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Lee SJ, Kim YH, Lee MY, Ko HS, Oh SY, Seol HJ, Kim JW, Ahn KH, Na S, Seong WJ, Kim HS, Park CW, Park JS, Jun JK, Won HS, Kim MY, Hwang HS, Lee SM. Ultrasonographic evaluation of ovarian mass for predicting malignancy in pregnant women. Gynecol Oncol 2021; 163:385-391. [PMID: 34561098 DOI: 10.1016/j.ygyno.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study is to compare ultrasonographic ovarian mass scoring systems in pregnant women. STUDY DESIGN This multicenter study included women with an ovarian mass during pregnancy who were evaluated using ultrasound and underwent surgery in 11 referral hospitals. The ovarian mass was evaluated and scored using three different scoring systems(International Ovarian Tumor Analysis Assessment of Different NEoplasias in the adnexa[IOTA ADNEX], Sassone, and Lerner). The final diagnosis was made histopathologically. Receiver operating characteristic(ROC) curves were generated for each scoring system. RESULTS During the study period, 236 pregnant women underwent surgery for an ovarian mass, including 223 women(94.5%) with a benign ovarian mass and 13 women(5.5%) with a malignant ovarian mass. Among 10 ultrasound image findings, six findings were different between benign and ovarian masses(maximal diameter of mass, maximal diameter of solid mass, wall thickness of mass, inner wall structure, thickness of septations, and papillarity). In all three scoring systems, the ovarian mass scores were significantly higher in malignant masses than in benign masses, with the highest area under the ROC curve(AUROC) in the Sassone scoring system(AUROC: 0.831 for Sassone, 0.710 for Lerner vs 0.709 for IOTA ADNEX; p < 0.05, between the Sassone and Lerner/ IOTA ADNEX). A combined model was developed with the six different ultrasound findings, and the AUROC of the combined model was 0.883(p = not significant between the combined model and Sassone). CONCLUSION In pregnant women, malignant ovarian tumors can be predicted with high accuracy using either the Sassone scoring system or the combined model.
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Affiliation(s)
- Se Jin Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Young-Han Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mi-Young Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunghun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Moon Young Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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External Validation of the IOTA Classification in Women with Ovarian Masses Suspected to Be Endometrioma. J Clin Med 2021; 10:jcm10132971. [PMID: 34279456 PMCID: PMC8269298 DOI: 10.3390/jcm10132971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 01/04/2023] Open
Abstract
The study aimed to perform external validation of the International Ovarian Tumor Analysis (IOTA) classification of adnexal masses as benign or malignant in women with suspected endometrioma. A retrospective study including women referred to an endometriosis tertiary referral center for dedicated transvaginal ultrasound (TVUS). Adnexal masses were evaluated using the IOTA classification simple descriptors, simple rules and expert opinion. The reference standard was definitive histology after mass removal at laparoscopy. In total, 621 women were evaluated and divided into four groups: endometrioma on TVUS and confirmed on surgery (Group 1 = 181), endometrioma on TVUS but other benign cysts on surgery (Group 2 = 9), other cysts on TVUS but endometrioma on surgery (Group 3 = 2), masses classified as other findings or suspicious for malignancy on TVUS and confirmed on surgery (Group 4 = 5 potentially malignant, 11 benign). This gave a sensitivity 98.9%, specificity 64%, positive 95.3% and negative 88.9% predictive values, positive 2.74 and negative 0.02 likelihood ratios and 94.7% overall accuracy. The surgical diagnosis for the five masses suspected to be malignant was: borderline serous tumor (2), borderline mucinous tumor (2), and endometrioid lesion with complex hyperplasia without atypia (1). The conclusions were that the IOTA classification simple descriptors, simple rules and expert opinion performs well for classifying adnexal masses suspected to be endometrioma. The most common potentially malignant masses in these women were borderline ovarian tumors.
