1
|
Delgado-Morell A, Nieto-Tous M, Andrada-Ripollés C, Pascual MÁ, Ajossa S, Guerriero S, Alcázar JL. Transvaginal Ultrasound Accuracy in the Hydrosalpinx Diagnosis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13050948. [PMID: 36900092 PMCID: PMC10000875 DOI: 10.3390/diagnostics13050948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an adequate reproductive assessment while avoiding unnecessary laparoscopies. The aim of the present systematic review and meta-analysis is to synthetize and report the current evidence on transvaginal sonography (TVS) accuracy to diagnose hydrosalpinx. Articles on the topic published between January 1990 and December 2022 were searched in five electronic databases. Data from the six selected studies, comprising 4144 adnexal masses in 3974 women, 118 of which were hydrosalpinxes, were analyzed as follows: overall, TVS had a pooled estimated sensitivity for hydrosalpinx of 84% (95% confidence interval (CI) = 76-89%), specificity of 99% (95% CI = 98-100%), positive likelihood ratio of 80.7 (95% CI = 33.7-193.0), and negative likelihood ratio of 0.16 (95% CI = 0.11-0.25) and DOR of 496 (95% CI = 178-1381). The mean prevalence of hydrosalpinx was 4%. The quality of the studies and their risk of bias were assessed using QUADAS-2, evidencing an overall acceptable quality of the selected articles. We concluded that TVS has a good specificity and sensitivity for diagnosing hydrosalpinx.
Collapse
Affiliation(s)
- Aina Delgado-Morell
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Institute of Biomedical Research Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 València, Spain
| | - Cristina Andrada-Ripollés
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, 12004 Castelló, Spain
| | - Maria Ángela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Silvia Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, 09042 Monserrato, Italy
- Department of Obstetrics and Gynecology, Università degli Studi di Cagliari, 09043 Monserrato, Italy
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, 09042 Monserrato, Italy
- Department of Obstetrics and Gynecology, Università degli Studi di Cagliari, 09043 Monserrato, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, School of Medicine, Universidad de Navarra, 31009 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-29-62-34
| |
Collapse
|
2
|
Diagnostic Accuracy of Transvaginal Sonography for Deeply Infiltrating Endometriosis and Pouch of Douglas Obliteration in the Presence or Absence of Ovarian Endometrioma. IRANIAN JOURNAL OF RADIOLOGY 2023. [DOI: 10.5812/iranjradiol-127068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Endometriosis is one of the most common gynecological diseases worldwide. Significant attention has been drawn to this multiorgan and often painful disorder. Objectives: This study aimed to examine the accuracy of transvaginal sonography (TVS) in the diagnosis of deeply infiltrating endometriosis (DIE) with respect to the presence or absence of ovarian endometrioma (OE). Patients and Methods: This cross-sectional study was performed on all patients undergoing TVS before gynecological laparoscopy. With pathological confirmation as the standard reference, the diagnostic accuracy of TVS for DIE and pouch of Douglas (POD) obliteration was compared with that of laparoscopy in the anterior and posterior pelvic compartments with respect to the presence or absence of OE. Agreement between TVS and laparoscopy was evaluated for each case, and Cohen’s kappa statistic was measured for each site of involvement. Moreover, sensitivity, specificity, negative and positive predictive values, and likelihood ratios of TVS were calculated, with laparoscopy as the reference test. Results: A total of 110 patients, with a mean age of 37.20 ± 7.16 years, were recruited in this study. The accuracy, sensitivity, and negative predictive value of TVS for the diagnosis of DIE and POD obliteration were estimated at 89.5%, 58.3%, and 88.9% in the anterior pelvic compartment and 93.3%, 92%, and 70.6% in the posterior pelvic compartment, respectively. Nevertheless, TVS showed lower sensitivity for detecting pelvic adhesions and peritoneal cysts compared to laparoscopy. The presence of OE did not significantly increase the accuracy of TVS for the diagnosis of DIE or POD obliteration (P > 0.05). Conclusion: The present study showed that TVS is an adequately accurate and non-invasive diagnostic tool for the detection and mapping of DIE and POD obliteration, regardless of the presence of OE. TVS may waive the need for exploratory laparoscopy in DIE or at least facilitate precise pre-procedural DIE mapping.
