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Roy Choudhury M, Pappas TC, Twiggs LB, Caoili E, Fritsche H, Phan RT. Ovarian Cancer surgical consideration is markedly improved by the neural network powered-MIA3G multivariate index assay. Front Med (Lausanne) 2024; 11:1374836. [PMID: 38756943 PMCID: PMC11097110 DOI: 10.3389/fmed.2024.1374836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Background Surgery remains the main treatment option for an adnexal mass suspicious of ovarian cancer. The malignancy rate is, however, only 10-15% in women undergoing surgery. This results in a high number of unnecessary surgeries. A surveillance-based approach is recommended to form the basis for surgical referrals. We have previously reported the clinical performance of MIA3G, a deep neural network-based algorithm, for assessing ovarian cancer risk. In this study, we show that MIA3G markedly improves the surgical selection for women presenting with adnexal masses. Methods MIA3G employs seven serum biomarkers, patient age, and menopausal status. Serum samples were collected from 785 women (IQR: 39-55 years) across 12 centers that presented with adnexal masses. MIA3G risk scores were calculated for all subjects in this cohort. Physicians had no access to the MIA3G risk score when deciding upon a surgical referral. The performance of MIA3G for surgery referral was compared to clinical and surgical outcomes. MIA3G was also tested in an independent cohort comprising 29 women across 14 study sites, in which the physicians had access to and utilized MIA3G prior to surgical consideration. Results When compared to the actual number of surgeries (n = 207), referrals based on the MIA3G score would have reduced surgeries by 62% (n = 79). The reduction was higher in premenopausal patients (77%) and in patients ≤55 years old (70%). In addition, a 431% improvement in malignancy prediction would have been observed if physicians had utilized MIA3G scores for surgery selection. The accuracy of MIA3G referral was 90.00% (CI 87.89-92.11), while only 9.18% accuracy was observed when the MIA3G score was not used. These results were corroborated in an independent multi-site study of 29 patients in which the physicians utilized MIA3G in surgical consideration. The surgery reduction was 87% in this cohort. Moreover, the accuracy and concordance of MIA3G in this independent cohort were each 96.55%. Conclusion These findings demonstrate that MIA3G markedly augments the physician's decisions for surgical intervention and improves malignancy prediction in women presenting with adnexal masses. MIA3G utilization as a clinical diagnostic tool might help reduce unnecessary surgeries.
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Affiliation(s)
- Manjusha Roy Choudhury
- Department of Research and Development, Aspira Women’s Health, Austin, TX, United States
| | - Todd C. Pappas
- Department of Research and Development, Aspira Women’s Health, Austin, TX, United States
| | - Leo B. Twiggs
- Division of Clinical Operations and Medical Affairs, Aspira Women's Health, Austin, TX, United States
| | - Emma Caoili
- Department of Regulatory Affairs and Quality Assurance, Aspira Women’s Health, Shelton, CT, United States
| | | | - Ryan T. Phan
- Department of Research and Development, Aspira Women’s Health, Austin, TX, United States
- Division of Clinical Operations and Medical Affairs, Aspira Women's Health, Austin, TX, United States
- Aspira Labs, Aspira Women's Health, Austin, TX, United States
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Liu Q, Li Z, Zhou H, Cao D, Yang J, Shen K, Lang J. Clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Orphanet J Rare Dis 2024; 19:132. [PMID: 38515195 PMCID: PMC10958921 DOI: 10.1186/s13023-024-03101-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our objective was to better define the clinical presentation of adnexal torsion and to distinguish characteristics of those with torsion and those with an alternate diagnosis. METHODS Retrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019.Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 26.0. RESULTS The median age of the patients was 14.5 ± 3.6 years at the operation. 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. A total of 82.1% (174/212) of the participants underwent adnexal conservative surgery. 179 (84.5%, 179/212) patients underwent laparoscopic surgery with an average tumor size of 7.7 ± 3.4 cm, while 33 patients ( 15.6%, 33/212) underwent laparotomy. Rupture of mass and ectopic pregnancy accounted for 7.5% (16/212) and 0.9%(2/212), respectively. Torsion was responsible for 36.8% (78/212) of all patients. Among the patients with torsion, the symptom of nausea and vomiting was more common among girls without torsion (P < 0.0001). 88.5% of the girls with torsion had acute onset of abdominal pain, while 92.3% had persistent pain that could not be relieved or occurred repeatedly, which significantly higher than that in the patients without torsion (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). 88.5% of girls with torsion had an ovarian cyst/mass ≥ 5 cm, compared with 75.0% in girls without torsion (P = 0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm (OR 4.134, 95% CI: 1.349-12.669,P = 0.013), acute onset pain (OR 24.150,95%CI: 8.398-69.444,P = 0.000), persistent or recurrent pain (OR 15.911,95%CI: 6.164-41.075,P = 0.000) were significantly associated with increased risk of torsion. CONCLUSIONS Torsion which is a relatively rare event in the pediatric population was not an uncommon condition and responsible for more than one third of all pediatric and adolescent patients presented with adnexal masses and abdominal pain. Pain assessment in children and adolescents is important to distinguish characteristics of those with torsion and those with an alternate diagnosis.Thus, pediatric and adolescent patients particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain have a benign cause and not missing the devastating condition that needs emergent attention. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL) may improve ovarian salvage.
