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Chaggar P, Tellum T, De Braud LV, Solangon SA, Setty T, Jurkovic D. Development of deep pelvic endometriosis following acute haemoperitoneum: a prospective ultrasound study. Hum Reprod Open 2024; 2024:hoae036. [PMID: 38905001 PMCID: PMC11189661 DOI: 10.1093/hropen/hoae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/07/2024] [Indexed: 06/23/2024] Open
Abstract
STUDY QUESTION Is acute haemoperitoneum that is managed conservatively a precursor of deep endometriosis? SUMMARY ANSWER Our study provides evidence to suggest that acute haemoperitoneum may lead to the development of deep endometriosis in a significant proportion of cases. WHAT IS KNOWN ALREADY A recent pilot study was the first to suggest that acute haemoperitoneum could be a precursor of deep endometriosis. However, the sample size was small, and the follow-up was not standardized owing to unknown rates of clot absorption and development of endometriosis. STUDY DESIGN SIZE DURATION This was a prospective observational cohort study conducted at a single centre over a 31-month period. A required sample size of 30 was calculated using results from a previous study, with a minimum of 15 women each in the groups with and without significant haemoperitoneum (study and control groups, respectively). A total of 59 women were recruited to the study and eight were lost to follow-up. The final sample comprised 51 women, 15 in the study group and 36 in the control group. PARTICIPANTS/MATERIALS SETTING METHODS All non-pregnant, premenopausal women aged 18-50 years who consecutively presented to our dedicated gynaecological diagnostic unit with severe acute lower abdominal pain were eligible for this study. We only included women who were clinically stable and were suitable for conservative management. Those with prior history or evidence of endometriosis on their initial ultrasound scan, previous hysterectomy, or bilateral oophorectomy were excluded. Participants had standardized follow-up visits for 6 months, with pelvic ultrasound scans and the British Society of Gynaecological Endoscopy pelvic pain questionnaires completed at each visit. The primary outcome was the sonographically confirmed presence of newly formed endometriosis. Secondary outcomes were the presence and change of pelvic pain symptoms and health-related quality of life (HR-QOL). MAIN RESULTS AND THE ROLE OF CHANCE After completion of follow-up, 7/15 (47%; 95% CI 21.3-71.4%) women presenting with acute haemoperitoneum (study group) developed sonographic evidence of deep endometriosis, compared to 0/36 (0%; 97.5% CI 0.0-9.7%) women in the control group. A ruptured functional haemorrhagic cyst was the most common cause of haemoperitoneum, occurring in 13/15 cases (87%). The time from the initial event to sonographic evidence of endometriosis varied from 2 to 6 months. The EuroQol visual analogue scores were not significantly different at baseline between the groups that developed and did not develop endometriosis [28 (interquartile range (IQR) 15-40, n = 6) vs 56 (IQR 35-75, n = 44), P = 0.09], while the EuroQol-5D values were lower in the endometriosis group [-0.01 (IQR -0.07 to 0.19, n = 6) vs 0.62 (IQR 0.24-0.73, n = 44), P = 0.002]. At 6 months, the EuroQol-5D scores were improved in both groups, but remained significantly lower in the endometriosis group compared to the no endometriosis group [0.69 (IQR 0.66-0.80, n = 6) vs 0.85 (IQR 0.76-1.00, n = 44), P = 0.03]. There was no clinically relevant difference in the pelvic pain scores at either time point. LIMITATIONS REASONS FOR CAUTION It remains uncertain whether minimal, superficial endometriosis existed at commencement of the study and had a role in the development of deep endometriosis. Although the ultrasound findings were in keeping with deep endometriosis, this was not confirmed histologically. The pelvic pain and HR-QOL findings could have been influenced by the baseline scores being taken when the patient was admitted with acute pain. Also, the sample size was too small to draw reliable conclusions regarding the impact of newly developed endometriosis on QoL. WIDER IMPLICATIONS OF THE FINDINGS Our study provides further evidence showing that significant haemoperitoneum may be a precursor of deep endometriosis. Haemodynamically stable women presenting with acute pelvic pain and significant haemoperitoneum should be counselled about the risk of developing deep endometriosis. Interventional studies should be carried out in the future to see whether laparoscopy and pelvic washout could prevent development of deep endometriosis. Preventative strategies, including treatment to suppress ovulation and formation of functional cysts, should be further investigated. This includes the combined and progesterone-only contraceptive pills. Larger future studies are also required to assess women over a longer period of time, with adjustment for confounding factors, to evaluate a possible effect on HR-QOL and pain symptoms. STUDY FUNDING/COMPETING INTERESTS Funding was obtained from The Gynaecology Ultrasound Centre, London, UK. TT received personal fees from GE, Samsung, Medtronic, and Merck for lectures on ultrasound. TT also received a postdoctoral grant from the South-Eastern Norwegian Health Authority (grant number 2020083). TRIAL REGISTRATION NUMBER researchregistry6472.