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Ștefan RA, Ștefan PA, Mihu CM, Csutak C, Melincovici CS, Crivii CB, Maluțan AM, Hîțu L, Lebovici A. Ultrasonography in the Differentiation of Endometriomas from Hemorrhagic Ovarian Cysts: The Role of Texture Analysis. J Pers Med 2021; 11:jpm11070611. [PMID: 34203314 PMCID: PMC8306221 DOI: 10.3390/jpm11070611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023] Open
Abstract
The ultrasonographic (US) features of endometriomas and hemorrhagic ovarian cysts (HOCs) are often overlapping. With the emergence of new computer-aided diagnosis techniques, this is the first study to investigate whether texture analysis (TA) could improve the discrimination between the two lesions in comparison with classic US evaluation. Fifty-six ovarian cysts (endometriomas, 30; HOCs, 26) were retrospectively included. Four classic US features of endometriomas (low-level internal echoes, perceptible walls, no solid components, and less than five locules) and 275 texture parameters were assessed for every lesion, and the ability to identify endometriomas was evaluated through univariate, multivariate, and receiver operating characteristics analyses. The sensitivity (Se) and specificity (Sp) were calculated with 95% confidence intervals (CIs). The texture model, consisting of seven independent predictors (five variations of difference of variance, image contrast, and the 10th percentile; 100% Se and 100% Sp), was able to outperform the ultrasound model composed of three independent features (low-level internal echoes, perceptible walls, and less than five locules; 74.19% Se and 84.62% Sp) in the diagnosis of endometriomas. The TA showed statistically significant differences between the groups and high diagnostic value, but it remains unclear if the textures reflect the intrinsic histological characteristics of the two lesions.
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Affiliation(s)
- Roxana-Adelina Ștefan
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
| | - Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Correspondence: or
| | - Carmen Mihaela Mihu
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
| | - Carmen Stanca Melincovici
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, Number 4, 400349 Cluj-Napoca, Romania; (R.-A.Ș.); (C.M.M.); (C.S.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
| | - Carmen Bianca Crivii
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes, Street, Number 8, 400012 Cluj-Napoca, Romania;
| | - Andrei Mihai Maluțan
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania;
- Obstetrics and Gynecology Clinic II, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 21 Decembrie 1989 Boulevard, Number 55, 400094 Cluj-Napoca, Romania
| | - Liviu Hîțu
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, Number 5, 400006 Cluj-Napoca, Romania; (C.C.); (A.L.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street, Number 3-5, 400006 Cluj-Napoca, Romania
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Ștefan PA, Lupean RA, Mihu CM, Lebovici A, Oancea MD, Hîțu L, Duma D, Csutak C. Ultrasonography in the Diagnosis of Adnexal Lesions: The Role of Texture Analysis. Diagnostics (Basel) 2021; 11:diagnostics11050812. [PMID: 33947150 PMCID: PMC8145244 DOI: 10.3390/diagnostics11050812] [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: 04/02/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
The classic ultrasonographic differentiation between benign and malignant adnexal masses encounters several limitations. Ultrasonography-based texture analysis (USTA) offers a new perspective, but its role has been incompletely evaluated. This study aimed to further investigate USTA’s capacity in differentiating benign from malignant adnexal tumors, as well as comparing the workflow and the results with previously-published research. A total of 123 adnexal lesions (benign, 88; malignant, 35) were retrospectively included. The USTA was performed on dedicated software. By applying three reduction techniques, 23 features with the highest discriminatory potential were selected. The features’ ability to identify ovarian malignancies was evaluated through univariate, multivariate, and receiver operating characteristics analyses, and also by the use of the k-nearest neighbor (KNN) classifier. Three parameters were independent predictors for ovarian neoplasms (sum variance, and two variations of the sum of squares). Benign and malignant lesions were differentiated with 90.48% sensitivity and 93.1% specificity by the prediction model (which included the three independent predictors), and with 71.43–80% sensitivity and 87.5–89.77% specificity by the KNN classifier. The USTA shows statistically significant differences between the textures of the two groups, but it is unclear whether the parameters can reflect the true histopathological characteristics of adnexal lesions.
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Affiliation(s)
- Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Victor Babes Street 8, 400012 Cluj-Napoca, Romania;
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
| | - Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street 4, 400349 Cluj-Napoca, Romania
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-7464-31286
| | - Carmen Mihaela Mihu
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street 4, 400349 Cluj-Napoca, Romania
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street 3–5, 400006 Cluj-Napoca, Romania
| | - Mihaela Daniela Oancea
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania;
- Obstetrics and Gynecology Clinic II, Mother and Child Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 21 Decembrie 1989 Boulevard 55, 400094 Cluj-Napoca, Romania
| | - Liviu Hîțu
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Daniel Duma
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Doctoral School, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Clinicilor Street 5, 400006 Cluj-Napoca, Romania; (C.M.M.); (A.L.); (D.D.); (C.C.)