Collapse
|
3
|
Short- and long-term outcomes of intraoperative spillage during laparoscopic removal of benign ovarian cysts. Surg Endosc 2019; 34:3883-3887. [DOI: 10.1007/s00464-019-07154-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
|
4
|
Rai R, Bhutia PC, Tshomo U. Clinicopathological profile of adnexal masses presenting to a tertiary-care hospital in Bhutan. South Asian J Cancer 2019; 8:168-172. [PMID: 31489290 PMCID: PMC6699236 DOI: 10.4103/sajc.sajc_303_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Adnexal masses of ovarian origin are of growing concern due to high fatality associated with ovarian malignancy because they are diagnosed at advanced stage due to vague symptoms and absence of recommended screening tests. AIMS The aim was to study the prevalence of histopathologic types of adnexal masses in different age groups and to analyze the accuracy of preoperative evaluation in diagnosing ovarian malignancy. SETTINGS AND DESIGN This was a cross-sectional study carried out in the Department of Obstetrics and Gynecology of a tertiary care hospital in Bhutan with gynecologic-oncology services, from January to December 2017. SUBJECTS AND METHODS Women presenting with adnexal mass were evaluated and those meeting criteria were enrolled. They were evaluated preoperatively with complete history, examination, ultrasound, and tumor markers. Risk of malignancy index (RMI) was calculated for all patients. Following surgery, histopathology results were compared with preoperative evaluation. STATISTICAL ANALYSIS USED Chi-square test, t-test, Cohen's Kappa, and receiver operating characteristic curve analysis were used for statistical analysis. RESULTS Of 165 patients evaluated, 127 fulfilling criteria were enrolled. Adnexal masses of ovarian origin were most common (n = 102, 80.3%), of which 12.7% were malignant. Epithelial ovarian malignancy was the most common malignant ovarian tumor, serous cystadenocarcinoma being the most common. Malignancy was significantly more in older, postmenopausal women with high RMI. Seven out of 11 women with high RMI were diagnosed in Stage 3 or 4. RMI score at cutoff of 200 was 54.6% sensitive and 85.7% specific. CONCLUSIONS Adnexal mass of ovarian origin was the most common. Malignancy was significantly more in older, postmenopausal women with high RMI. RMI showed moderate correlation in diagnosing epithelial ovarian malignancies.
Collapse
Affiliation(s)
- Rojna Rai
- Department of Obstetrics and Gynecology, Faculty of Postgraduate Medicine, Jigme Dorji Wangchuck National Referral Hospital, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Pema Choden Bhutia
- Department of Obstetrics and Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Ugyen Tshomo
- Department of Obstetrics and Gynecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| |
Collapse
|
5
|
The limited oncogenic potential of unilocular adnexal cysts: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:101-109. [DOI: 10.1016/j.ejogrb.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
|
6
|
Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, Alcazar JL. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:534-545. [PMID: 26250349 DOI: 10.1002/uog.15667] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 07/27/2015] [Accepted: 08/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of endometriosis in the uterosacral ligaments (USL), rectovaginal septum (RVS), vagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis (DIE). METHODS An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. Studies were considered eligible if they reported on the use of TVS for the preoperative detection of endometriosis in the USL, RVS, vagina and bladder in women with clinical suspicion of DIE using the surgical data as a reference standard. Study quality was assessed using the PRISMA guidelines and QUADAS-2 tool. RESULTS Of the 801 citations identified, 11 studies (n = 1583) were considered eligible and were included in the meta-analysis. For detection of endometriosis in the USL, the overall pooled sensitivity and specificity of TVS were 53% (95%CI, 35-70%) and 93% (95%CI, 83-97%), respectively. The pretest probability of USL endometriosis was 54%, which increased to 90% when suspicion of endometriosis was present after TVS examination. For detection of endometriosis in the RVS, the overall pooled sensitivity and specificity were 49% (95%CI, 36-62%) and 98% (95%CI, 95-99%), respectively. The pretest probability of RVS endometriosis was 24%, which increased to 89% when suspicion of endometriosis was present after TVS examination. For detection of vaginal endometriosis, the overall pooled sensitivity and specificity were 58% (95%CI, 40-74%) and 96% (95%CI, 87-99%), respectively. The pretest probability of vaginal endometriosis was 17%, which increased to 76% when suspicion of endometriosis was present after TVS assessment. Substantial heterogeneity was found for sensitivity and specificity for all these locations. For detection of bladder endometriosis, the overall pooled sensitivity and specificity were 62% (95%CI, 40-80%) and 100% (95%CI, 97-100%), respectively. Moderate heterogeneity was found for sensitivity and specificity for bladder endometriosis. The pretest probability of bladder endometriosis was 5%, which increased to 92% when suspicion of endometriosis was present after TVS assessment. CONCLUSION Overall diagnostic performance of TVS for detecting DIE in uterosacral ligaments, rectovaginal septum, vagina and bladder is fair with high specificity.
