencing the Discordancy Between Intraoperative Frozen Sections and Final Paraffin Pathologies in Ovarian Tumors. Front Oncol 2021; 11:694441. [PMID: 34277439 PMCID: PMC8281203 DOI: 10.3389/fonc.2021.694441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim To retrospectively investigate the pre-operative clinical factors and ultrasonographic features that influence the accuracy of the intraoperative frozen section (IFS) of ovarian tumors. Patients and methods Women with ovarian tumors that underwent IFS in one tertiary medical center were recruited from January 2010 to December 2018. Demographic and clinical data of these women were retrieved from medical records in the hospital's centralized database. Results A total of 903 ovarian tumors were enrolled, including 237 (26.2%) benign, 150 (16.6%) borderline tumor, and 516 (57.2%) malignant. The overall accuracy of IFS among all specimens was 89.9%. The sensitivities of IFS in diagnosing borderline tumors (82.0%) and malignant tumors (88.2%) were lower than in diagnosing benign tumors (98.7%, p <0.001, Z-test). The specificity of diagnosing malignant tumors (99.7%) was significantly higher than that of diagnosing benign tumors (94.7%, p <0.001, Z-test). The group with discordant IFS and final paraffin pathology (FPP) had younger age (47.2 ± 14.0 vs. 51.5 ± 11.8 years, p = 0.013, Mann-Whitney U test), and higher percentage of early-stage disease (85.2% vs. 65.1%, p = 0.001, chi-square test) and mucinous (39.3% vs. 3.3%) and endometrioid histologic types (34.4% vs. 20.2%) than the concordant group (all by chi-square test). Menopause (OR 0.34, 95% CI 0.15-0.76, p = 0.009), multicystic tumor in ultrasound (OR 2.14, 95% CI 1.14-4.01, p = 0.018), and ascites existence (OR 0.33, 95% CI 0.14-0.82, p = 0.016) were factors related to the discordant IFS by multivariate analysis. Conclusions IFS has good accuracy in the diagnosis of ovarian tumors. We recommend more frozen tissue sampling for sonographic multicystic tumors in premenopausal women to improve the accuracy of IFS.
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Affiliation(s)
- Hung Shen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Xin-Chu, Taiwan
| | - Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Ting Kuo
- Department and Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ying Wu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Xin-Chu, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan
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16
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McKendry K, Duff S, Huang Y, Redha M, Scanlon Á, Abu Saadeh F, Gleeson N, O'Leary J, Norris L, O'Toole S. The value of human epididymis 4, D-dimer, and fibrinogen compared with CA 125 alone in triaging women presenting with pelvic masses: a retrospective cohort study. Acta Obstet Gynecol Scand 2021; 100:1239-1247. [PMID: 33590896 DOI: 10.1111/aogs.14126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION CA 125, the biomarker in common clinical use for ovarian cancer, is limited by low sensitivity for early disease and high false positives. The aim of this study was to evaluate several candidate biomarkers, alone or in combination, compared with CA 125 in the prediction of malignant/borderline vs benign tumor status in premenopausal and postmenopausal women with pelvic masses. MATERIAL AND METHODS This was a retrospective observational cohort study set in St James's Hospital, a tertiary referral center for gynecological malignancy in Dublin, Ireland. Women undergoing surgery for pelvic masses between 2012 and 2018 were included. Preoperative human epididymis protein 4 (HE4), the Risk of Ovarian Malignancy Algorithm, the Risk of Malignancy Index I and II, D-dimer, and fibrinogen were assessed. Logistic regression models were fitted for each biomarker alone and in combination. Receiver operating characteristics-area under the curve (ROC-AUC) and partial AUCs in the 90%-100% specificity range were determined. RESULTS In all, 89 premenopausal and 185 postmenopausal women were included. In premenopausal women, no biomarker(s) outperformed CA 125 (AUC 0.73; 95% CI 0.63-0.84). In postmenopausal women, HE4 had a partial AUC (pAUC) of 0.71 (95% CI 0.64-0.79) compared with 0.57 (95% CI 0.51-0.69) for CA 125 (p = 0.009). HE4 + D-dimer had an improved pAUC of 0.74 (95% CI 0.68-0.81, p < 0.001) and HE4 + D-dimer + fibrinogen had a pAUC of 0.75 (95% CI 0.68-0.82). CONCLUSIONS A novel biomarker panel of HE4 ± D-dimer ± fibrinogen outperformed CA 125 alone as a high-specificity biomarker in postmenopausal women and could aid in the preoperative triaging of pelvic masses. No biomarker(s) outperformed CA 125 in premenopausal women.