- Radiology, Surgical Specialties Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Clinicilor Street 3–5, 400006 Cluj-Napoca, Romania
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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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JAMMAL MILLENAPRATA, DA SILVA ALLISONARAÚJO, FILHO AGRIMALDOMARTINS, DE CASTRO CÔBO ELIÂNGELA, ADAD SHEILAJORGE, MURTA EDDIEFERNANDOCANDIDO, NOMELINI ROSEKEILASIMÕES. Immunohistochemical staining of tumor necrosis factor-α and interleukin-10 in benign and malignant ovarian neoplasms. Oncol Lett 2015; 9:979-983. [PMID: 25624918 PMCID: PMC4301559 DOI: 10.3892/ol.2014.2781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/21/2014] [Indexed: 01/29/2023] Open
Abstract
Ovarian cancer is the ninth most common malignancy and the fifth leading cause of cancer death in women in the USA. The majority of malignant tumors of the ovary are diagnosed at an advanced stage, making it the most fatal gynecological cancer. The aim of the current study was to determine whether there are differences in immunohistochemical tissue staining of cytokine tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) between benign tumors and malignant primary ovarian cancer. In total, 28 patients undergoing surgery for ovarian cysts were evaluated, and a diagnosis of benign neoplasm (n=14) or malignant neoplasm (n=14) was determined. An immunohistochemical study of histological sections of ovarian tumors was conducted. The results were analyzed using Fisher's exact test, with P<0.05 indicating a statistically significant difference. Immunohistochemical staining of IL-10 was increased in malignant tumors compared with benign tumors (P=0.0128). For TNF-α, the immunohistochemical staining was more intense in malignant neoplasms, however, a statistically significant difference was not observed. These results indicate that the analysis of cytokines may be useful as a potential tissue marker of ovarian malignancy.
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Affiliation(s)
- MILLENA PRATA JAMMAL
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ALLISON ARAÚJO DA SILVA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - AGRIMALDO MARTINS FILHO
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ELIÂNGELA DE CASTRO CÔBO
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - SHEILA JORGE ADAD
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - EDDIE FERNANDO CANDIDO MURTA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ROSEKEILA SIMÕES NOMELINI
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
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Filho AM, Jammal MP, Côbo EDC, Silveira TP, Adad SJ, Murta EFC, Nomelini RS. Correlation of cytokines and inducible nitric oxide synthase expression with prognostic factors in ovarian cancer. Immunol Lett 2014; 158:195-9. [DOI: 10.1016/j.imlet.2014.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/17/2013] [Accepted: 01/10/2014] [Indexed: 01/21/2023]
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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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9
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Borderline ovarian tumors: features and controversial aspects. Eur J Obstet Gynecol Reprod Biol 2013; 167:86-9. [DOI: 10.1016/j.ejogrb.2012.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 09/08/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022]
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10
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Bazot M, Cortez A, Daraï É, Froment-Leonetti V, Nassar-Slaba J, Haouy D, Morel A, Dechoux-Vodovar S, Thomassin-Naggara I. Imagerie des tumeurs ovariennes épithéliales frontières. IMAGERIE DE LA FEMME 2012. [DOI: 10.1016/j.femme.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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.