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Affiliation(s)
- Prubpreet Chaggar
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
| | - Tina Tellum
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Lucrezia Viola De Braud
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
| | - Sarah Annie Solangon
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
| | - Thulasi Setty
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
| | - Davor Jurkovic
- EGA Institute for Women's Health, Faculty of Population and Health Sciences, University College Hospital, London, UK
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Chaggar P, Tellum T, Cohen A, Jurkovic D. Intra- and interobserver reproducibility of transvaginal ultrasound for the detection and measurement of endometriotic lesions of the bowel. Acta Obstet Gynecol Scand 2023; 102:1306-1315. [PMID: 37641421 PMCID: PMC10541154 DOI: 10.1111/aogs.14660] [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: 03/04/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The number and invasion depth of endometriotic bowel lesions, total length of bowel affected by endometriosis, lesion-to-anal verge distance, and extent of pouch of Douglas obliteration are important factors in preoperatively determining risk and complexity of endometriosis surgery. The intra- and interobserver reproducibility of transvaginal ultrasound in the evaluation of many of these parameters has not yet been investigated. Our study aimed to assess the intra- and interobserver reproducibility of transvaginal ultrasound between an experienced and less experienced examiner for all of these parameters. MATERIAL AND METHODS This prospective observational cross-sectional study was conducted between July 2019 and November 2020. Fifty consecutive premenopausal women who underwent transvaginal ultrasound examination in our clinic for the first time, were examined by the same two operators during the same attendance. Outcomes of interest were the inter-rater reproducibility of transvaginal ultrasound for detecting the presence, number, depth and size of bowel endometriotic nodules, lesion-to-anal-verge distance, total length of bowel affected, and pouch of Douglas obliteration. The intraobserver reproducibility was assessed for the continuous parameters. Cohen's kappa (κ) statistic, Cohen's weighted kappa (κ), proportions of agreement, intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement were used to assess the reproducibility of the parameters. RESULTS The inter-rater agreement and reliability were very good for identifying bowel endometriosis, the number and invasion depth of bowel nodules, determining whether the maximum nodule length was <3 cm, and lesion-to-anal-verge distance <8 cm (proportion of agreement 0.92, 0.94, 0.97, 0.94, 0.96; κ 0.92, 0.91, 0.92, 0.82, 0.89). The inter-rater agreement and reliability were good for assessing pouch of Douglas obliteration (proportion of agreement 0.86, κ 0.80). The intra-rater reliability for the mean nodule diameter (ICC 0.93 and 0.97) and total length of bowel affected (ICC 0.94 and 0.91) were excellent for operators A and B, respectively. The inter-rater reliability for the mean nodule diameter was good (ICC 0.80), and moderate for the total length of bowel affected (ICC 0.70). The Bland-Altman limits of agreement demonstrated clinically acceptable ranges for these two parameters. CONCLUSIONS This study demonstrated a high intra- and inter-rater reproducibility of transvaginal ultrasound in the diagnosis of bowel endometriosis and measurement of its various components.
