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Lu B, He W, Liu C, Wang P, Yang P, Zhao Z, Qi J, Huang B. Differentiating Benign From Malignant Ovarian Masses With Solid Components: Diagnostic Performance of CEUS Combined With IOTA Simple Rules and O-RADS. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1449-1458. [PMID: 38876911 DOI: 10.1016/j.ultrasmedbio.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aimed to apply the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR), the Ovarian-Adnexal Reporting and Data System (O-RADS) and contrast-enhanced ultrasound (CEUS) in an identical cohort of Chinese patients and to analyze their performance in discrimination of ovarian masses with solid components. METHODS This was a two-center retrospective study that included a total of 94 ovarian lesions in 86 women enrolled from January 2018 to February 2023. The lesions were classified by using the IOTA terminology and CEUS was performed for the lesions exhibiting solid components on ultrasonography, IOTA SR and O-RADS were applied, and CEUS images were analyzed retrospectively. We assessed the time to wash-in, time to peak intensity (PI), PI compared to myometrium, and time to wash-out, and observed statistically significant differences between benign and malignant lesions in the first three parameters. CEUS characteristics were employed to determine CEUS scores for benign (score 0) and malignant (score 3) lesions. Subsequently, the lesions were reassessed based on the IOTA SR and O-RADS classifications and CEUS scores. The sensitivity, specificity, and area under the receiver-operating-characteristics curve (AUC) of the different models were also determined. RESULTS Among the 94 ovarian lesions, 46 (48.9%) were benign and 48 (51.1%) were malignant. It was found that in the 60 lesions to which the SR could be applied, the sensitivity, specificity, and AUC was 0.900, 0.667, and 0.783, respectively. The sensitivity, specificity, and AUC of O-RADS was observed to be 1.000, 0.283 and 0.641, respectively. When SR and O-RADS were combined with CEUS, their sensitivity, specificity, and AUC values were increased to 0.917, 0.891, 0.904, and 0.958, 0.783, 0.871, respectively. CONCLUSION IOTA SR and O-RADS exhibited relatively low specificity in differentiating malignant from benign ovarian lesions with the solid components, and their diagnostic performance can be significantly improved when combined with CEUS.
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Affiliation(s)
- Beilei Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China
| | - Pan Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengyong Zhao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; The Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture, Yunnan, China
| | - Jiuling Qi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China.
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
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Zhou S, Guo Y, Wen L, Liu J, Fu Y, Xu F, Liu M, Zhao B. Comparison of the diagnostic efficiency between the O-RADS US risk stratification system and doctors' subjective judgment. BMC Med Imaging 2023; 23:190. [PMID: 37986051 PMCID: PMC10662783 DOI: 10.1186/s12880-023-01153-9] [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: 11/30/2022] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND This study aimed to compare the diagnostic efficiency of Ovarian-Adnexal Reporting and Data System (O-RADS) and doctors' subjective judgment in diagnosing the malignancy risk of adnexal masses. METHODS This was an analysis of 616 adnexal masses between 2017 and 2020. The clinical findings, preoperative ultrasound images, and pathological diagnosis were recorded. Each adnexal mass was evaluated by doctors' subjective judgment and O-RADS by two senior doctors and two junior doctors. A mass with an O-RADS grade of 1 to 3 was a benign tumor, and a mass with an O-RADS grade of 4-5 was a malignant tumor. All outcomes were compared with the pathological diagnosis. RESULTS Of the 616 adnexal masses, 469 (76.1%) were benign, and 147 (23.9%) were malignant. There was no difference between the area under the curve of O-RADS and the subjective judgment for junior doctors (0.83 (95% CI: 0.79-0.87) vs. 0.79 (95% CI: 0.76-0.83), p = 0.0888). The areas under the curve of O-RADS and subjective judgment were equal for senior doctors (0.86 (95% CI: 0.83-0.89) vs. 0.86 (95% CI: 0.83-0.90), p = 0.8904). O-RADS had much higher sensitivity than the subjective judgment in detecting malignant tumors for junior doctors (84.4% vs. 70.1%) and senior doctors (91.2% vs. 81.0%). In the subgroup analysis for detecting the main benign lesions of the mature cystic teratoma and ovarian endometriosic cyst, the junior doctors' diagnostic accuracy was obviously worse than the senior doctors' on using O-RADS. CONCLUSIONS O-RADS had excellent performance in predicting malignant adnexal masses. It could compensate for the lack of experience of junior doctors to a certain extent. Better performance in discriminating various benign lesions should be expected with some complement.