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Affiliation(s)
- F Amor
- Centro Ecografico Ultrasonic Panoramico, Santiago, Chile
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Hata T, Hata K, Noguchi J, Kanenishi K, Shiota A. Ultrasound for evaluation of adnexal malignancy: From 2D to 3D ultrasound. J Obstet Gynaecol Res 2011; 37:1255-68. [DOI: 10.1111/j.1447-0756.2011.01642.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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13
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Gatreh-Samani F, Tarzamni MK, Olad-Sahebmadarek E, Dastranj A, Afrough A. Accuracy of 64-multidetector computed tomography in diagnosis of adnexal tumors. J Ovarian Res 2011; 4:15. [PMID: 21846406 PMCID: PMC3170630 DOI: 10.1186/1757-2215-4-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adnexal cancers are in fifth place among the tumors with the highest mortality in the female population. The aim of the present study was to evaluate the accuracy of Multi-detector computed tomography (MDCT) on a 64-multislice CT scanner in the detection and differentiation of adnexal masses stages. METHODS During the present prospective study, 95 women with a primary diagnosis of ovarian mass in base of clinical examination and ultrasonographic findings underwent preoperative evaluation by a 64-slice MDCT with a section thickness of 0.6 mm, 50% overlap and reconstructed images. Afterward, results of MDCT were compared with surgical and histopathological findings, and the sensitivity, specificity, positive and negative predictive value and accuracy were determined. RESULTS The mean age of patients was 48.63 ± 13.93 years. MDCT diagnosed 25 (26.3%) masses to be benign and 70 (73.7%) to be malignant (sensitivity, specificity, positive and negative predictive value and accuracy were 92.8%, 88.0%, 95.5%, 81.4% and 91.5% respectively). The sensitivity and specificity of MDCT in determining local extension was 72.2% and 93.4% respectively. And the sensitivity and specificity of MDCT in determining peritoneal seeding and liver extension was 81.8% and 93% respectively. Estimated stage was significantly agreed with the surgical (Cohen's Kappa (κ) = 0.891) and histopathological findings (κ = 0.858). CONCLUSION MDCT is a highly sensitive and specific diagnostic method in evaluation of adnexal masses and successfully stage the tumor in consistent with surgery and histopathology.
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Affiliation(s)
- Fatemeh Gatreh-Samani
- Department of Radiology, Imam Reza Hospital, Tabriz University (Medical Sciences), Tabriz, Eastern Azerbaijan, Iran.
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Lutz AM, Willmann JK, Drescher CW, Ray P, Cochran FV, Urban N, Gambhir SS. Early Diagnosis of Ovarian Carcinoma: Is a Solution in Sight? Radiology 2011; 259:329-45. [DOI: 10.1148/radiol.11090563] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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15
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Alcázar JL, Guerriero S, Laparte C, Ajossa S, Ruiz-Zambrana Á, Melis GB. Diagnostic performance of transvaginal gray-scale ultrasound for specific diagnosis of benign ovarian cysts in relation to menopausal status. Maturitas 2011; 68:182-8. [DOI: 10.1016/j.maturitas.2010.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/08/2010] [Accepted: 09/09/2010] [Indexed: 11/25/2022]
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Guerriero S, Alcazar JL, Pascual MA, Ajossa S, Graupera B, Hereter L, Melis GB. The diagnosis of ovarian cancer: is color Doppler imaging reproducible and accurate in examiners with different degrees of experience? J Womens Health (Larchmt) 2011; 20:273-7. [PMID: 21265646 DOI: 10.1089/jwh.2010.2277] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the reproducibility and accuracy of color Doppler flow location in indeterminate masses after a gray-scale sonography in the diagnosis of ovarian malignancy. METHODS Digitally stored color Doppler sonographic images from a random sample of 130 women with an indeterminate adnexal mass submitted to surgery were evaluated by six different examiners with different degrees of experience. A mass was graded malignant if flow was shown within the excrescences or solid areas. Intraobserver agreement and interobserver agreement according to the level of experience were assessed by calculating the kappa index. RESULTS Intraobserver agreement was good for all examiners with different degrees of experience (kappa 0.72-0.89). Interobserver agreement was good to moderate for all operators (kappa 0.48-0.71) irrespective of degree of experience. The accuracy was comparable among different operators. CONCLUSIONS Our results indicate that color Doppler imaging for detection of adnexal malignancy seems to be a reproducible method even in moderately experienced examiners.
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Affiliation(s)
- Stefano Guerriero
- San Giovanni di Dio Hospital, Department of Obstetrics and Gynaecology, University of Cagliari, Cagliari, Italy.