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Affiliation(s)
- Qian Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Zhiqiang Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250062, Jinan, China
| | - Huimei Zhou
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China.
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 ShuaiFu Yuan, Dongcheng District, 100730, Beijing, China
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Antil N, Wang H, Kaffas AE, Desser TS, Folkins A, Longacre T, Berek J, Lutz AM. In Vivo Ultrasound Molecular Imaging in the Evaluation of Complex Ovarian Masses: A Practical Guide to Correlation with Ex Vivo Immunohistochemistry. Adv Biol (Weinh) 2023; 7:e2300091. [PMID: 37403275 DOI: 10.1002/adbi.202300091] [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: 02/24/2023] [Revised: 04/22/2023] [Indexed: 07/06/2023]
Abstract
Ovarian cancer is the fifth leading cause of cancer-related deaths in women and the most lethal gynecologic cancer. It is curable when discovered at an early stage, but usually remains asymptomatic until advanced stages. It is crucial to diagnose the disease before it metastasizes to distant organs for optimal patient management. Conventional transvaginal ultrasound imaging offers limited sensitivity and specificity in the ovarian cancer detection. With molecularly targeted ligands addressing targets, such as kinase insert domain receptor (KDR), attached to contrast microbubbles, ultrasound molecular imaging (USMI) can be used to detect, characterize and monitor ovarian cancer at a molecular level. In this article, the authors propose a standardized protocol is proposed for the accurate correlation between in- vivo transvaginal KDR-targeted USMI and ex vivo histology and immunohistochemistry in clinical translational studies. The detailed procedures of in vivo USMI and ex vivo immunohistochemistry are described for four molecular markers, CD31 and KDR with a focus on how to enable the accurate correlation between in vivo imaging findings and ex vivo expression of the molecular markers, even if not the entire tumor could can be imaged by USMI, which is not an uncommon scenario in clinical translational studies. This work aims to enhance the workflow and the accuracy of characterization of ovarian masses on transvaginal USMI using histology and immunohistochemistry as reference standards, which involves sonographers, radiologists, surgeons, and pathologists in a highly collaborative research effort of USMI in cancer.
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Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Huaijun Wang
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Terry S Desser
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Ann Folkins
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Teri Longacre
- Department of Pathology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Jonathan Berek
- Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford University, School of Medicine, Stanford, CA, 94304, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford University, School of Medicine, Stanford, CA, 94304, USA
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AlDakhil L, Aljuhaimi A, AlKhattabi M, Alobaid S, Mattar RE, Alobaid A. Ovarian neoplasia in adolescence: a retrospective chart review of girls with neoplastic ovarian tumors in Saudi Arabia. J Ovarian Res 2022; 15:105. [PMID: 36114569 PMCID: PMC9482250 DOI: 10.1186/s13048-022-01033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ovarian neoplasia in children and adolescents is a rare tumor. The diagnosis and management of such tumors is often difficult and delayed due to non-specific symptoms and low suspicion. Surgical management that preserves fertility and ovarian function should be the goal. Objective This study aimed to review the clinical presentation, tumor characteristics, and management of Saudi Arabian adolescents. Methods A retrospective chart review was conducted on adolescent girls aged 19 or less admitted to tow referral hospital in Riyadh, Saudi Arabia, diagnosed with adnexal mass over an 8 years’ period; patients who were older than 19 were excluded. The data collected from patients’ charts included age, presenting symptoms, radiologic findings, type of surgery, specialist who performed the surgery, and histopathology of the tumors. We classified patients according to age using the three WHO developmental stages: early adolescence (10–13 years old), middle adolescence (14–16 years old), and late adolescence (16–17 years old). The statistical study used SPSS version 18.0 to determine the data’s frequency, distributions, and means (SPSS Inc., Chicago, IL). Results We analyzed 164 patients, between 10 and 19 years old, admitted to two hospitals between 2009 and 2017. We found that 85% of these patients underwent surgery for adnexal mass removal, and 90.2% were symptomatic or emergency cases. The majority of our patients were post-menarche (96.95%), and were between the ages of 14 and 19. The most common surgical procedure for tumor removal was laparoscopic cystectomy (74.4%). An adnexal mass with a solid component on ultrasound is the most commonly found indicator of malignancy. The majority of tumors were benign (32.3%). Germ cell tumors were the most common (68.7%) malignant tumor, and yolk sac tumors were the most common subgroup of germ cell tumors. When managed by a gynecologist, surgical intervention can be a successful method of preserving fertility. Conclusions Our results confirm that the majority of neoplastic ovarian tumors in children and adolescents are benign, and surgical intervention can be used to maintain fertility, especially when managed by a gynecologist. This is one of the largest reported series and the first from our area.