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Affiliation(s)
- Prubpreet Chaggar
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Tina Tellum
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - Abigail Cohen
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
| | - Davor Jurkovic
- Gynecology Diagnostic and Outpatient Treatment Unit, Lower Ground Floor, Elizabeth Garrett Anderson WingUniversity College London HospitalLondonUK
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Chaggar P, Tellum T, Thanatsis N, De Braud LV, Setty T, Jurkovic D. Prevalence of deep and ovarian endometriosis in women attending a general gynecology clinic: prospective cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:632-641. [PMID: 36776112 DOI: 10.1002/uog.26175] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To assess using transvaginal ultrasound the prevalence of deep and ovarian endometriosis in premenopausal women attending a general gynecology clinic. We also investigated whether the presence of endometriosis was associated with various demographic factors and other pelvic abnormalities. METHODS This was a prospective observational cohort study carried out between February 2019 and October 2020. Consecutive premenopausal women who attended our general gynecology clinic underwent pelvic ultrasound examination, performed by a single experienced operator. Pregnant women and those with a history of hysterectomy or oophorectomy were excluded. The primary outcome was the prevalence of deep and/or ovarian endometriosis. Secondary outcomes were the anatomical distribution of endometriotic lesions and the association of endometriosis with demographic characteristics and various pelvic abnormalities, which were analyzed using logistic regression and multivariable analysis. RESULTS A total of 1026 women were included in the final study sample, of whom 194 (18.9% (95% CI, 16.6-21.4%)) had sonographic evidence of deep and/or ovarian endometriosis. Of the 194 women diagnosed with endometriosis, 106 (54.6% (95% CI, 47.4-61.8%)) were diagnosed with endometriotic nodules only, 26 (13.4% (95% CI, 9.0-19.0%)) with ovarian endometriomas only, and 62 (32.0% (95% CI, 25.5-39.0%)) women had evidence of both. There was a total of 348 endometriotic nodules in 168 women, located most frequently in the retrocervical area (166/348; 47.7% (95% CI, 42.4-53.1%)), uterosacral ligaments (96/348; 27.6% (95% CI, 23.0-32.6%)) and bowel (40/348; 11.5% (95% CI, 8.3-15.3%)). Multivariable analysis found significant positive associations between endometriosis and both adenomyosis (odds ratio (OR), 1.72 (95% CI, 1.10-2.69); P = 0.02) and pelvic adhesions (OR, 25.7 (95% CI, 16.7-39.3); P < 0.001), whilst higher parity (OR, 0.44 (95% CI, 0.24-0.81); P = 0.03) and history of Cesarean section (OR, 0.18 (95% CI, 0.06-0.52); P = 0.002) were associated with a lower occurrence of endometriosis. A total of 75/1026 women (7.3% (95% CI, 5.8-9.1%)) underwent laparoscopy within 6 months of pelvic ultrasound examination. There was very good agreement between ultrasound and surgical findings, with a kappa value of 0.84 (95% CI, 0.69-0.99). CONCLUSIONS Deep and/or ovarian endometriosis was present in nearly one in five women attending a general gynecology clinic. There were significant positive associations with adenomyosis and pelvic adhesions and negative associations with higher parity and previous Cesarean section. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Chaggar
- Institute for Women's Health, University College Hospital, London, UK
| | - T Tellum
- Institute for Women's Health, University College Hospital, London, UK
- Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | - N Thanatsis
- Institute for Women's Health, University College Hospital, London, UK
| | - L V De Braud
- Institute for Women's Health, University College Hospital, London, UK
| | - T Setty
- Institute for Women's Health, University College Hospital, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
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Kozasa K, Takemoto Y, Goto T, Kobayashi M, Sakaguchi H, Fujiwara S, Ichikawa F, Kuroda M, Komura N, Tanaka A, Masuda K, Otsuka H, Yokoi T. Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy. J Surg Case Rep 2020; 2020:rjaa506. [PMID: 33365120 PMCID: PMC7748126 DOI: 10.1093/jscr/rjaa506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/02/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Peritoneal inclusion cysts (PICs) often develop in post-operative patients. Since the incidence of adhesions is lower with laparoscopic surgery than with open surgery, PICs are less likely to occur in the former. Although post-operative adhesions or PICs rarely develop after laparoscopic surgery (such as total laparoscopic hysterectomy: TLH), we encountered two cases of giant PICs with abdominal pain after TLH. In Case 1, strong adhesion was already present when TLH was performed. Therefore, this case may have been predisposed to the development of adhesions in the abdominal cavity. However, no adhesions were observed during TLH in case 2, and there were no risk factors, such as pre-operative adhesions and endometriosis. Therefore, adhesions and PICs may develop even after TLH, and approaches need to be considered for their prevention.