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Affiliation(s)
- Shan Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
- Health Management Center, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Yuyang Guo
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Lieming Wen
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Jieyu Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Yaqian Fu
- Health Management Center, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Fang Xu
- Department of Ultrasonography, The First Hospital of Changsha, No.311, Yingpan Road, Changsha, 410005, Hunan, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China
| | - Baihua Zhao
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011, Hunan, China.
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Liu D, Lyu G, Lai H, Li L, Gan Y, Yang S. Can the ultrasound microcystic pattern accurately predict borderline ovarian tumors? J Ovarian Res 2023; 16:162. [PMID: 37563718 PMCID: PMC10416400 DOI: 10.1186/s13048-023-01253-8] [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: 01/26/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To investigate whether the ultrasound microcystic pattern (MCP) can accurately predict borderline ovarian tumors (BOTs). METHODS A retrospective collection of 393 patients who met the inclusion criteria was used as the study population. Indicators that could well identify BOT in different pathological types of tumors were derived by multivariate unordered logistic regression analysis. Finally, the correlation between ultrasound MCP and pathological features was analyzed. RESULTS (1) MCP was present in 55 of 393 ovarian tumors, including 34 BOTs (34/68, 50.0%), 16 malignant tumors (16/88, 18.2%), and 5 benign tumors (5/237, 2.1%). (2) Univariate screening showed significant differences (P < 0.05) in patient age, CA-125 level, ascites, > 10 cyst locules, a solid component, blood flow, and MCP among BOTs, benign ovarian tumors, and malignant ovarian tumors. (3) Multivariate unordered logistic regression analysis showed that the blood flow, > 10 cyst locules, and MCP were significant factors in identifying BOTs (P < 0.05). (4) The pathology of ovarian tumors with MCP showed "bubble"- or "fork"- like loose tissue structures. CONCLUSION MCP can be observed in different pathological types of ovarian tumors and can be used as a novel sonographic marker to differentiate between BOTs, benign tumors and malignant tumors. MCP may arise as a result of anechoic cystic fluid filling the loose tissue gap.
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Affiliation(s)
- Danyi Liu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
- Department of Ultrasound, Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, No.2, Anji Road, Quanzhou, Fujian, China.
| | - Hongwei Lai
- Department of Ultrasound, Fujian Provincial Maternity and Children's Hospital, Fuzhou, Fujian, China
| | - Liya Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yaduan Gan
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
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Tsuboyama T, Sato K, Ota T, Fukui H, Onishi H, Nakamoto A, Tatsumi M, Tomiyama N. MRI of Borderline Epithelial Ovarian Tumors: Pathologic Correlation and Diagnostic Challenges. Radiographics 2022; 42:2095-2111. [PMID: 36083804 DOI: 10.1148/rg.220068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Borderline epithelial ovarian tumors are a distinct pathologic entity characterized by increased epithelial proliferation and nuclear atypia, but without frank stromal invasion. Borderline tumor (BT) is now considered to represent an intermediate phase in the stepwise progression from benign to malignant ovarian epithelial tumor. Since BTs commonly manifest at early stages in women of reproductive age and are associated with a good prognosis, making the correct diagnosis is important in determining whether a patient is a candidate for fertility-sparing surgery. There are six histologic BT subtypes (serous, mucinous, seromucinous, endometrioid, clear cell, and Brenner), and each has different MRI features, reflecting their unique histologic architectures. Radiologists should be aware of the MRI features that can suggest BTs. These features include a hyperintense papillary architecture with hypointense internal branching, which can be observed with serous and seromucinous BTs on T2-weighted images; aggregates of microcysts that have hypointensity on T2-weighted images and reticular enhancement on contrast-enhanced T2-weighted images, which can be seen with mucinous BTs; and moderately high signal intensity on diffusion-weighted images along with relatively high apparent diffusion coefficient values, which can be observed regardless of the histologic subtype. Nevertheless, because the imaging features of BTs overlap with those of many benign lesions (eg, cystadenoma and cystadenofibroma, decidualized endometriosis, and polypoid endometriosis) and malignant tumors (ovarian cancers and metastases), histologic confirmation is required for the final diagnosis. Special emphasis is placed on the MRI features of BTs, pathologic correlation, and the challenges related to diagnosis. ©RSNA, 2022.