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Raźnikiewicz A, Korlacki W, Grabowski A. Evaluation of the usefulness of laparoscopy in the diagnosis and treatment of adnexal pathologies in the pediatric population. Wideochir Inne Tech Maloinwazyjne 2020; 15:366-376. [PMID: 32489499 PMCID: PMC7233164 DOI: 10.5114/wiitm.2020.93998] [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: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The current trend in adnexal surgery in children is to minimize the invasiveness of diagnostic and therapeutic procedures, reduce the number of complications and reduce the risk of infertility. AIM Evaluation of the usefulness and effectiveness of laparoscopy in diagnostics and treatment of pathological lesions of adnexa in the pediatric population and evaluation of the correlation of imaging with the intraoperative diagnosis during laparoscopy. MATERIAL AND METHODS The study included 89 patients aged 0-18 years (mean: 12.62) who underwent an emergency or elective laparoscopic procedure due to the suspicion of adnexa pathology in the imaging tests or in which intraoperative pathology of the adnexa was found without previous suspicion of these changes in the imaging tests. Patients were divided into 2 groups according to the procedure (emergency or elective) and into 4 age groups. RESULTS The most frequent postoperative diagnosis was an adnexal cyst and ovarian tumor. The ratio of malignant to benign lesions was 0.087. In 32.58% of patients appendix pathology was found. Coexistence of adnexa and appendix pathology was statistically significantly more frequent in patients undergoing emergency surgery (p = 0.013). There was no correlation between the size of the tumor or ovarian cyst and the occurrence of adnexal torsion, and no correlation between the size of the tumor and the degree of torsion of the adnexa. Three conversions were performed. The average operation time was 63.7 min. CONCLUSIONS Laparoscopic diagnosis and treatment of adnexal pathology seems to be safe due to the low percentage of perioperative complications. It shows high sensitivity in recognizing adnexal pathologies and other defects.
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Affiliation(s)
- Aleksandra Raźnikiewicz
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Wojciech Korlacki
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Andrzej Grabowski
- Department of Children's Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
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Ohliger MA, Choi HH, Coutier J. Imaging Safety and Technical Considerations in the Reproductive Age Female. Radiol Clin North Am 2020; 58:199-213. [DOI: 10.1016/j.rcl.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Elgendy A, Lakshminarayanan B, Elrouby A, Mostafa M, Salem MA, Turner K, Khairi A, Squire R, K Shehata SM, Shehata S, Powis M. Management of pediatric benign ovarian tumors in England and Egypt: A comparative study. Afr J Paediatr Surg 2020; 17:33-38. [PMID: 33106451 PMCID: PMC7818669 DOI: 10.4103/ajps.ajps_64_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIM OF THE STUDY We aimed to compare the management of pediatric benign ovarian tumors between an English center and three Egyptian institutions. MATERIALS AND METHODS This was a retrospective review of all children presenting with benign ovarian tumors between January 2014 and January 2019. A standardized dataset was used to compare between both sides. RESULTS Eighty-nine patients were included (54 English and 35 Egyptians). Median age at diagnosis in England was 13 years (2-16y), while in Egypt it was 7 years (9m-16y) with P =0.001. Mature teratomas or dermoid cysts were the most common findings in England and Egypt; 75.9% and 82.8% of cases, respectively. The presentation with an acute abdomen represented 27.8% of English and 28.6% of Egyptian patients. Incidentally diagnosed lesions constituted 15% of English patients, whereas none of the Egyptian cases were discovered incidentally. There were variations in diagnostic imaging; England: Ultrasound (USS) (54), magnetic resonance imaging (MRI) (37), and computed tomography (CT) (only one)-Egypt: USS (35), CT (17), and MRI (only one). Minimally invasive surgery (MIS) was performed in 15% of English and 23% of Egyptian patients (P = 0.334). Ovarian-sparing surgery (OSS) was performed in: England 35%, Egypt 37%; P = 0.851. OSS was performed using MIS in 87.5% (7/8) of English patients and 100% (8/8) of Egyptians. Patients presented as emergencies generally had open oophorectomies: England; 86.7% open and 80% oophorectomy-Egypt; 100% open and 90% oophorectomy. Recurrences or metachronous disease occurred in 5.6% of English and 5.7% of Egyptian patients. CONCLUSIONS There were no significant differences regarding surgical management, tumor pathology, and recurrence or metachronous disease. However, age, incidental diagnosis, and imaging modalities showed notable differences. MIS was correlated with ovarian preservation, whereas emergency surgery generally resulted in open oophorectomy.