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Affiliation(s)
- Kate McKendry
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - Stephen Duff
- UCD Clinical Research Centre, UCD School of Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Yanmei Huang
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - Mostafa Redha
- Department of Biochemistry, Clinical Pathology Laboratory, St James's Hospital, James's Street, Dublin, Ireland
| | - Áine Scanlon
- Department of Biochemistry, Clinical Pathology Laboratory, St James's Hospital, James's Street, Dublin, Ireland
| | - Feras Abu Saadeh
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - Noreen Gleeson
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - John O'Leary
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland.,Department of Histopathology, Trinity College Dublin, and Emer Casey Molecular Pathology Research Laboratory, Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Lucy Norris
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - Sharon O'Toole
- Department of Obstetrics & Gynaecology, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland.,Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
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Abstract
Importance Several predictive models and scoring systems have been developed to differentiate between benign and malignant ovarian masses, in order to guide effective management. These models use combinations of patient characteristics, ultrasound markers, and biochemical markers. Objective The aim of this study was to describe, compare, and prioritize, according to their strengths and qualities, all the adnexal prediction models. Evidence Acquisition This was a state-of-the-art review, synthesizing the findings of the current published literature on the available prediction models of adnexal masses. Results The existing models include subjective assessment by expert sonographers, the International Ovarian Tumor Analysis models (logistic regression models 1 and 2, Simple Rules, 3-step strategy, and ADNEX [Assessment of Different NEoplasias in the adneXa] model), the Risk of Malignancy Index, the Risk of Malignancy Ovarian Algorithm, the Gynecologic Imaging Reporting and Data System, and the Ovarian-Adnexal Reporting and Data System. Overall, subjective assessment appears to be superior to all prediction models. However, the International Ovarian Tumor Analysis models are probably the best available methods for nonexpert examiners. The Ovarian-Adnexal Reporting and Data System is an international approach that incorporates both the common European and North American approaches, but still needs to be validated. Conclusions Many prediction models exist for the assessment of adnexal masses. The adoption of a particular model is based on local guidelines, as well as sonographer's experience. The safety of expectant management of adnexal masses with benign ultrasound morphology is still under investigation.
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Reinhold C, Rockall A, Sadowski EA, Siegelman ES, Maturen KE, Vargas HA, Forstner R, Glanc P, Andreotti RF, Thomassin-Naggara I. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J Am Coll Radiol 2021; 18:713-729. [PMID: 33484725 DOI: 10.1016/j.jacr.2020.12.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
MRI is used in the evaluation of ovarian and adnexal lesions. MRI can further characterize lesions seen on ultrasound to help decrease the number of false-positive lesions and avoid unnecessary surgery in benign lesions. Currently, the reporting of ovarian and adnexal findings on MRI is inconsistent because of the lack of standardized descriptor terminology. The development of uniform reporting descriptors can lead to improved interpretation agreement and communication between radiologists and referring physicians. The Ovarian-Adnexal Reporting and Data Systems MRI Committee was formed under the direction of the ACR to create a standardized lexicon for adnexal lesions with the goal of improving the quality and consistency of imaging reports. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon.
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Affiliation(s)
- Caroline Reinhold
- Codirector, Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Center, McGill University, Montreal, Canada.
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London and Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Evan S Siegelman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine E Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, Michigan
| | | | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria
| | - Phyllis Glanc
- University of Toronto, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Rochelle F Andreotti
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Imagerie, Paris, France
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Van Calster B, Valentin L, Froyman W, Landolfo C, Ceusters J, Testa AC, Wynants L, Sladkevicius P, Van Holsbeke C, Domali E, Fruscio R, Epstein E, Franchi D, Kudla MJ, Chiappa V, Alcazar JL, Leone FPG, Buonomo F, Coccia ME, Guerriero S, Deo N, Jokubkiene L, Savelli L, Fischerová D, Czekierdowski A, Kaijser J, Coosemans A, Scambia G, Vergote I, Bourne T, Timmerman D. Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study. BMJ 2020; 370:m2614. [PMID: 32732303 PMCID: PMC7391073 DOI: 10.1136/bmj.m2614] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively. DESIGN Multicentre cohort study. SETTING 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre. PARTICIPANTS Consecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up. MAIN OUTCOME MEASURES Overall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (±2) months. Multiple imputation was used when outcome based on follow-up was uncertain. RESULTS The primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the best calibrated. Calibration of the estimated risks for the tumour subtypes was good for ADNEX irrespective of whether or not CA125 was included as a predictor. Overall clinical utility (net benefit) was highest for the ADNEX models and SRRisk, and lowest for RMI. For patients who received at least one follow-up scan (n=1958), overall area under the receiver operating characteristic curve ranged from 0.76 (95% confidence interval 0.66 to 0.84) for RMI to 0.89 (0.81 to 0.94) for ADNEX with CA125. CONCLUSIONS Our study found the ADNEX models and SRRisk are the best models to distinguish between benign and malignant masses in all patients presenting with an adnexal mass, including those managed conservatively. TRIAL REGISTRATION ClinicalTrials.gov NCT01698632.