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Affiliation(s)
- Katsumi Kozasa
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Yuki Takemoto
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Takeshi Goto
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Mariya Kobayashi
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Hitomi Sakaguchi
- Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Sho Fujiwara
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Fuyuki Ichikawa
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Misako Kuroda
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Naoko Komura
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Asuka Tanaka
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Kumi Masuda
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Hirofumi Otsuka
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
| | - Takeshi Yokoi
- Department of Obstetrics and Gynecology, Kaizuka City Hospital, Osaka, Japan
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Goel A, Garg PK. Abdominal Cyst in a 39-year-old Woman. Oman Med J 2019; 34:172-173. [PMID: 30918614 PMCID: PMC6425051 DOI: 10.5001/omj.2019.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Aakanksha Goel
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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Guerriero S, Saba L, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Sedda F, Peddes C, Fabbri P, Pilla F, Zajicek M, Giuseppina P, Melis GB. Past, present and future ultrasonographic techniques for analyzing ovarian masses. ACTA ACUST UNITED AC 2016; 11:369-83. [PMID: 26102474 DOI: 10.2217/whe.15.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography is today the method of choice for distinguishing between benign and malignant adnexal pathologies. Using pattern recognition several types of tumors can be recognized according to their characteristic appearance on gray-scale imaging. Color Doppler imaging should be used only to perform a semiquantitative color score or evaluate the flow location. International Ovarian Tumor Analysis group had standardized definitions characterizing adnexal masses and suggested the use of 'simple rules' in premenopausal women. Recently, the use of 3D vascular indices has been proposed but its potential use in clinical practice is debated. Also computerized aided diagnosis algorithms showed encouraging results to be confirmed in the future.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics & Gynecology, University of Navarra, Pamplona, Spain
| | | | - Silvia Ajossa
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Maura Perniciano
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Cristina Peddes
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Paola Fabbri
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Pilla
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Michal Zajicek
- Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Parodo Giuseppina
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
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Sayasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, Timmerman D, Bourne T. The characteristic ultrasound features of specific types of ovarian pathology (review). Int J Oncol 2014; 46:445-58. [PMID: 25406094 PMCID: PMC4277251 DOI: 10.3892/ijo.2014.2764] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/22/2014] [Indexed: 01/05/2023] Open
Abstract
Characterizing ovarian masses enables patients with malignancy to be appropriately triaged for treatment by subspecialist gynecological oncologists, which has been shown to optimize care and improve survival. Furthermore, correctly classifying benign masses facilitates the selection of patients with ovarian pathology that may either not require intervention, or be suitable for minimal access surgery if intervention is required. However, predicting whether a mass is benign or malignant is not the only clinically relevant information that we need to know before deciding on appropriate treatment. Knowing the specific histology of a mass is becoming of increasing importance as management options become more tailored to the individual patient. For example predicting a mucinous borderline tumor gives the opportunity for fertility sparing surgery, and will highlight the need for further gastrointestinal assessment. For benign disease, predicting the presence of an endometrioma and possible deeply infiltrating endometriosis is important when considering both who should perform and the extent of surgery. An examiner’s subjective assessment of the morphological and vascular features of a mass using ultrasonography has been shown to be highly effective for predicting whether a mass is benign or malignant. Many masses also have features that enable a reliable diagnosis of the specific pathology of a particular mass to be made. In this narrative review we aim to describe the typical morphological features seen on ultrasound of different adnexal masses and illustrate these by showing representative ultrasound images.