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Affiliation(s)
- Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Tanta University, Tanta, Egypt
| | | | - Ahmed Elrouby
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mahmoud Mostafa
- Department of Pediatric Surgery, Assiut University, Assiut, Egypt
| | | | - Kerry Turner
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | - Ahmed Khairi
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Roly Squire
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
| | | | - Sameh Shehata
- Department of Pediatric Surgery, Alexandria University, Alexandria, Egypt
| | - Mark Powis
- Department of Pediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK
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Rizzo S, De Piano F, Buscarino V, Pagan E, Bagnardi V, Zanagnolo V, Colombo N, Maggioni A, Del Grande M, Del Grande F, Bellomi M, Aletti G. Pre-operative evaluation of epithelial ovarian cancer patients: Role of whole body diffusion weighted imaging MR and CT scans in the selection of patients suitable for primary debulking surgery. A single-centre study. Eur J Radiol 2019; 123:108786. [PMID: 31862634 DOI: 10.1016/j.ejrad.2019.108786] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE to evaluate the accuracy of Whole Body MRI including Diffusion-Weighted Imaging sequences (WB DWI MR) in the assessment of sites of disease in epithelial ovarian cancer (EOC), in comparison to CT; to evaluate whether a clinical-radiological score may predict suboptimal cytoreductive surgery. METHODS patients with suspected EOC who underwent pre-operative WB DWI MR were included; CT scans were recorded. Data recorded included: age, staging, dates of examinations and surgery; tumour markers; sites of disease at imaging scans and at surgery. For calculation of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of WB DWI MR and CT, surgical evaluation represented the gold standard. The accuracy of WB DWI MR and CT was compared. The association between clinical and radiological criteria with sub-optimal cytoreduction was tested to identify a final model to predict sub-optimal cytoreduction. RESULTS 92 patients were included; 77/92 (83.7 %) were optimally cytoreduced. Sixty-six CT and 92 MR examinations were evaluated. WB DWI MR showed overall higher accuracy than CT in assessing all sites, but it performed significantly better than CT specifically for involvement of mesentery, lumbo-aortic lymph nodes, pelvis, large bowel, sigmoid-rectum. The predicting score for suboptimal cytoreduction included: mesenteric carcinomatosis; mesenteric retraction; large bowel carcinomatosis. CONCLUSIONS In pre-operative evaluation of EOC patients, WB DW MRI is accurate for assessment of multiple sites and it is significantly more accurate than CT for specific unresectable sites. In our series, significant sites of disease for suboptimal cytoreduction were mesenteric carcinomatosis, mesenteric retraction and large bowel carcinomatosis.
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Affiliation(s)
- Stefania Rizzo
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Via Tesserete, 46- 6900, Lugano, Switzerland.
| | - Francesca De Piano
- Università degli Studi di Milano, Postgraduation School in Radiodiagnostics, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Valentina Buscarino
- Department of Radiology, ASLVC, corso Mario Abbiate 21, 13100, Vercelli, Italy
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
| | - Vanna Zanagnolo
- Department of Gynecologic Oncology, IEO European Institute of Oncology, IRCCS via Ripamonti 435, 20141 Milan, Italy
| | - Nicoletta Colombo
- Department of Gynecologic Oncology, IEO European Institute of Oncology, IRCCS via Ripamonti 435, 20141 Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Italy
| | - Angelo Maggioni
- Department of Gynecologic Oncology, IEO European Institute of Oncology, IRCCS via Ripamonti 435, 20141 Milan, Italy
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Filippo Del Grande
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Via Tesserete, 46- 6900, Lugano, Switzerland
| | - Massimo Bellomi
- Department of Radiology, IEO European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giovanni Aletti
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Via Tesserete, 46- 6900, Lugano, Switzerland; Department of Radiology, IEO European Institute of Oncology IRCCS, via Ripamonti 435, 20141 Milan, Italy
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Subtil JC, Alcázar JL, Betes MT, Mínguez JÁ, Zozaya FJ, Chacon E, Manzour N, Hidalgo A, Lozano MD, Muñoz-Navas M, Jurado M. Gastrointestinal Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Assessing Suspected Deep Pelvic or Abdominal Recurrence in Gynecologic Cancer: A Feasibility Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:761-765. [PMID: 30171619 DOI: 10.1002/jum.14766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the feasibility of gastrointestinal endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for histologic confirmation of cancer recurrence in women with gynecologic cancer. METHODS This work was a retrospective cohort study comprising 46 consecutive women treated for gynecologic cancer and suspected of having a deep pelvic or abdominal recurrence on ultrasound imaging, computed tomography, positron emission tomography-computed tomography, or magnetic resonance imaging, evaluated at our institution from January 2010 to December 2017. Primary cancer was ovarian (n = 22), cervical (n = 13), endometrial (n = 4), sarcoma (n = 4), and other (n = 3). All women underwent EUS examinations for locating the lesion and guiding FNA. The results of FNA (benign/malignant) were assessed. Procedure-related complications were recorded. RESULTS The patients' mean age was 57.8 years. A total of 66 procedures were performed. Eleven women underwent 2 procedures; 2 women underwent 3 procedures; and 1 woman underwent 6 procedures at different times during the study period. In 1 case, no lesion was detected on the EUS assessment, and in 2 cases, FNA was not successful. Most lesions were located in the retroperitoneum or involved the intestine. Fine-needle aspiration could be performed in 63 cases (94.5%). Cytologic samples were adequate in 62 of 63 (98.4%). Recurrence was confirmed in 56 cases (90.3%) and ruled out in 6 (9.7%). No patient had any complication related to the procedure. CONCLUSIONS Endoscopic ultrasound-guided FNA is a minimally invasive, feasible, and safe technique for confirming pelvic/abdominal recurrence of gynecologic cancer.