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Affiliation(s)
- Takahiro Tsuboyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuaki Sato
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Ota
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideyuki Fukui
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiromitsu Onishi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Atsushi Nakamoto
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Mitsuaki Tatsumi
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Noriyuki Tomiyama
- From the Departments of Radiology (T.T., T.O., H.F., H.O., A.N., M.T., N.T.) and Pathology (K.S.), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Wang M, Li Y, Xu T, Shi C, Jiang L, Liu K. Clinical Analysis of 17 Cases of Borderline Ovarian Tumors During Pregnancy. Front Oncol 2022; 12:934751. [PMID: 35912239 PMCID: PMC9326021 DOI: 10.3389/fonc.2022.934751] [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: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The study retrospectively analyzed the clinical characteristics and prognosis of 17 cases of pregnancy complicated by borderline ovarian tumors to provide help for clinical workers. Materials and Methods The clinicopathological data of 17 patients with ovarian borderline tumors during pregnancy at the Shengjing Hospital of China Medical University from January 2015 to June 2021 were collected and analyzed retrospectively. The average age of the patients was 31.82 years (25–45 years), the average number of pregnancies was 2.06 times (1–6 times), and the average number of births was 0.41 times (0–1 time). Results Among the 17 patients, 4 were diagnosed in the first trimester, 2 in the second trimester, and 11 in the third trimester. Most of the first symptoms were cysts, cyst enlargement, or cyst rupture. Among them, 3 cases (1 in the first trimester and 2 in the second trimester) continued pregnancy after a conservative operation, 9 cases underwent cesarean section and a conservative operation simultaneously, and the mother and child had a good outcome. Two cases underwent conservative operations and induced abortion, and 1 case underwent an ectopic pregnancy operation at the same time. The prognosis of the patients was good without recurrence. Conclusion Preoperative diagnosis of borderline ovarian tumors in pregnancy is delayed, and imaging and tumor markers are not specific. The coincidence rate between intraoperative frozen pathology and postoperative paraffin pathology was not high. Borderline tumors are mainly treated by surgery, and the prognosis for mothers and infants is good.
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Haddad L, Kugelman N, Shapiro I, Bakry H, Weizman B, Korobochka R, Sagie S, Said-Idris S, Bejar J, Leibovitz Z. A New Insight on Exophytic Serous Borderline Adnexal Tumors: Specific Sonographic Features. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1549-1557. [PMID: 34562042 DOI: 10.1002/jum.15838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To characterize and compare the sonographic features of exophytic serous borderline ovarian tumors (ESBOT) with those of high-grade serous carcinoma of the ovary (HGSC). METHODS Seven patients with histological diagnosis of ESBOT diagnosed between 2011 and 2019 and 10 consecutive cases of HGSC detected during 2019, both depicting an exophytic growth pattern, were identified retrospectively. The sonographic imaging of the masses was reassessed and characterized according to the International Ovarian Tumor Analysis terms. RESULTS A unilateral irregular solid adnexal mass was demonstrated in all patients with ESBOT. The mass typically wrapped an apparently normal ovary, with a clear demarcation line depicted between them and it contained tiny cystic inclusions and calcifications. On color Doppler study of all the ESBOT cases, a unique vascular pattern could be demonstrated: an intratumoral vascular bundle originating from the ovarian vessels and supplying a rich radial blood flow to the tumor periphery. These characteristic morphological and color Doppler features could not be observed in any of the HGSC cases (P < .001). In 42.8% of the patients with ESBOT, additional unilocular-solid components (ipsilateral or contralateral) could be detected, whereas all the HGSC patients presented with a multilocular-solid tumor morphology (P < .001). The interface of the external mass border with the adjacent pelvic walls was regular in all the cases with ESBOT, whereas in 80% of HGSC patients, it was irregular, suggesting invasiveness (P = .002). CONCLUSIONS ESBOT can mimic HGSC. Our results suggest that ESBOT has specific B-mode and color Doppler features, enabling differentiation from HGSC and planning appropriate intervention.