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Affiliation(s)
- Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
- EPI-Centre, KU Leuven, Leuven, Belgium
| | - Lil Valentin
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Wouter Froyman
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Chiara Landolfo
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - Jolien Ceusters
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Antonia C Testa
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Department of Life Science and Public Health, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Povilas Sladkevicius
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Ekaterini Domali
- First Department of Obstetrics and Gynaecology, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Fruscio
- Clinic of Obstetrics and Gynaecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Elisabeth Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden
| | - Dorella Franchi
- Preventive Gynaecology Unit, Division of Gynaecology, European Institute of Oncology IRCCS, Milan, Italy
| | - Marek J Kudla
- Department of Perinatology and Oncological Gynaecology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Valentina Chiappa
- Department of Gynaecologic Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Juan L Alcazar
- Department of Obstetrics and Gynaecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain
| | - Francesco P G Leone
- Department of Obstetrics and Gynaecology, Biomedical and Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - Francesca Buonomo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Elisabetta Coccia
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynaecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - Nandita Deo
- Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London, UK
| | - Ligita Jokubkiene
- Department of Obstetrics and Gynaecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Luca Savelli
- Department of Obstetrics and Gynaecology, University of Bologna, Bologna, Italy
| | - Daniela Fischerová
- Gynaecological Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Artur Czekierdowski
- First Department of Gynaecological Oncology and Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Jeroen Kaijser
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, Netherlands
| | - An Coosemans
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Department of Life Science and Public Health, Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - Ignace Vergote
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
- Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Herestraat 49 Box 805, 3000 Leuven, Belgium dirk.timmerman@uzleuven
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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20
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Chiofalo B, Baiocco E, Mancini E, Vocaturo G, Cutillo G, Vincenzoni C, Bruni S, Bruno V, Mancari R, Vizza E. Practical recommendations for gynecologic surgery during the COVID-19 pandemic. Int J Gynaecol Obstet 2020; 150:146-150. [PMID: 32471012 PMCID: PMC9087771 DOI: 10.1002/ijgo.13248] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/13/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
Surgery in suspected/confirmed COVID‐19 patients is a high‐risk venture. In infected patients, COVID‐19 is present in the body cavity. During surgery it could be nebulized in the spray generated by surgical instruments and could theoretically infect members of the surgical team. Nevertheless, some surgical gynecologic pathologies cannot be postponed. We present a list of the most frequent gynecologic diseases and recommendations on their surgical management during the COVID‐19 pandemic, based on expert opinion, current available information, and international scientific society recommendations to support the work of gynecologists worldwide. In brief, any kind of surgical treatment should be scrutinized and postponed if possible. Nonoperative conservative treatment including pharmacological therapies for hormone‐sensitive pathologies should be implemented. Health risk assessment by patient history and COVID‐19 test before elective surgery are pivotal to protect both patients and healthcare providers. In confirmed COVID‐19 patients or highly suspected cases, elective surgery should be postponed until full recovery. The COVID‐19 pandemic required crucial reorganization of health services according to priorities. Recommendations for gynecologic surgery are presented.