Collapse
Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J A Minguez
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - G B Melis
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| |
Collapse
|
7
|
Menakaya UA, Adno A, Lanzarone V, Johnson NP, Condous G. Integrating the concept of advanced gynaecological imaging for endometriosis. Aust N Z J Obstet Gynaecol 2015; 55:409-12. [PMID: 26426947 DOI: 10.1111/ajo.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Uche A. Menakaya
- Calvary Health Care; Calvary Public Hospital; Bruce Australian Capital Territory Australia
- JUNIC Specialist Imaging and Women's Centre; Charnwood Australian Capital Territory Australia
| | - Alan Adno
- Sydney South West Area Health Service; Women Children and Adolescent Health Liverpool Hospital; Sydney New South Wales Australia
| | | | - Neil P. Johnson
- Robinson Research Institute; University of Adelaide; Adelaide South Australia Australia
- Repromed Auckland and Fertility Plus; University of Auckland; Auckland New Zealand
| | - George Condous
- Acute Gynaecology; Early Pregnancy and Advanced Endosurgery Unit; Nepean Medical School; Nepean Hospital; University of Sydney; Kingswood New South Wales Australia
- OMNI Gynaecological Care; Centre for Women's Ultrasound and Early Pregnancy; St Leonards Sydney New South Wales Australia
| |
Collapse
|
8
|
Closed entry technique for the laparoscopic management of adnexal mass during pregnancy. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s10397-014-0851-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
9
|
Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. BMC WOMENS HEALTH 2013; 13:43. [PMID: 24165087 PMCID: PMC3815071 DOI: 10.1186/1472-6874-13-43] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 10/08/2013] [Indexed: 11/18/2022]
Abstract
Background Endometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy. Methods Consecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings. Results 198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively. The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions. Conclusions Our study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.