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Affiliation(s)
- Ahmad Sayasneh
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK
| | - Christine Ekechi
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Laura Ferrara
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Jeroen Kaijser
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Catriona Stalder
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Shyamaly Sur
- Early Pregnancy and Acute Gynecology Unit, Queen Charlottes and Chelsea Hospital, Imperial College London, London, W12 0HS, UK
| | - Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK
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Jokubkiene L, Sladkevicius P, Valentin L. Prevalence of extrauterine pelvic lesions on transvaginal ultrasound in asymptomatic 20-39-year-old women. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:228-237. [PMID: 24375888 DOI: 10.1002/uog.13294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/12/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To estimate the prevalence of extrauterine pelvic lesions on transvaginal ultrasound examination of gynecologically asymptomatic women of fertile age, and to compare this prevalence between women with spontaneous menstrual cycles, those using the combined oral contraceptive (COC) pill and those using a gestagen intrauterine contraceptive device (IUD). METHODS Six hundred and forty-four gynecologically asymptomatic 20-39-year-old Caucasian women with no current or previous gynecological problems, who were recruited from a Swedish population registry, were examined with transvaginal ultrasound on cycle day 4-8. Our definition of ovarian cyst was a unilocular cyst with anechoic cyst contents ≥ 35 mm in mean diameter, or any other type of intraovarian lesion. The prevalence of extrauterine pelvic lesions was compared between women not using hormonal contraception and those using COC or a gestagen IUD. RESULTS Ovarian lesions were found in 24 (3.7%) women. One woman had bilateral ovarian lesions. An ultrasound diagnosis of paraovarian cyst was made in 41 (6.4%) women, of peritoneal cyst in four (0.6%) women and of hydrosalpinx in one (0.2%) woman. All incidentally detected lesions had a mean diameter of ≤ 5 cm. One 17-mm intraovarian lesion was suspicious for malignancy, and histology confirmed a Sertoli-Leydig cell tumor. The ultrasound diagnoses in the remaining 23 women were endometrioma (n = 10 (1.6%)), dermoid cyst (n = 5 (0.8%)), cystadenofibroma (n = 1 (0.2%)), mature teratoma (n = 1 (0.2%)) and functional cyst, i.e. a cyst that resolved within 3-5 months (n = 6 (0.9%)). Four women with an ultrasound diagnosis of a benign lesion were operated on, and the ultrasound diagnoses of endometrioma (n = 2), dermoid cyst (n = 1) and mature teratoma (n = 1) were confirmed histologically. The prevalence of persisting ovarian lesions was highest in women with spontaneous menstrual cycles (4.4% vs 0.9% and 0% in women using COC and gestagen IUD, respectively; P = 0.025), but age was the only factor independently associated with persisting ovarian masses, the prevalence increasing with age. CONCLUSIONS Benign ovarian lesions are found in about 1 in 25 gynecologically asymptomatic women aged 20-39 years with no history of gynecological disease. To be able to offer optimal management of such masses, their natural history needs to be elucidated in a large prospective observational study.
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Affiliation(s)
- L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
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Guerriero S, Ajossa S, Gerada M, Virgilio B, Pilloni M, Galvan R, Laparte MC, Alcázar JL, Melis GB. Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.6.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
To discriminate ovarian lesions is of particular importance in gynecological practice. Two main problems need answers: discrimination of benign and malignant adnexal masses and choice of the appropriate surgical treatment if necessary. Nearly 2% of the adnexal masses are ovarian carcinomas or borderline tumors. It is now, well established that ultrasonography is the gold standard for ovarian cyst diagnosis. The purpose of this data was to review the literature and to establish, with the evidence base medicine model, which parameters and existing diagnostic models using ultrasound and Doppler perform best in the evaluation of adnexal masses. Transvaginal sonography has demonstrated considerable advantage over conventional transabdominal sonography. However, transparietal sonography is still useful in large tumors. Definition of the nomenclature and classification was done and should be used. Unilocular ovarian cyst characterization seems easy using sonography and Doppler. In front of complication, discrimination of such functional cyst may be difficult but spontaneous regression confirms usually the expectative management. Dermoid cysts and endometriomas seem to be easier to discriminate from other adnexal masses. Ultrasound and morphologic parameters have a sensitivity of about 90% and a specificity of 80%; that makes this exam the gold standard for ovarian masses diagnosis. Only 50% of ovarian masses are characterized by sonography. Scoring systems help to differentiate benign from malignant masses (sensitivity of about 90%). Logistic regression and models are good methods especially for LR1 and 2 and RMI and may be useful for malignancy prediction but are difficult to use in current practice. Expert diagnosis is a subjective but most important performing parameter. Any suspicious ovarian mass or not easily diagnosed mass requires sonography by an expert, which can first use all the techniques and the different parameters to discriminate benign and malignant tumors. An explicit report will help the physician to define the right attitude for an appropriate management. Six to 16% of adnexial masses are complex or not classified and will result in MRI prescription or surgery.
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Affiliation(s)
- H Marret
- Pôle de gynécologie, obstétrique, médecine fœtale et reproduction humaine, hôpital Bretonneau, 37044 Tours cedex 1, France.
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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.
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Tumors and pseudotumors of the secondary müllerian system: review with emphasis on cross-sectional imaging findings. AJR Am J Roentgenol 2011; 195:1452-9. [PMID: 21098209 DOI: 10.2214/ajr.10.4302] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Microscopic structures lined by müllerian epithelium are frequently seen outside the uterus and fallopian tubes and are termed "müllerian rests" or "secondary müllerian system." Varied entities ranging from benign endosalpingosis to highly malignant ovarian tumors are thought to be derived from the secondary müllerian system. Cross-sectional imaging findings of diseases and disorders of the secondary müllerian system are presented here. CONCLUSION Familiarity with a wide spectrum of diseases and disorders of the secondary müllerian system allows accurate diagnosis and management.