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Affiliation(s)
- Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Ermelinda Baiocco
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Emanuela Mancini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Vocaturo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Cutillo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Cristina Vincenzoni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Simone Bruni
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Rosanna Mancari
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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21
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Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, Millet I, Bharwani N, Juhan V, Cunha TM, Masselli G, Balleyguier C, Malhaire C, Perrot NF, Sadowski EA, Bazot M, Taourel P, Porcher R, Darai E, Reinhold C, Rockall AG. Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA Netw Open 2020; 3:e1919896. [PMID: 31977064 PMCID: PMC6991280 DOI: 10.1001/jamanetworkopen.2019.19896] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Approximately one-quarter of adnexal masses detected at ultrasonography are indeterminate for benignity or malignancy, posing a substantial clinical dilemma. OBJECTIVE To validate the accuracy of a 5-point Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score for risk stratification of adnexal masses. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study was conducted between March 1, 2013, and March 31, 2016. Among patients undergoing expectant management, 2-year follow-up data were completed by March 31, 2018. A routine pelvic MRI was performed among consecutive patients referred to characterize a sonographically indeterminate adnexal mass according to routine diagnostic practice at 15 referral centers. The MRI score was prospectively applied by 2 onsite readers and by 1 reader masked to clinical and ultrasonographic data. Data analysis was conducted between April and November 2018. MAIN OUTCOMES AND MEASURES The primary end point was the joint analysis of true-negative and false-negative rates according to the MRI score compared with the reference standard (ie, histology or 2-year follow-up). RESULTS A total of 1340 women (mean [range] age, 49 [18-96] years) were enrolled. Of 1194 evaluable women, 1130 (94.6%) had a pelvic mass on MRI with a reference standard (surgery, 768 [67.9%]; 2-year follow-up, 362 [32.1%]). A total of 203 patients (18.0%) had at least 1 malignant adnexal or nonadnexal pelvic mass. No invasive cancer was assigned a score of 2. Positive likelihood ratios were 0.01 for score 2, 0.27 for score 3, 4.42 for score 4, and 38.81 for score 5. Area under the receiver operating characteristic curve was 0.961 (95% CI, 0.948-0.971) among experienced readers, with a sensitivity of 0.93 (95% CI, 0.89-0.96; 189 of 203 patients) and a specificity of 0.91 (95% CI, 0.89-0.93; 848 of 927 patients). There was good interrater agreement among both experienced and junior readers (κ = 0.784; 95% CI, 0.743-0824). Of 580 of 1130 women (51.3%) with a mass on MRI and no specific gynecological symptoms, 362 (62.4%) underwent surgery. Of them, 244 (67.4%) had benign lesions and a score of 3 or less. The MRI score correctly reclassified the mass origin as nonadnexal with a sensitivity of 0.99 (95% CI, 0.98-0.99; 1360 of 1372 patients) and a specificity of 0.78 (95% CI, 0.71-0.85; 102 of 130 patients). CONCLUSIONS AND RELEVANCE In this study, the O-RADS MRI score was accurate when stratifying the risk of malignancy in adnexal masses.
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Affiliation(s)
- Isabelle Thomassin-Naggara
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
| | - Edouard Poncelet
- Service d’Imagerie de la Femme, Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | - Laure S. Fournier
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia and Montenegro
| | - Ingrid Millet
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Nishat Bharwani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Teresa M. Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Gabriele Masselli
- Department of Radiology, Umberto I Hospital, Sapienza University Roma, Rome, Italy
| | | | | | | | - Elizabeth A. Sadowski
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- University of Wisconsin, Madison, Wisconsin
| | - Marc Bazot
- Service de Radiologie, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Sorbonne Université, Paris, France
- Institute for Computing and Data Sciences, Sorbonne Université, Paris, France
| | - Patrice Taourel
- Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Raphaël Porcher
- Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, Institute national de la santé et de la recherche médicale, Joint Research Unit 1153, Paris, France
| | - Emile Darai
- Service de Gynecologie et Obstetrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris, Hôpitaux Univesitaires Est Parisien, Paris, France
- Faculté de Médecine Pierre et Marie Curie, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Medical Imaging, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrea G. Rockall
- American College of Radiology, Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging Committee
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Cancer and Surgery, Faculty of Medicine, Imperial College London, United Kingdom
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22
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Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts. AJR Am J Roentgenol 2019; 214:694-700. [PMID: 31770022 DOI: 10.2214/ajr.18.20630] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. MATERIALS AND METHODS. A retrospective multicenter study of ultrasound-detected adnexal cystic lesions with appropriate follow-up was conducted. Lesions were classified into benign, indeterminate, or malignant categories according to criteria based on the IOTA simple rules and the SRU guidelines. The prevalence of nonneoplastic cysts, neoplasms, and malignant tumors was calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and ROC analysis for the diagnosis of malignancy was performed. RESULTS. A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). CONCLUSION. Both imaging characterization methods were sensitive for identifying ovarian malignancies, but the PPV was low among women presenting to radiology departments, and the indeterminate classification harbored one-third of the total malignancies. Exploration of varied clinical settings and inclusion of secondary tests may help to refine these systems.
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