Collapse
|
10
|
Perez-Medina T, Orensanz I, Pereira A, Valero de Bernabé J, Engels V, Troyano J, SanFrutos L, Iglesias E. Three-Dimensional Angioultrasonography for the Prediction of Malignancy in Ovarian Masses. Gynecol Obstet Invest 2013; 75:120-5. [DOI: 10.1159/000345576] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 11/03/2012] [Indexed: 11/19/2022]
|
11
|
Amor F, Alcázar JL, Vaccaro H, León M, Iturra A. GI-RADS reporting system for ultrasound evaluation of adnexal masses in clinical practice: a prospective multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:450-455. [PMID: 21465605 DOI: 10.1002/uog.9012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the clinical usefulness of a structured reporting system based on ultrasound findings for management of adnexal masses. METHODS This was a prospective multicenter study comprising 432 adnexal masses in 372 women (mean age, 44.0 (range, 13-78) years) over a 36-month period. Ninety-three (25%) women were postmenopausal and 279 (75%) women were premenopausal. Patients were evaluated with transvaginal ultrasound by one of three examiners expert in gynecological ultrasound. Reporting was provided to referring clinicians according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. A predetermined management protocol was offered to referral clinicians. It was suggested that patients classified as GI-RADS 2 be managed with follow-up scan, patients classified as GI-RADS 3 undergo laparoscopic surgery and patients classified as GI-RADS 4 or 5 be referred to a gynecologic oncologist. Definitive histologic diagnosis was available in 370 cases and 62 additional cases were considered as benign because of spontaneous resolution during follow-up. These outcomes were used as the gold standard for calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of GI-RADS classification for identifying adnexal masses at high risk of malignancy, considering GI-RADS 4 and 5 as being malignant. RESULTS Of the 432 tumors, 112 were malignant and 320 benign. The GI-RADS classification rate was as follows: GI-RADS 2, 92 (21%) cases; GI-RADS 3, 184 (43%) cases; GI-RADS 4, 40 (9%) cases; GI-RADS 5, (27%) 116 cases. Sensitivity for this system was 99.1% (95% CI, 95.1-99.8%), specificity was 85.9% (95% CI, 81.7-89.3%), LR+ was 7.05 (95% CI, 5.37-9.45) and LR- was 0.01 (95% CI, 0.001-0.07). PPV and NPV were 71.1% and 99.6%, respectively. CONCLUSIONS The GI-RADS reporting system performed well in identifying adnexal masses at high risk of malignancy and seems to be useful for clinical decision-making.
Collapse
Affiliation(s)
- F Amor
- Centro Ecografico Ultrasonic Panoramico, Santiago, Chile
| | | | | | | | | |
Collapse
|
12
|
Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:257-263. [PMID: 20954166 DOI: 10.1002/uog.8858] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To critically analyze the diagnostic value of transvaginal sonography (TVS) for non-invasive, presurgical detection of bowel endometriosis. METHODS MEDLINE (1966-2010) and EMBASE (1980-2010) databases were searched for relevant studies investigating the diagnostic accuracy of TVS for diagnosing deep infiltrating endometriosis involving the bowel. Diagnosis was established by laparoscopy and/or histopathological analysis. Likelihood ratios (LRs) were recalculated in addition to traditional measures of effectiveness. RESULTS Out of 188 papers, a total of 10 studies fulfilled predefined inclusion criteria involving 1106 patients with suspected endometriosis. The prevalence of bowel endometriosis varied from 24 to 73.3%. LR+ ranged from 4.8 to 48.56 and LR- ranged from 0.02 to 0.36, with wide confidence intervals. Pooled estimates of sensitivities and specificities were 91 and 98%; LR+ and LR- were 30.36 and 0.09; and positive and negative predictive values were 98 and 95%, respectively. Three of the studies used bowel preparations to enhance the visibility of the rectal wall; one study directly compared the use of water contrast vs. no prior bowel enema, for which the LR- was 0.04 and 0.47, respectively. CONCLUSIONS TVS with or without the use of prior bowel preparation is an accurate test for non-invasive, presurgical detection of deep infiltrating endometriosis of the rectosigmoid.