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Testa AC, Van Holsbeke C, Mascilini F, Timmerman D. Dynamic and interactive gynecological ultrasound examination. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:225-229. [PMID: 19644933 DOI: 10.1002/uog.7309] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- A C Testa
- Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy.
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14
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Characterising acute gynaecological pathology with ultrasound: an overview and case examples. Best Pract Res Clin Obstet Gynaecol 2009; 23:577-93. [PMID: 19403338 DOI: 10.1016/j.bpobgyn.2009.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 02/11/2009] [Indexed: 11/23/2022]
Abstract
This article summarises the ultrasound features of a number of gynaecological emergencies: ectopic pregnancy, haemorrhagic corpus luteum, twisted adnexa, pelvic inflammatory disease, acute myoma necrosis, haematocolpos and haematometra. The basis of all diagnosis in women with acute gynaecological conditions is history and clinical examination. An ultrasound examination should only be performed if it is likely to provide information that would change the likelihood of the diagnosis suspected on the basis of clinical data. If ultrasound findings are abnormal, then it is important to thoroughly evaluate if they do explain the woman's symptoms or if they are merely an incidental finding. If ultrasound findings are completely normal, then the risk of significant pelvic pathology is probably small.
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Van Holsbeke C, Yazbek J, Holland TK, Daemen A, De Moor B, Testa AC, Valentin L, Jurkovic D, Timmerman D. Real-time ultrasound vs. evaluation of static images in the preoperative assessment of adnexal masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:828-831. [PMID: 18925606 DOI: 10.1002/uog.6214] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine if the prediction of the malignancy of an adnexal mass using pattern recognition, i.e. subjective evaluation of gray-scale and Doppler ultrasound findings, is as accurate when based on static images as it is when based on a real-time ultrasound examination. METHODS The static images of 166 non-consecutive patients with 'difficult' adnexal masses, who all underwent surgery and for whom a histopathological diagnosis was available, were evaluated by three experts in gynecological ultrasound ('image experts'). All ultrasound examinations had been performed and the static images saved by a fourth expert sonologist ('real-time' sonologist). All four sonologists classified the adnexal masses as benign or malignant based on their subjective impression and stated with what degree of confidence their diagnosis was made. The diagnostic performance of the real-time sonologist was compared with that of each of the three image experts and with that of the 'consensus opinion' of the image experts (i.e. the diagnosis suggested by at least two of the latter). RESULTS The real-time sonologist correctly predicted the diagnosis with an accuracy of 89% (148/166) vs. 85% (141/166) for the consensus opinion of static images (P = 0.0707). Equivalent values for sensitivity and specificity were 80% (56/70) vs. 83% (58/70) (P = 0.4142) and 96% (92/96) vs. 86% (83/96) (P = 0.0027), respectively. CONCLUSIONS The preoperative diagnosis of an adnexal mass made on the basis of a real-time ultrasound examination is more precise than a diagnosis made on the basis of saved static ultrasound images. Evaluation of static images is associated with lower diagnostic specificity.
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Affiliation(s)
- C Van Holsbeke
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium.
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Abstract
Because pelvic ultrasound is commonly used to evaluate adnexal masses, it is important to understand the most useful sonographic features for predicting benign and malignant masses. Determining whether an adnexal mass is of ovarian or extraovarian origin is key in arriving at the most likely diagnosis. Most adnexal masses are benign, and each of the most common benign ovarian lesions has a typical sonographic appearance. Additionally, most malignant ovarian neoplasms have a solid component with detectable flow by Doppler ultrasound, allowing one to strongly suggest the diagnosis. We will review an approach to the ultrasound diagnosis of adnexal masses that progresses through a series of 4 questions to help lead one to the most likely diagnosis.
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Affiliation(s)
- Douglas L Brown
- Professor of Radiology, Mayo Clinic, Department of Radiology, Rochester, MN 55905, USA.