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Affiliation(s)
- José Carlos Subtil
- Department of Gastroenterology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Maria Teresa Betes
- Department of Gastroenterology, Clinica Universidad de Navarra, Pamplona, Spain
| | - José Ángel Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Nabil Manzour
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Alberto Hidalgo
- Department of Obstetrics and Gynecology, Hospital Clinico San Cecilio, Granada, Spain
| | | | - Miguel Muñoz-Navas
- Department of Gastroenterology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Matías Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
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External validation of ADNEX MR SCORING system: a single-centre retrospective study. Clin Radiol 2018; 74:131-139. [PMID: 30514585 DOI: 10.1016/j.crad.2018.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022]
Abstract
AIM To evaluate the accuracy of the ADNEX MR SCORING system for characterising adnexal masses. MATERIALS AND METHODS An institutional review board approved this retrospective study. The study population comprised 663 women who underwent magnetic resonance imaging (MRI) from January 2007 to December 2014 to characterise 778 adnexal masses that were indeterminate under ultrasonography (590 benign and 188 malignant). Two radiologists independently reviewed the MRI images. The masses were scored from 1 to 5 according to the ADNEX MR SCORING system. The diagnostic performance of the system was evaluated by receiver operating characteristic (ROC) analysis. Masses scored 4 or greater were considered malignant (including tumours of borderline malignancy or low malignant potential). RESULTS The malignancy rates of masses with scores of 2, 3, 4 and 5 were 1.9% (8/419), 12.8% (19/149), 62.6% (57/91) and 87.4% (104/119) for reader 1 and 2.1% (9/424), 13.6% (20/147), 67.6% (71/105) and 86.3% (88/102) for reader 2, respectively. The areas under the ROC curves for the differentiation of benign and malignant masses were 0.929 and 0.923, respectively; the sensitivity, specificity and accuracy of diagnosis were 85.6% (161/188), 91.7% (541/590), and 90.2% (702/778) for reader 1 and 84.6% (159/188), 91.9% (542/590), and 90.1% (701/778) for reader 2, respectively. Tumours of borderline malignancy or low malignant potential had a higher rate of misclassification (46.1%) than other malignant tumours (6-7.4%). CONCLUSION The ADNEX MR SCORING system was highly accurate in differentiating benign and malignant adnexal masses, although it may be less accurate for tumours of borderline malignancy or low malignant potential.
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Lin X, Wu D, Zheng N, Xia Q, Han Y. Gonadal germ cell tumors in children: A retrospective review of a 10-year single-center experience. Medicine (Baltimore) 2017; 96:e7386. [PMID: 28658171 PMCID: PMC5500093 DOI: 10.1097/md.0000000000007386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The true incidence of gonadal germ cell tumors (GCTs) in children is unknown. Few studies have been published concerning about pediatric gonadal GCTs. The aim of this study is to review and analyze clinical data on the diagnosis and management of gonadal GCTs in children. METHODS Between 2005 and 2015, 127 pediatric patients (<14 years old) with gonadal GCTs admitted to our institute were reviewed. Clinical features, imaging and laboratory studies, surgical approaches, as well as pathological diagnoses were recorded. RESULTS The series comprised 53 males with testicular GCTs and 74 females with ovarian GCTs. Their median age was 5.8 years old. Palpable mass was the main clinical manifestation of testicular GCTs, while abdominal pain and abdominal distention were the most frequent presenting symptoms of ovarian GCTs. Both computed tomography and magnetic resonance imaging showed a high diagnostic yield. AFP levels were elevated in most malignant GCTs, markedly elevated in yolk sac tumors. All patients were treated surgically. Mature teratoma was the most common type of benign GCTs, while yolk sac tumor was the most common type of malignant GCTs. CONCLUSION Gonadal GCTs in children have various of pathological types, as well as clinical manifestations. Imaging and laboratory data could be useful for differentiation of malignant from benign tumors. Final diagnosis depends on pathology. Surgical excision of the gonadal GCTs is the prior option.