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Affiliation(s)
- Leila Haddad
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel
| | - Israel Shapiro
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Hasan Bakry
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Boris Weizman
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Roman Korobochka
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Shlomi Sagie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Suraya Said-Idris
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Haifa, Israel
| | - Jacob Bejar
- Department of Pathology, Bnai-Zion Medical Center, Haifa, Israel
| | - Zvi Leibovitz
- Obstetrics and Gynecology Ultrasound Unit, Bnai-Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Timor-Tritsch IE, Monteagudo A, Popiolek DA, Duncan KM, Goldstein SR. Reaffirming microcystic ultrasound appearance of borderline ovarian tumors using three-dimensional 'silhouette' rendering. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:700-704. [PMID: 35195307 DOI: 10.1002/uog.24883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Affiliation(s)
- I E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - A Monteagudo
- Icahn School of Medicine, Carnegie Imaging for Women, New York, NY, USA
| | - D A Popiolek
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - K M Duncan
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - S R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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Scioscia M, Virgilio BA, Sacchi D, Iaria L, Guerriero S. Fallopian tube entrapped within inflammatory or endometriotic ovarian cyst may mimic malignancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:399-401. [PMID: 34159672 DOI: 10.1002/uog.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M Scioscia
- Unit of Gynecological Surgery, Mater Dei Hospital, Bari, Italy
- Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - B A Virgilio
- Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - D Sacchi
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padua, Italy
| | - L Iaria
- Department of Pathology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
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9
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Advances in fertility preserving surgery for borderline ovarian tumors. Eur J Obstet Gynecol Reprod Biol 2022; 270:206-211. [DOI: 10.1016/j.ejogrb.2021.11.428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022]
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10
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Qi L, Chen D, Li C, Li J, Wang J, Zhang C, Li X, Qiao G, Wu H, Zhang X, Ma W. Diagnosis of Ovarian Neoplasms Using Nomogram in Combination With Ultrasound Image-Based Radiomics Signature and Clinical Factors. Front Genet 2021; 12:753948. [PMID: 34650603 PMCID: PMC8505695 DOI: 10.3389/fgene.2021.753948] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: To establish and validate a nomogram integrating radiomics signatures from ultrasound and clinical factors to discriminate between benign, borderline, and malignant serous ovarian tumors. Materials and methods: In this study, a total of 279 pathology-confirmed serous ovarian tumors collected from 265 patients between March 2013 and December 2016 were used. The training cohort was generated by randomly selecting 70% of each of the three types (benign, borderline, and malignant) of tumors, while the remaining 30% was included in the validation cohort. From the transabdominal ultrasound scanning of ovarian tumors, the radiomics features were extracted, and a score was calculated. The ability of radiomics to differentiate between the grades of ovarian tumors was tested by comparing benign vs borderline and malignant (task 1) and borderline vs malignant (task 2). These results were compared with the diagnostic performance and subjective assessment by junior and senior sonographers. Finally, a clinical-feature alone model and a combined clinical-radiomics (CCR) model were built using predictive nomograms for the two tasks. Receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA) were performed to evaluate the model performance. Results: The US-based radiomics models performed satisfactorily in both the tasks, showing especially higher accuracy in the second task by successfully discriminating borderline and malignant ovarian serous tumors compared to the evaluations by senior sonographers (AUC = 0.789 for seniors and 0.877 for radiomics models in task one; AUC = 0.612 for senior and 0.839 for radiomics model in task 2). We showed that the CCR model, comprising CA125 level, lesion location, ascites, and radiomics signatures, performed the best (AUC = 0.937, 95%CI 0.905-0.969 in task 1, AUC = 0.924, 95%CI 0.876-0.971 in task 2) in the training as well as in the validation cohorts (AUC = 0.914, 95%CI 0.851-0.976 in task 1, AUC = 0.890, 95%CI 0.794-0.987 in task 2). The calibration curve and DCA analysis of the CCR model more accurately predicted the classification of the tumors than the clinical features alone. Conclusion: This study integrates novel radiomics signatures from ultrasound and clinical factors to create a nomogram to provide preoperative diagnostic information for differentiating between benign, borderline, and malignant ovarian serous tumors, thereby reducing unnecessary and risky biopsies and surgeries.