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Ying W, Li Y, Zhou Y, Xie X. Cyst distortion: a new sonographic sign of peritoneal pseudocyst with regular morphology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:240-1. [PMID: 17252530 DOI: 10.1002/uog.3926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Savelli L, Ghi T, De Iaco P, Ceccaroni M, Venturoli S, Cacciatore B. Paraovarian/paratubal cysts: comparison of transvaginal sonographic and pathological findings to establish diagnostic criteria. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:330-4. [PMID: 16823765 DOI: 10.1002/uog.2829] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES To describe the sonographic features of paraovarian cysts and to compare these features with pathological findings in order to define the best treatment options (surgical vs. conservative). METHODS Fifty patients (mean age 48 (range, 14-68) years), each with a surgically proven paraovarian cyst, were retrospectively recruited. Preoperative transvaginal ultrasonographic B-mode and power Doppler observations were re-evaluated and histological reports were analyzed. RESULTS All cysts were correctly diagnosed as paraovarian at preoperative transvaginal sonography (TVS). Paraovarian cysts appeared as unilocular ('simple') cysts in 33 (66%) cases and multilocular in two (4%). In 15 patients (30%) the cyst showed a variable number of papillary projections growing from the cyst wall (unilocular-solid cysts). Power Doppler examination of the papillae showed the presence of blood vessels in four of these patients (27%). Histological analysis of the masses containing papillary projections diagnosed eight cystadenofibromas, five cystadenomas and two serous papillary borderline tumors, while analysis of paraovarian cysts without papillations revealed benign, serous cysts of paramesonephric or mesothelial origin. CONCLUSIONS Paraovarian cysts can show a wide range of sonographic features. Their risk of malignancy is low if no papillary projections are detected at transvaginal sonography, but when mural proliferations are present a borderline tumor can be found at pathological examination.
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Affiliation(s)
- L Savelli
- Department of Obstetrics and Gynecology, University of Bologna, Italy.
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Okaro E, Condous G, Khalid A, Timmerman D, Ameye L, Huffel SV, Bourne T. The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain-can we reduce the need for laparoscopy? BJOG 2006; 113:251-6. [PMID: 16487194 DOI: 10.1111/j.1471-0528.2006.00849.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the accuracy of new transvaginal ultrasound-scan-based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP). DESIGN A prospective observational study. SETTING Teaching hospital. POPULATION A total of 120 consecutive women with CPP undergoing transvaginal ultrasonography before either diagnostic or operative laparoscopy. METHODS Anatomical abnormalities, e.g. endometrioma or hydrosalpinx (hard markers), were documented. The woman was then assessed for the presence or absence of 'soft markers' (reduced ovarian mobility and site-specific pelvic tenderness). MAIN OUTCOME MEASURE Presence or absence of pelvic pathology noted during laparoscopy. RESULTS Seventy women had pelvic pathology, of whom 51 had endometriosis alone, 7 both endometriosis and pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx with endometriosis and 5 hydrosalpinx and pelvic adhesions. The likelihood ratio for the hard markers was infinity (specificity was 100%), for the soft makers 1.9 (95% CI 1.2-3.1) and for a 'normal' ultrasound 0.18 (0.09-0.34). The pre-test probability of pelvic disease in our population of women with CPP was 58%, and this probability of disease was raised to 100% with the presence of hard markers and to 73% with the presence of soft markers. The pre-test probability of 58% fell to 20% when ultrasound finding was found to be normal. CONCLUSION This new approach improves the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.
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Affiliation(s)
- E Okaro
- Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK.
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Okaro E, Condous G. Diagnostic and therapeutic capabilities of ultrasound in the management of pelvic pain. Curr Opin Obstet Gynecol 2005; 17:611-7. [PMID: 16258344 DOI: 10.1097/01.gco.0000191902.07439.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review discusses the current diagnostic and therapeutic role of ultrasound in the management of pelvic pain. RECENT FINDINGS Recent advances in ultrasound technology and expertise have facilitated the accurate diagnosis of common gynaecological and nongynaecological pathologies. Peritoneal and deep infiltrating endometriosis can now be diagnosed using hard and soft ultrasound-based markers. The combination of ultrasound-guided aspiration and instillation of a sclerosant is an alternative to surgery in the management of adnexal masses. SUMMARY Experience is a key factor in the ability of transvaginal ultrasound to characterize common gynaecological disorders with accuracy. Therapeutic ultrasound provides an alternative to surgery.
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Affiliation(s)
- Emeka Okaro
- Department of Obstetrics and Gynaecology, St. Bartholomew's and the Royal London NHS Trust, Royal London Hospital, UK.