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Affiliation(s)
- Xiaokun Lin
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Dazhou Wu
- Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Na Zheng
- Department of Pediatric Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiongzhang Xia
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
| | - Yijiang Han
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University
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Boaventura CS, Rodrigues DP, Silva OAC, Beltrani FH, de Melo RAB, Bitencourt AGV, Mendes GG, Chojniak R. Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria. Radiol Bras 2017; 50:1-6. [PMID: 28298725 PMCID: PMC5347495 DOI: 10.1590/0100-3984.2015.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the indications for performing magnetic resonance imaging of the
female pelvis at a referral center for cancer. Materials and Methods This was a retrospective, single-center study, conducted by reviewing medical
records and imaging reports. We included 1060 female patients who underwent
magnetic resonance imaging of the pelvis at a cancer center between January
2013 and June 2014. The indications for performing the examination were
classified according to the American College of Radiology (ACR)
criteria. Results The mean age of the patients was 52.6 ± 14.8 years, and 49.8% were
perimenopausal or postmenopausal. The majority (63.9%) had a history of
cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the
patients evaluated, 44.0% had clinical complaints, the most common being
pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had
previously had abnormal findings on ultrasound. Most (76.7%) of the patients
met the criteria for undergoing magnetic resonance imaging, according to the
ACR guidelines. The main indications were evaluation of tumor recurrence
after surgical resection (in 25.9%); detection and staging of gynecologic
neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in
17.1%). Conclusion In the majority of the cases evaluated, magnetic resonance imaging was
clearly indicated according to the ACR criteria. The main indication was
local recurrence after surgical treatment of pelvic malignancies, which is
consistent with the routine protocols at cancer centers.
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Affiliation(s)
| | | | | | | | | | | | | | - Rubens Chojniak
- PhD, MD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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Imaging diagnostics in ovarian cancer: magnetic resonance imaging and a scoring system guiding choice of primary treatment. Eur J Obstet Gynecol Reprod Biol 2017; 210:83-89. [DOI: 10.1016/j.ejogrb.2016.10.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/27/2016] [Accepted: 10/21/2016] [Indexed: 11/21/2022]
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Cipolla V, Guerrieri D, Pietrangeli D, Santucci D, Argirò R, de Felice C. Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility. Acta Radiol 2016; 57:1132-9. [PMID: 26663038 DOI: 10.1177/0284185115617351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. PURPOSE To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. MATERIAL AND METHODS A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). RESULTS The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. CONCLUSION 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up.
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Affiliation(s)
- Valentina Cipolla
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Daniele Guerrieri
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Daniela Pietrangeli
- Department of Obstetrics, Gynaecology and Urological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Domiziana Santucci
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Renato Argirò
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
| | - Carlo de Felice
- Department of Radiological, Oncological and Pathological Sciences, University of Rome “Sapienza”, Rome, Italy
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Hemorrhagic ovarian cysts: Clinical and sonographic correlation with the management options. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Spinelli C, Pucci V, Strambi S, Piccolo RL, Martin A, Messineo A. Treatment of ovarian lesions in children and adolescents: a retrospective study of 130 cases. Pediatr Hematol Oncol 2015; 32:199-206. [PMID: 24274683 DOI: 10.3109/08880018.2013.856050] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this study, we analyze the management of ovarian masses in a total of 130 children surgically treated for 137 ovarian lesions (7 bilateral). The most frequent symptoms were chronic (52.3%) and acute (25.4%) abdominal pain. Histological examination revealed 64 (46.7%) functional lesions, 59 (43.1%) benign neoplasms, 5 (3.7%) malignant ones, and 7 (6.6%) torsed normal ovaries. Ovarian torsion occurred in 36 cases (26.27%). A conservative treatment was performed in 81 (59.1%) girls: 61 (75.3%) treated in nonemergency and 20 (24.7%) in emergency surgery; laparoscopic approach in 35 cases (43.2%); and open surgery in 46 (56.8%). The remaining 56 (40.9%) ovarian masses underwent nonconservative surgery: 40 cases (71.4%) nonemergency and 16 (28.6%) emergency; laparoscopy in 20 patients (35.7%); and open surgery in 36 (64.3%). Fertility preservation should be a goal in the surgical treatment. The management of ovarian torsion should include adnexal detorsion and recovery of the ovarian tissue. In case of benign neoplasms, laparoscopic tumorectomy should be the gold standard; in early stage malignant tumors, fertility-sparing surgery with accurate staging is preferred.