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Alcázar JL, Guerriero S, Laparte C, Ajossa S, Jurado M. Contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women. Eur J Obstet Gynecol Reprod Biol 2011; 155:99-105. [PMID: 21211896 DOI: 10.1016/j.ejogrb.2010.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 10/18/2010] [Accepted: 11/22/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the contribution of power Doppler blood flow mapping to gray-scale ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women. STUDY DESIGN One thousand and ninety-four women with adnexal mass were included. Patients were divided into three groups according to clinical complaints: asymptomatic (group A), patients with symptoms non-suspicious of ovarian cancer (group B) and patients with symptoms suspicious of ovarian cancer (group C). All patients underwent transvaginal power Doppler ultrasound prior to surgery. Any mass in which the echo architecture at B-mode ultrasound was not highly suggestive of benign histology was categorized as questionable. In these cases power Doppler was performed as the second step. Definitive histological diagnosis was used as the standard reference. Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR) were calculated for B-mode diagnosis and B-mode plus Doppler in each group. RESULTS In group A, B-mode was significantly more sensitive (98.1%) than Doppler ultrasound (91.3%) (p<0.01). In group B Doppler ultrasound (97.0%) was more specific than B-mode ultrasound (92.2%) (p<0.001). In group C Doppler ultrasound (84.0%) was more specific than B-mode ultrasound (68.0%) (p<0.001). Positive LR was significantly higher after Doppler evaluation in all groups (30.5 vs 12.8 in group A, 33.2 vs 12.8 in group B and 6.0 vs 3.1 in group C). CONCLUSIONS The diagnostic performance of B-mode and power Doppler ultrasound is different depending on patients' complaints.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain.
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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]
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Arab M, Gillani MM, Morvarian S, Tehranian A, Golfam F, Ebrahimi M, Akhavan S. Dermoid Cyst: A Multicentric Analysis. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maliheh Arab
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shiva Morvarian
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afsaneh Tehranian
- Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Farzaneh Golfam
- Shahed University of Medical Sciences and Health Services, Tehran, Iran
| | - Mojgan Ebrahimi
- Hamadan University of Medical Sciences and Health Services, Hamadan, Iran
| | - Setareh Akhavan
- Kordistan University of Medical Sciences and Health Services, Kordistan, Iran
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Guerriero S, Alcazar JL, Ajossa S, Galvan R, Laparte C, García-Manero M, Lopez-Garcia G, Melis GB. Transvaginal Color Doppler Imaging in the Detection of Ovarian Cancer in a Large Study Population. Int J Gynecol Cancer 2010; 20:781-6. [DOI: 10.1111/igc.0b013e3181de9481] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group.Methods:The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral.Results:Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P = 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status.Conclusions:The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.
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Can quantitative dynamic contrast-enhanced MRI independently characterize an ovarian mass? Eur Radiol 2010; 20:2176-83. [DOI: 10.1007/s00330-010-1795-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/29/2010] [Accepted: 02/28/2010] [Indexed: 11/27/2022]
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Guerriero S, Alcazar JL, Pascual MA, Ajossa S, Gerada M, Bargellini R, Virgilio B, Melis GB. Diagnosis of the most frequent benign ovarian cysts: is ultrasonography accurate and reproducible? J Womens Health (Larchmt) 2009; 18:519-27. [PMID: 19361320 DOI: 10.1089/jwh.2008.0997] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the reproducibility and the accuracy of B-mode ultrasonographic features of three different kinds of benign ovarian cysts: ovarian endometrioma, mature teratoma, and serous cyst. METHODS Digitally stored B-mode sonographic images of 98 women submitted to surgery for the presence of an adnexal mass were evaluated by five different examiners with different degrees of experience. The histological type of each mass was predicted on the basis of the B-mode typical benign findings, as in the case of endometrioma (groundglass endocystic pattern), cystic teratoma (echogenic pattern with or without acoustic shadow), and serous cyst (anechoic cyst without endocystic vegetations). To assess the reproducibility of the B-mode findings, intraobserver and interobserver agreements were calculated using the kappa index. RESULTS The intraobserver agreement was good or very good for all examiners and for all patterns (kappa = 0.71-1) except for the dermoid cyst, which showed moderate agreement (kappa = 0.42) for the highly experienced operator. The interobserver agreement was good for all experts for endometrioma (kappa = 0.66-0.78) and for serous cyst (kappa = 0.82-1), whereas it was moderate or good for cystic teratoma (kappa = 0.51-0.72). Interobserver agreement between experts and highly experienced operators was fair (kappa = 0.33-0.36) for teratoma and good or very good for endometrioma (kappa = 0.70-0.83) and serous cyst (kappa = 0.76-0.82). For different kinds of cysts, the accuracy was comparable among different operators. CONCLUSIONS Typical features of benign masses using grayscale transvaginal ultrasonography are reproducible even in moderately experienced examiners, although more experience was associated with better interobserver agreement. The diagnostic performance of different operators with different degrees of experience is similar.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy.