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Affiliation(s)
- Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Dandan Chen
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chunxiang Li
- National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Ultrasonographic Diagnosis and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jinghan Li
- Department of Ultrasonographic Diagnosis and Therapy, Tianjin Ninghe Hospital, Tianjin, China
| | - Jingyi Wang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Chao Zhang
- National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaofeng Li
- National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ge Qiao
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Haixiao Wu
- National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaofang Zhang
- Department of Clinical Laboratory, Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjuan Ma
- National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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11
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Sahin H, Akdogan AI, Smith J, Zawaideh JP, Addley H. Serous borderline ovarian tumours: an extensive review on MR imaging features. Br J Radiol 2021; 94:20210116. [PMID: 34111956 DOI: 10.1259/bjr.20210116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Serous borderline ovarian tumours (SBOTs) are an intermediate group of neoplasms, which have features between benign and malignant ovarian tumours and for which, fertility-sparing surgery can be offered. MRI in imaging of SBOTs is, therefore, crucial in raising the possibility of the diagnosis, in order to present the patient with the most appropriate treatment options. There are characteristic MRI features that SBOTs demonstrate. In addition, recent advanced techniques, and further classification into subtypes within the borderline group have been developed. The aim of this article is to review the MRI features of SBOT and provide the reporter with an awareness of the imaging tips and tricks in the differential diagnosis of SBOT.
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Affiliation(s)
- Hilal Sahin
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Asli Irmak Akdogan
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Janette Smith
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jeries Paolo Zawaideh
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Addley
- Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK.,Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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12
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Singh P, Katkar PK, Patil UM, Bohara RA. A robust electrochemical immunosensor based on core-shell nanostructured silica-coated silver for cancer (carcinoembryonic-antigen-CEA) diagnosis. RSC Adv 2021; 11:10130-10143. [PMID: 35423536 PMCID: PMC8695619 DOI: 10.1039/d0ra09015h] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
This work addresses the fabrication of an efficient, novel, and economically viable immunosensing armamentarium that will detect the carcinoembryonic antigen (CEA) typically associated with solid tumors (sarcomas, carcinomas, and lymphomas) and is used as a clinical tumor marker for all these malignancies. We synthesized silver nanoparticles by single-step chemical reduction and coated with silica using a modified Stober method to fabricate silica-coated silver core-shell nanoparticles. The morphologies, structure, and size of the nanoparticles were characterized by Transmission Electron Microscopy (TEM), UV-Visible spectroscopy, X-ray diffraction (XRD), Raman spectroscopy, Fourier Transform Infra-Red Spectroscopy (FTIR), and Dynamic Light Scattering (DLS), respectively. The results indicated that the average size of Ag nanoparticles and silica-coated Ag nanoparticles is 50 nm and 80 nm, respectively. Our TEM results indicate that the silica-shell uniformly encapsulates silver core particles. Further, a disposable electrochemical immunosensor for carcinoembryonic antigen (CEA) was proposed based on the antigen immobilized in a silica-coated silver core-shell nanoparticle film on the surface of an indium-tin-oxide (ITO) flat substrate. The morphological characteristics of the constructed biosensor were observed by scanning electron microscopy (SEM) and electrochemical methods. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were employed for the characterization of the proposed bioelectrode. The cyclic voltammogram appears to be more irreversible on silica coated silver core-shell nanoparticles. It is found that the fabricated immunosensor shows fast potentiometric response under the optimized conditions. The CEA could be determined in the linear range from 0.5 to 10 ng mL-1 with a detection limit of 0.01 ng mL-1 using the interface. The developed flat substrate of ITO for CEA detection (the model reagent) is a potentially promising immunosensing system, manifests good stability, and allows batch fabrication because of its economic feasibility.
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Affiliation(s)
- Priyanka Singh
- D. Y. Patil Education Society (Institution Deemed to be University) Kolhapur (M.S) India
| | - Pranav K Katkar
- D. Y. Patil Education Society (Institution Deemed to be University) Kolhapur (M.S) India
| | - Umakant M Patil
- D. Y. Patil Education Society (Institution Deemed to be University) Kolhapur (M.S) India
| | - Raghvendra A Bohara
- D. Y. Patil Education Society (Institution Deemed to be University) Kolhapur (M.S) India
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway Ireland
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13
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Sonographic Assessment of Complex Ultrasound Morphology Adnexal Tumors in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems. Diagnostics (Basel) 2021; 11:diagnostics11030414. [PMID: 33671023 PMCID: PMC7997447 DOI: 10.3390/diagnostics11030414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Methods: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20–42 years old) with a mean gestation age of 13.5 (range: 8–31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. Results: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR− = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70–75%) except for SRR (53%). Conclusion: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.