Collapse
Affiliation(s)
- G Hudelist
- Department of Obstetrics and Gynaecology, Endometriosis and Pelvic Pain Clinic, Wilhelminen Hospital, Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
13
|
Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography. Fertil Steril 2010; 94:742-6. [DOI: 10.1016/j.fertnstert.2009.03.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/12/2009] [Accepted: 03/09/2009] [Indexed: 11/22/2022]
|
14
|
Sokalska A, Timmerman D, Testa AC, Van Holsbeke C, Lissoni AA, Leone FPG, Jurkovic D, Valentin L. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:462-470. [PMID: 19685552 DOI: 10.1002/uog.6444] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To determine the sensitivity and specificity of subjective evaluation of gray-scale and Doppler ultrasound findings (here called pattern recognition) when used by experienced ultrasound examiners with regard to making a specific diagnosis of adnexal masses. METHODS Within the framework of a European multicenter study, the International Ovarian Tumor Analysis study, comprising nine ultrasound centers, women with at least one adnexal mass were examined with gray-scale and color Doppler ultrasonography by experienced ultrasound examiners. A standardized examination technique, and standardized terms and definitions were used. Using pattern recognition the examiners classified each mass as benign or malignant and suggested a specific diagnosis (e.g. dermoid cyst or endometrioma). The reference standard was the histology of the surgically removed adnexal tumors. RESULTS A total of 1066 women were included, of whom 800 had a benign mass and 266 a malignant mass. A specific diagnosis based on ultrasound findings was suggested in 899 (84%) tumors. The specificity was high for all diagnoses (range, 94-100%). The sensitivity was highest for benign teratoma/dermoid cysts (86%, 100/116), hydrosalpinges (86%, 18/21), peritoneal pseudocysts (80%, 4/5) and endometriomas (77%, 153/199), and lowest for functional cysts (17%, 4/24), paraovarian/parasalpingeal cysts (14%, 3/21), benign rare tumors (11%, 1/9), adenofibromas (8%, 3/39), simple cysts (6%, 1/18) and struma ovarii (0%, 0/5). The positive and negative likelihood ratios of pattern recognition with regard to dermoid cysts, hydrosalpinges and endometriomas were 68.2 and 0.14, 38.9 and 0.15, and 33.3 and 0.24, respectively. Dermoid cysts, hydrosalpinges, functional cysts, paraovarian cysts, peritoneal pseudocysts, fibromas/fibrothecomas and simple cysts were never misdiagnosed as malignancies by the ultrasound examiner, whereas more than 10% of inflammatory processes, adenofibromas and rare benign tumors including struma ovarii were misdiagnosed as malignancies. CONCLUSIONS Using subjective evaluation of gray-scale and Doppler ultrasound findings it is possible to make an almost conclusive diagnosis of a dermoid cyst, endometrioma and hydrosalpinx. Many other adnexal pathologies can be recognized but not confidently confirmed or excluded.
Collapse
Affiliation(s)
- A Sokalska
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Zerem E, Imamović G, Omerović S. Percutaneous Drainage without Sclerotherapy for Benign Ovarian Cysts. J Vasc Interv Radiol 2009; 20:921-5. [DOI: 10.1016/j.jvir.2009.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 04/08/2009] [Accepted: 04/14/2009] [Indexed: 01/23/2023] Open
|
16
|
Delanaye P, Cavalier E, Depas G, Chapelle JP, Krzesinski JM. New data on the intraindividual variation of cystatin C. Nephron Clin Pract 2008; 108:c246-8. [PMID: 18391572 DOI: 10.1159/000124327] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Accepted: 01/03/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cystatin C is a new interesting marker of glomerular filtration rate (GFR). However, data regarding its biological variance are scarce and conflicting. The ability of cystatin C to longitudinally follow renal function in patients therefore remains questionable. METHODS 12 healthy subjects (6 men and 6 women) were included in the final statistical analysis. Serum creatinine, plasma cystatin C and GFR were measured twice after a 1-week interval on the same day, at the same time, and under the same preanalytical and analytical conditions. GFR was measured with an iohexol method. Serum creatinine was measured with a compensated Jaffé and an enzymatic method. Plasma cystatin C was measured by a particle-enhanced immunonephelometric method. Analytical (CV(A)) and within-subject (CV(I)) variances were classically calculated. RESULTS CV(A) for creatinine (Jaffé and enzymatic methods) and cystatin C was 2.5, 0.97 and 1.29%, respectively. CV(I) was 5.8, 5 and 4.5% for the Jaffé creatinine, enzymatic creatinine and cystatin C determinations, respectively. CONCLUSION Our study confirms that intraindividual variation of cystatin C and creatinine are similar. Therefore, from a biological point of view, cystatin C seems as accurate as creatinine for the longitudinal follow-up of renal function in daily clinical practice.
Collapse
Affiliation(s)
- Pierre Delanaye
- Department of Nephrology, University of Liege, CHU Sart Tilman, Liege, Belgium.
| | | | | | | | | |
Collapse
|