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Amor F, Vaccaro H, Alcázar JL, León M, Craig JM, Martinez J. Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:285-291. [PMID: 19244063 DOI: 10.7863/jum.2009.28.3.285] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to describe a new reporting system called the Gynecologic Imaging Reporting and Data System (GI-RADS) for reporting findings in adnexal masses based on transvaginal sonography. METHODS A total of 171 women (mean age, 39 years; range, 16-77 years) suspected of having an adnexal mass were evaluated by transvaginal sonography before treatment. Pattern recognition analysis and color Doppler blood flow location were used for determining the presumptive diagnosis. Then the GI-RADS was used, with the following classifications: GI-RADS 1, definitively benign; GI-RADS 2, very probably benign; GI-RADS 3, probably benign; GI-RADS 4, probably malignant; and GI-RADS 5, very probably malignant. Patients with GI-RADS 1 and 2 tumors were treated expectantly. All GI-RADS 3, 4, and 5 tumors were removed surgically, and a definitive histologic diagnosis was obtained. The GI-RADS classification was compared with final histologic diagnosis. RESULTS A total of 187 masses were evaluated. The prevalence rate for malignant tumors was 13.4%. Overall GI-RADS classification rates were as follows: GI-RADS 1, 4 cases (2.1%); GI-RADS 2, 52 cases (27.8%); GI-RADS 3, 90 cases (48.1%); GI-RADS 4, 13 cases (7%); and GI-RADS 5, 28 cases (15%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92%, 97%, 85%, 99%, and 96%, respectively. CONCLUSIONS Our proposed reporting system showed good diagnostic performance. It is simple and could facilitate communication between sonographers/sonologists and clinicians.
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Affiliation(s)
- Fernando Amor
- Centro Ecografico Ultrasonic Panoramico, Santiago, Chile
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Alcázar JL, Rodriguez D. Three-dimensional power Doppler vascular sonographic sampling for predicting ovarian cancer in cystic-solid and solid vascularized masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:275-281. [PMID: 19244062 DOI: 10.7863/jum.2009.28.3.275] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the role of 3-dimensional (3D) power Doppler (PD) sonography to discriminate between benign and malignant cystic-solid and solid vascularized adnexal masses and to define cutoff values for 3D PD indices to be used in a clinical setting. METHODS A total of 143 consecutive women (mean age, 50.4 years; range, 17-82 years) with diagnoses of cystic-solid or solid vascularized adnexal masses on B-mode and 2-dimensional PD sonography were evaluated by 3D PD sonography before surgery. Three-dimensional PD sonography was used to assess vascularization within papillary projections and solid areas with a virtual organ computer-aided analysis program. Three-dimensional PD vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS A total of 113 masses (74%) were malignant, and 39 (26%) were benign. Morphologic evaluation revealed 30 unilocular solid masses (19.7%), 43 multilocular solid masses (28.3%), and 79 mostly solid masses (52%). The mean VI (9.365% versus 3.3%; P< .001), FI (34.318 versus 28.794; P< .001), and VFI (3.233 versus 1.15; P<0.01) were significantly higher in malignant tumors. No differences were found in the resistive index, pulsatility index, and peak systolic velocity. Receiver operating characteristic analysis revealed an area under the curve of 0.77 (95% confidence interval, 0.69-0.85), 0.71 (0.60-0.81), and 0.75 (0.66-0.83) for the VI, FI and VFI, respectively. For reducing the false-positive rate by almost one-third, sensitivity values for the VI (cutoff, 1.556%), FI (25.212), and VFI (0.323) were 92%, 95%, and 93%, respectively. CONCLUSIONS Three-dimensional PD vascular indices could be helpful for reducing the false-positive rate in cystic-solid and solid vascularized adnexal masses.