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14
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Zheng X, Lyu G, Gan Y, Hu M, Liu X, Chen S, Wu X, Yang W, Ye F, Yan X, Zhang Y. Microcystic pattern and shadowing are independent predictors of ovarian borderline tumors and cystadenofibromas in ultrasound. Eur Radiol 2020; 31:45-54. [PMID: 32780208 DOI: 10.1007/s00330-020-07113-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/06/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs). METHODS Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis. RESULTS A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs. CONCLUSIONS Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs. KEY POINTS • Sonographic findings for borderline tumors and cystadenofibromas are complex and mimic malignancy. • Microcystic pattern and shadowing are independent predictors of borderline tumors and cystadenofibromas respectively.
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Affiliation(s)
- Xinying Zheng
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Guorong Lyu
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China. .,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.
| | - Yaduan Gan
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Maiguo Hu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, Xiamen Maternal and Child Health Care Hospital, Xiamen, Fujian, China
| | - Xianlan Liu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Shuqiang Chen
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiuming Wu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China.,Department of Ultrasound, the Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
| | - Wenmin Yang
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Fengying Ye
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Xiaobin Yan
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
| | - Ying Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China.,Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China
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15
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Virgilio BA, De Blasis I, Sladkevicius P, Moro F, Zannoni GF, Arciuolo D, Mascilini F, Ciccarone F, Timmerman D, Kaijser J, Fruscio R, Van Holsbeke C, Franchi D, Epstein E, Leone FPG, Guerriero S, Czekierdowski A, Scambia G, Testa AC, Valentin L. Imaging in gynecological disease (16): clinical and ultrasound characteristics of serous cystadenofibromas in adnexa. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:823-830. [PMID: 30937992 DOI: 10.1002/uog.20277] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/19/2019] [Accepted: 03/23/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of serous cystadenofibromas in the adnexa. METHODS This was a retrospective study of patients identified in the International Ovarian Tumor Analysis (IOTA) database, who had a histological diagnosis of serous cystadenofibroma and had undergone preoperative ultrasound examination by an experienced ultrasound examiner, between 1999 and 2012. In the IOTA database, which contains data collected prospectively, the tumors were described using the terms and definitions of the IOTA group. In addition, three authors reviewed, first independently and then together, ultrasound images of serous cystadenofibromas and described them using pattern recognition. RESULTS We identified 233 women with a histological diagnosis of serous cystadenofibroma. In the IOTA database, most cystadenofibromas (67.4%; 157/233) were described as containing solid components but 19.3% (45/233) were described as multilocular cysts and 13.3% (31/233) as unilocular cysts. Papillary projections were described in 52.4% (122/233) of the cystadenofibromas. In 79.5% (97/122) of the cysts with papillary projections, color Doppler signals were absent in the papillary projections. Most cystadenofibromas (83.7%; 195/233) manifested no or minimal color Doppler signals. On retrospective analysis of 201 ultrasound images of serous cystadenofibromas, using pattern recognition, 10 major types of ultrasound appearance were identified. The most common pattern was a unilocular solid cyst with one or more papillary projections, but no other solid components (25.9%; 52/201). The second most common pattern was a multilocular solid mass with small solid component(s), but no papillary projections (19.4%; 39/201). The third and fourth most common patterns were multi- or bilocular cyst (16.9%; 34/201) and unilocular cyst (11.9%; 24/201). Using pattern recognition, shadowing was identified in 39.8% (80/201) of the tumors, and microcystic appearance of the papillary projections was observed in 34 (38.6%) of the 88 tumors containing papillary projections. CONCLUSIONS The ultrasound features of serous cystadenofibromas vary. The most common pattern is a unilocular solid cyst with one or more papillary projections but no other solid components, with absent color Doppler signals. Most serous cystadenofibromas were poorly vascularized on color Doppler examination and many manifested acoustic shadowing. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- B A Virgilio
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy
| | - I De Blasis
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G F Zannoni
- Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Ginecopatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Arciuolo
- Dipartimento Scienze della Salute della Donna e del Bambino, Unità di Ginecopatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - J Kaijser
- Department of Obstetrics and Gynecology, University Hospitals, Katholieke Universiteit Leuven, Leuven, Belgium
| | - R Fruscio
- Clinic of Obstetrics and Gynecology, Department of Medicine and Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - C Van Holsbeke
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - D Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, IRCCS, Milan, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute, L. Sacco, Milan, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - A Czekierdowski
- First Department of Gynecological Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A C Testa
- Istituto di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Institution of Clinical Sciences Malmö, Lund University, Lund, Sweden
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