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Affiliation(s)
- Claudio Spinelli
- 1 Department of Surgical, Medical, Molecular pathology and of the Critical Area, Chair of Pediatric Surgery, University of Pisa, Pisa, Italy
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Dariushnia SR, Gill AE, Martin LG, Saad WE, Baskin KM, Caplin DM, Kalva SP, Hogan MJ, Midia M, Siddiqi NH, Walker TG, Nikolic B. Quality Improvement Guidelines for Diagnostic Arteriography. J Vasc Interv Radiol 2014; 25:1873-81. [DOI: 10.1016/j.jvir.2014.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022] Open
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Thomassin-Naggara I, Bazot M. IRM et TDM dans le diagnostic des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:744-51. [DOI: 10.1016/j.jgyn.2013.09.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hu HJ, Huang YW, Zhu YC. Tumor feeding artery reconstruction with multislice spiral CT in the diagnosis of pelvic tumors of unknown origin. Diagn Interv Radiol 2013; 20:9-16. [PMID: 24100058 DOI: 10.5152/dir.2013.12176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to compare multislice spiral computed tomography (MSCT) angiography diagnosis with both surgical findings and postoperative pathological results in patients with pelvic tumors of unknown origin. In addition, the diagnostic accuracy of MSCT angiography was compared with that of routine computed tomography for tumor feeding artery volume reconstruction to determine the origin and nature of pelvic tumors. MATERIALS AND METHODS The records of 43 patients with pelvic tumors of unknown origin who underwent MSCT angiography were retrospectively reviewed. Volume reconstructions using add vessel and merge views methods were performed for abdominal and pelvic blood vessels. The tumor origin was identified based on observations of the origin, number, morphology, starting/ending locations, route, and distribution of the tumor feeding arteries. RESULTS Overall, the mean tumor diameter was 9.8±3.5 cm (range, 4.2-23.5 cm); 11 tumors (25.6%) were cystic in nature; and 32 tumors (74.4%) were either solid/cystic or solid in nature. When considering all MSCT angiography examinations used to predict the nature of the tumor (e.g., malignant or benign), the sensitivity and specificity were 77.3% and 95.2%, respectively. The positive and negative predictive values were 94.4% and 80%, respectively. The overall diagnostic accuracy was 86.05% with an area under the curve of 0.961 (95% confidence interval, 0.913-1.000). CONCLUSIONS MSCT angiography volume reconstruction for pelvic tumor feeding arteries of unknown origin is highly valuable for localization, qualitative diagnosis, and quantitative diagnosis of pelvic tumors.
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Affiliation(s)
- Hai-Jing Hu
- From the Departments of Radiology (H.H.) and Surgery (Y.Z. e-mail: ), Nanhai Hospital, Nanfang Medical University, Foshan, Guangdong, China; the Department of Gynecology (Y.H.), State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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Spinelli C, Pucci V, Buti I, Liserre J, Messineo A, Bianco F, Ugolini C. The Role of Tumor Markers in the Surgical Approach of Ovarian Masses in Pediatric Age: A 10-Year Study and a Literature Review. Ann Surg Oncol 2012; 19:1766-73. [DOI: 10.1245/s10434-012-2249-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Indexed: 01/27/2023]
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Magnetic resonance imaging in women with pelvic pain from gynaecological causes: a pictorial review. Radiol Med 2012; 117:575-92. [DOI: 10.1007/s11547-011-0773-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/21/2011] [Indexed: 11/30/2022]
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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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Medeiros LR, Freitas LB, Rosa DD, Silva FR, Silva LS, Birtencourt LT, Edelweiss MI, Rosa MI. Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review. Am J Obstet Gynecol 2011; 204:67.e1-10. [PMID: 21047612 DOI: 10.1016/j.ajog.2010.08.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 06/05/2010] [Accepted: 08/17/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate the diagnostic accuracy of magnetic resonance in ovarian tumors. STUDY DESIGN A quantitative systematic review was performed. Studies that compared magnetic resonance and paraffin sections within subjects for diagnosis of ovarian tumors were included. RESULTS Fifteen primary studies were analyzed, which included 1267 ovarian masses. For borderline or malignant ovarian cancer vs benign ovarian lesions, the pooled likelihood ratio for the occurrence of a positive magnetic resonance result was 6.6 (95% confidence interval, 4.7-9.2) and the posttest probability for borderline or malignant diagnosis was 77% (95% confidence interval, 70-82). Because specificity and likelihood ratio positive were heterogeneous, a random effect model was used and a summary receiver operating characteristic curve was generated. For borderline or malignant ovarian cancer vs benign ovarian lesions, the area under curve was 0.9526. CONCLUSION Magnetic resonance seems to be a useful preoperative test for predicting the diagnosis of pelvic masses.