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Affiliation(s)
- Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
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Guerriero S, Alcazar JL, Pascual MA, Ajossa S, Gerada M, Bargellini R, Virgilio B, Melis GB. Intraobserver and interobserver agreement of grayscale typical ultrasonographic patterns for the diagnosis of ovarian cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1711-1716. [PMID: 18524459 DOI: 10.1016/j.ultrasmedbio.2008.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/27/2008] [Accepted: 04/11/2008] [Indexed: 05/26/2023]
Abstract
The purpose of this study was to evaluate the intraobserver and interobserver agreement for identifying ovarian malignancy using typical grayscale ultrasonographic patterns. Digitally stored grayscale sonographic images from a random sample of 98 women with an adnexal mass submitted to surgery after a grayscale transvaginal sonography were evaluated by five different examiners with different degrees of experience in three European university departments of obstetrics and gynecology. Masses in which the echo features were highly characteristic of a benign pathology were categorized as benign. Any cystic mass containing excrescences, thick septations, multiple irregular septations or solid component in which the echo architecture was not highly suggestive of benign histology was categorized as malignant. Intraobserver and interobserver agreement according to the level of experience were assessed by calculating the kappa index. Of the 98 cases randomly selected, 28 (29%) were malignant masses and 70 (71%) were benign. Intraobserver agreement was good or very good for all examiners with different degrees of experience (kappa = 0.72 to 1). Interobserver agreement was good for all expert operators (kappa = 0.69 to 0.75). Interobserver agreement between experts and highly experienced operators was moderate or good (kappa = 0.51 to 0.63). Interobserver agreement between the moderately experienced operator and experts was fair to moderate (kappa = 0.29 to 0.46). Interobserver agreement between moderately and highly experienced operators was fair (kappa = 0.33). Our results indicate that ultrasonographic malignant patterns are reproducible, even in moderately experienced examiners, although more experience is associated with better interobserver agreement.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy.
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Alcázar JL, Royo P, Jurado M, Mínguez JA, García-Manero M, Laparte C, Galván R, López-García G. Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:220-225. [PMID: 18618475 DOI: 10.1002/uog.5401] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment. METHODS Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology. RESULTS One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant. CONCLUSIONS Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.
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Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
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Sladkevicius P, Jokubkiene L, Valentin L. Contribution of morphological assessment of the vessel tree by three-dimensional ultrasound to a correct diagnosis of malignancy in ovarian masses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:874-882. [PMID: 17943717 DOI: 10.1002/uog.5150] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine whether subjective evaluation of the morphology of the vessel tree of ovarian tumors, as depicted by three-dimensional (3D) power Doppler ultrasound, can discriminate between benign and malignant ovarian tumors, and whether it improves characterization compared with using gray-scale ultrasound imaging alone. METHODS A consecutive series of 104 women scheduled for surgical removal of an ovarian mass were examined with transvaginal two-dimensional (2D) gray-scale and 3D power Doppler ultrasound. Predetermined vessel characteristics, e.g. density of vessels, branching, caliber changes and tortuosity, were evaluated in 360 degrees rotating 3D images of the vessel tree of the tumor. Ultrasound results were compared with those of the histology of the surgical specimens. Univariate and multivariate logistic regression were used. RESULTS There were 77 benign tumors, six borderline tumors and 21 invasive malignancies. All vascular features differed significantly between benign and malignant tumors. The areas under their receiver-operating characteristics (ROC) curves (AUCs) were in the range 0.61-0.83. The AUC of a logistic regression model containing three gray-scale ultrasound variables was 0.98. This model correctly classified all malignancies, with a false-positive rate of 10% (8/77). Adding branching of vessels in the whole tumor to the gray-scale model yielded an AUC of 0.99 and resulted in all malignancies and an additional four benign tumors being correctly classified. CONCLUSIONS Subjective evaluation of the morphology of the vessel tree, as depicted by 3D power Doppler ultrasound, can be used to discriminate between benign and malignant ovarian tumors, but adds little to gray-scale ultrasound imaging in an ordinary population of tumors.