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Current World Literature. Curr Opin Obstet Gynecol 2005. [DOI: 10.1097/01.gco.0000194327.87451.dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sella T, Mironov S, Hricak H. Imaging of transposed ovaries in patients with cervical carcinoma. AJR Am J Roentgenol 2005; 184:1602-10. [PMID: 15855125 DOI: 10.2214/ajr.184.5.01841602] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lateral ovarian transposition is a surgical procedure performed in premenopausal women with pelvic malignancies in which the ovaries are surgically displaced from the pelvis, before radiation therapy. In this article, we present the imaging features of normal transposed ovaries as well as the spectrum of abnormalities associated with lateral ovarian transposition. CONCLUSION After lateral ovarian transposition, it is important to recognize the ovaries to avoid confusing them with peritoneal implants. In addition, benign ovarian lesions must be distinguished from primary and secondary malignancies.
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Affiliation(s)
- Tamar Sella
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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Créquat J, Teboul-Faure L, Fortin A, Batallan A, Madelenat P. [Endorectal sonography in gynecology: usefulness and diagnostic accuracy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2004; 32:950-3. [PMID: 15567683 DOI: 10.1016/j.gyobfe.2004.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 09/20/2004] [Indexed: 05/01/2023]
Abstract
OBJECTIVE The aim of this study was to assess feasibility and diagnostic accuracy of endorectal sonography (ERS) in comparison with transabdominal sonography (TAS) in women with a contraindication to endovaginal sonography (EVS). PATIENTS AND METHODS ERS was proposed to 32 patients in the immediate continuation of TAS. It was performed either with a specific probe or with a vaginal probe. The protocol included a complete evaluation of pelvic structures observed with both sonographic techniques. RESULTS After counselling and assent, 29 of the 32 patients (90%) accepted ERS. The examination was regarded as complete in 28 cases. ERS confirmed the absence of pelvic anomaly in the 12 cases of normal TAS. ERS modified diagnosis in 5 of the 8 cases of anechoic ovarian cysts seen in TAS. In 4 cases, PCOs not seen in TAS were identified. Two partially sub-mucous myomas not recognized by TAS were diagnosed by ERS. Sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TAS and ERS were 38,4 and 87,5%, 41,6 and 100%, 50 and 100%, 40 and 85,7% respectively. DISCUSSION AND CONCLUSION These findings suggest ERS is an effective diagnostic tool in pelvic exploration when EVS cannot be performed. It should be widely proposed after information and assent.
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Affiliation(s)
- J Créquat
- Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris 18, France.
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Guerriero S, Ajossa S, Mais V, Angiolucci M, Paoletti AM, Melis GB. Role of transvaginal sonography in the diagnosis of peritoneal inclusion cysts. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1193-1200. [PMID: 15328434 DOI: 10.7863/jum.2004.23.9.1193] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The aim of this prospective study was to investigate the accuracy of B-mode transvaginal sonography alone and combined with color Doppler imaging and cancer antigen 125 (CA 125) plasma concentrations in differentiating peritoneal cysts from other adnexal masses. METHODS Between September 1999 and September 2003, 213 adnexal masses underwent transvaginal sonography combined with power Doppler evaluation. Plasma concentrations of CA 125 were measured before surgery. The sonographic suspicion of peritoneal cysts (the presence of a bizarre lump-shaped cyst with a thin wall and fine internal septations with or without an ovary suspended among adhesions) was then compared with the surgical diagnosis. The overall agreement between the sonographic test results and the surgical findings was calculated by the kappa index. The diagnostic value of each test was also evaluated with likelihood ratios (LRs). RESULTS Thirteen of 213 patients were found to have peritoneal cysts. Specificity and sensitivity of B-mode sonography for differentiating peritoneal cysts from other adnexal masses were 96% (95% confidence interval, 94%-97%) and 62% (95% confidence interval, 35%-83%), respectively. The value of the negative LR (0.40) indicated a good clinical test, whereas the positive LR (15) indicated an excellent test. Power Doppler imaging did not seem to increase the accuracy of B-mode transvaginal sonography (kappa = 0.51 and 0.52, respectively), nor did the association of CA 125 plasma concentration (kappa = 0.34). CONCLUSIONS Transvaginal sonography alone is a useful method for detection of peritoneal cysts.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124, Italy.
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