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Asher V, Hammond R, Duncan TJ. Pelvic mass associated with raised CA 125 for benign condition: a case report. World J Surg Oncol 2010; 8:28. [PMID: 20398372 PMCID: PMC2861664 DOI: 10.1186/1477-7819-8-28] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Raised CA 125 with associated pelvic mass is highly suggestive of ovarian malignancy, but there are various other benign conditions that can be associated with pelvic mass and a raised CA 125. CASE PRESENTATION We present a case of 19 year old, Caucasian British woman who presented initially with sudden onset right sided iliac fossa pain and on imaging was found to have 9.8 x 4.5 cm complex cystic mass in right adnexa with a raised CA 125 of 657, which was initially thought to be highly suspicious of cancer but was subsequently found to be due to pelvic inflammatory disease on histology. CONCLUSION This case highlights the fact that though a pelvic mass with raised CA 125 is highly suggestive of malignancy, pelvic inflammatory disease should always be considered as a differential diagnosis especially in a young patient and a thorough sexual history and screening for pelvic infection should always be carried out in these patients.
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Affiliation(s)
- Viren Asher
- Department of Obstetrics and Gynaecology, Royal Derby Hospital, Uttoxeter road, Derby DE22 3NE, UK.
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Spinelli C, Di Giacomo M, Mucci N, Massart F. Hemorrhagic corpus luteum cysts: an unusual problem for pediatric surgeons. J Pediatr Adolesc Gynecol 2009; 22:163-7. [PMID: 19539202 DOI: 10.1016/j.jpag.2008.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 07/06/2008] [Accepted: 07/08/2008] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE Hemorrhagic corpus luteum cysts (HCLC) constitute a common disorder in pediatric subjects undergoing surgical intervention. HCLCs especially develop in the early period after menarche, and they are commonly associated with dysfunctional ovulation. DESIGN Retrospective analysis of surgery outcome of HCLC patients. SETTING Pediatric Surgery Unit, S. Chiara University Hospital. PARTICIPANT 13 girls with HCLC diagnosis. INTERVENTIONS Surgical treatment of HCLCs. MAIN OUTCOME MEASURES We reviewed the clinical presentation and outcome of 13 post-menarcheal girls surgically treated for HCLCs in the Pediatric Surgical Unit from 2002 to 2006. RESULTS Primary presentation was persistent abdominal pain in 84.6% and acute abdominal pain in 15.4% of patients, respectively. Ultrasound examination showed complex ovarian masses in 77.23% cases and simple ovarian masses in 33.7% cases, respectively. Although laparoscopic excision of HCLC was performed in more than 45% cases, laparotomic approach was commonly required. After conservative surgery, ovarian size and viability were normal, as assessed by 6-month ultrasound scan. No recurrences of disease and regular menses were reported at 2 years follow-up. CONCLUSIONS In pediatric subjects with HCLC that required surgical intervention, no complications or disorder recurrence were reported. In order to preserve ovarian function, conservative surgery has to be performed whenever feasible.
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Affiliation(s)
- C Spinelli
- Department of Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy.
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Spinelli C, Di Giacomo M, Cei M, Mucci N. Functional ovarian lesions in children and adolescents: when to remove them. Gynecol Endocrinol 2009; 25:294-8. [PMID: 19340623 DOI: 10.1080/09513590802530932] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
STUDY OBJECTIVE Functional ovarian lesions represent 45% of all pediatric adnexal abnormalities. Their surgical management, even if frequent, is not clear, especially in pediatric age. MATERIALS AND METHODS We retrospectively reviewed 22 pediatric patients surgically treated for functional ovarian lesions from 2000 to 2006. The following characteristics were analysed: age, size of the lesion, ultrasound (US) aspect and clinical presentation. RESULTS The average age was 16.1 years of age (range: 6 months-18 years). Of the 22 functional lesions, 12 (55%) were follicular cysts and 10 (45%) corpus luteum ones. The average size was 6.7 cm (range: 5.1-33 cm). US scan showed simple lesions in 10 cases (45%) and complex ones in 12 cases (55%). In 16 girls (72.8%) the presenting symptom was abdominal pain while 2 patients (9%) presented abdominal distention. In the other 4 patients (16.2%) the lesion was found accidentally during US examination. CONCLUSION In pediatric subjects, functional ovarian cysts rarely required surgical intervention, though no complications or disorder recurrence were reported. To preserve ovarian function, conservative surgery has to be performed whenever feasible.
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Affiliation(s)
- C Spinelli
- Chair of Pediatric and Infantile Surgery, Department of Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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Padovan RS, Kralik M, Prutki M, Hrabak M, Oberman B, Potocki K. Cross-sectional imaging of the pelvic tumors and tumor-like lesions in gynecologic patients—misinterpretation points and differential diagnosis. Clin Imaging 2008; 32:296-302. [DOI: 10.1016/j.clinimag.2007.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 11/28/2007] [Indexed: 10/21/2022]
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Lijoi D, Biscaldi E, Mistrangelo E, Bogliolo S, Ragni N. MRI appearance of the low transverse incision after caesarean section in a symptomatic woman. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.ejrex.2006.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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