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Affiliation(s)
- P Sladkevicius
- Department of Obstetrics and Gynecology, Malmö University Hospital, Lund University, Malmö, Sweden.
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Yazbek J, Helmy S, Ben-Nagi J, Holland T, Sawyer E, Jurkovic D. Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:883-888. [PMID: 17932999 DOI: 10.1002/uog.5169] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses. METHODS Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy. RESULTS One hundred and forty-three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94-99%), specificity of 79% (95% CI, 60-90%), positive predictive value of 95% (95% CI, 89-98%), positive likelihood ratio of 4.58 (95% CI, 2.25-9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01-0.09). CONCLUSIONS A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK.
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Guerriero S, Ajossa S, Piras S, Gerada M, Floris S, Garau N, Minerba L, Paoletti AM, Melis GB. Three-dimensional quantification of tumor vascularity as a tertiary test after B-mode and power Doppler evaluation for detection of ovarian cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1271-8. [PMID: 17901131 DOI: 10.7863/jum.2007.26.10.1271] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the role of 3-dimensional (3D) quantification of tumor vascularity in the differential diagnosis of pelvic indeterminate masses with a solid appearance or unilocular or multilocular cysts with a solid component showing central vascularization on 2-dimensional power Doppler sonography. METHODS One hundred fifty-seven consecutive pelvic masses in 153 patients were included in this study and underwent sonography before surgery. Masses that showed a typical benign pattern on B-mode sonography (n = 112) and indeterminate masses with peripheral or absent flow on power Doppler sonography (n = 10) were not evaluated by 3D sonography. Only masses with central vascularization were submitted to 3D power Doppler imaging (n = 35). The following 3D vascular parameters were calculated: relative color and flow measure (similar to the vascularization flow index obtained with other systems). RESULTS With receiver operating characteristic curve analysis, the best cutoff values for relative color and flow measure were 4.4 and 2.7, respectively. Flow measure had sensitivity of 68% and specificity of 40% in the overall population submitted to 3D power Doppler sonography. Accuracy slightly increased when masses with small papillary projections (<10 mL) were excluded. In this group (n = 22), sensitivity was 83%, and specificity was 50%. CONCLUSIONS In masses with central vascularization on 2-dimensional power Doppler sonography, the use of 3D quantification of tumor vascularity had low diagnostic accuracy in the detection of adnexal malignancies, although an increase in accuracy in masses with a solid portion of greater than 10 mL was reported.
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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 Cagliari, Italy.
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30
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Abstract
Ovarian cancer is the commonest cause of death from a gynaecological malignancy. Diagnosis of the disease at an early stage is associated with significantly improved survival rate. This suggests that screening may impact on disease mortality. This review addresses the current methods of screening, the ongoing trials and future of screening for ovarian cancer.
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Affiliation(s)
- Aarti Sharma
- Gynaecological Cancer Research Centre, Institute of Womens Health, University College London, London W1T 7DN
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31
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Abstract
PURPOSE OF REVIEW Ovarian cancer is an important cause of death among women with a malignant gynecological tumor. Cure rates for the disease at an early stage are around 80-90%, but survival is only 50% as the majority of women already show advanced disease upon diagnosis. The combination of gynecological examination, ultrasonography, and systemic tumor marker assay is considered to be a good strategy for the early diagnosis of ovarian neoplasia. RECENT FINDINGS Today, new technologies such as ultrasonography and tumor marker assay have increased the diagnosis rate for adnexal masses. These non-invasive methods, however, frequently do not distinguish benign conditions from malignant ones, which results in unnecessary surgery. Transvaginal ultrasonography is useful for diagnosing adnexal masses, but benign and malignant adnexal masses can present similar morphological characteristics. Combination with color Doppler ultrasonography and/or tumor markers may improve the accuracy of the method. Gene-expression array, proteomics and mathematical models form new approaches, but proper prospective studies are needed to validate them. SUMMARY The techniques of pelvic examination, ultrasonography, color Doppler ultrasonography, and tumor markers can be indicated for the diagnosis of ovarian cancer. The differentiation between benign and malignant ovarian tumor is, however, a clinical challenge. Until better diagnostic methods become available, patients and their physicians can use these techniques to decide on management.
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Affiliation(s)
- Eddie F C Murta
- Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil.
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