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Patel-Lippmann KK, Gupta A, Martin MF, Phillips CH, Maturen KE, Jha P, Sadowski EA, Stein EB. The Roles of Ovarian-Adnexal Reporting and Data System US and Ovarian-Adnexal Reporting and Data System MRI in the Evaluation of Adnexal Lesions. Radiology 2024; 312:e233332. [PMID: 39162630 DOI: 10.1148/radiol.233332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) is an evidence-based clinical support system for ovarian and adnexal lesion assessment in women of average risk. The system has both US and MRI components with separate but complementary lexicons and assessment categories to assign the risk of malignancy. US is an appropriate initial imaging modality, and O-RADS US can accurately help to characterize most adnexal lesions. MRI is a valuable adjunct imaging tool to US, and O-RADS MRI can help to both confirm a benign diagnosis and accurately stratify lesions that are at risk for malignancy. This article will review the O-RADS US and MRI systems, highlight their similarities and differences, and provide an overview of the interplay between the systems. When used together, the O-RADS US and MRI systems can help to accurately diagnose benign lesions, assess the risk of malignancy in lesions suspicious for malignancy, and triage patients for optimal management.
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Affiliation(s)
- Krupa K Patel-Lippmann
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Akshya Gupta
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Marisa F Martin
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Catherine H Phillips
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Katherine E Maturen
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Priyanka Jha
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Elizabeth A Sadowski
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Erica B Stein
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
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Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, Eskander RN, Feldman MK, Jones LP, Martino MA, Patel MD, Patlas MN, Revzin MA, VanBuren W, Yashar CM, Kang SK. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update. J Am Coll Radiol 2024; 21:S79-S99. [PMID: 38823957 DOI: 10.1016/j.jacr.2024.02.017] [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: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Asymptomatic adnexal masses are commonly encountered in daily radiology practice. Although the vast majority of these masses are benign, a small subset have a risk of malignancy, which require gynecologic oncology referral for best treatment outcomes. Ultrasound, using a combination of both transabdominal, transvaginal, and duplex Doppler technique can accurately characterize the majority of these lesions. MRI with and without contrast is a useful complementary modality that can help characterize indeterminate lesions and assess the risk of malignancy is those that are suspicious. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Susan M Ascher
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ramez N Eskander
- University of California, San Diego, San Diego, California; American College of Obstetricians and Gynecologists
| | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin A Martino
- Ascension St. Vincent's, Jacksonville, Florida; University of South Florida, Tampa, Florida, Gynecologic oncologist
| | | | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margarita A Revzin
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | | | - Catheryn M Yashar
- University of California, San Diego, San Diego, California; Commission on Radiation Oncology
| | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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Liu L, Cai W, Tian H, Wu B, Zhang J, Wang T, Hao Y, Yue G. Ultrasound image-based nomogram combining clinical, radiomics, and deep transfer learning features for automatic classification of ovarian masses according to O-RADS. Front Oncol 2024; 14:1377489. [PMID: 38812784 PMCID: PMC11133542 DOI: 10.3389/fonc.2024.1377489] [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: 01/27/2024] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
Background Accurate and rapid discrimination between benign and malignant ovarian masses is crucial for optimal patient management. This study aimed to establish an ultrasound image-based nomogram combining clinical, radiomics, and deep transfer learning features to automatically classify the ovarian masses into low risk and intermediate-high risk of malignancy lesions according to the Ovarian- Adnexal Reporting and Data System (O-RADS). Methods The ultrasound images of 1,080 patients with 1,080 ovarian masses were included. The training cohort consisting of 683 patients was collected at the South China Hospital of Shenzhen University, and the test cohort consisting of 397 patients was collected at the Shenzhen University General Hospital. The workflow included image segmentation, feature extraction, feature selection, and model construction. Results The pre-trained Resnet-101 model achieved the best performance. Among the different mono-modal features and fusion feature models, nomogram achieved the highest level of diagnostic performance (AUC: 0.930, accuracy: 84.9%, sensitivity: 93.5%, specificity: 81.7%, PPV: 65.4%, NPV: 97.1%, precision: 65.4%). The diagnostic indices of the nomogram were higher than those of junior radiologists, and the diagnostic indices of junior radiologists significantly improved with the assistance of the model. The calibration curves showed good agreement between the prediction of nomogram and actual classification of ovarian masses. The decision curve analysis showed that the nomogram was clinically useful. Conclusion This model exhibited a satisfactory diagnostic performance compared to junior radiologists. It has the potential to improve the level of expertise of junior radiologists and provide a fast and effective method for ovarian cancer screening.
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Affiliation(s)
- Lu Liu
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Wenjun Cai
- Department of Ultrasound, Shenzhen University General Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Hongyan Tian
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Beibei Wu
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Jing Zhang
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Ting Wang
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Yi Hao
- Department of Ultrasound Medicine, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guanghui Yue
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
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Behr GG, Morani AC, Artunduaga M, Desoky SM, Epelman M, Friedman J, Lala SV, Seekins J, Towbin AJ, Back SJ. Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29995. [PMID: 36184758 PMCID: PMC10642215 DOI: 10.1002/pbc.29995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
Ovarian tumors in children are uncommon. Like those arising in the adult population, they may be broadly divided into germ cell, sex cord, and surface epithelium subtypes; however, germ cell tumors comprise the majority of lesions in children, whereas tumors of surface epithelial origin predominate in adults. Diagnostic workup, including the use of imaging, requires an approach that often differs from that required in an adult. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary ovarian malignancy at diagnosis and during follow-up.
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Affiliation(s)
- Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medicine, New York, New York, USA
| | - Ajaykumar C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maddy Artunduaga
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah M Desoky
- Department of Radiology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Monica Epelman
- Department of Radiology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Jonathan Friedman
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Shailee V Lala
- Department of Radiology, New York University Langone Health, New York, New York, USA
| | - Jayne Seekins
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California, USA
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Yoeli-Bik R, Lengyel E, Mills KA, Abramowicz JS. Ovarian Masses: The Value of Acoustic Shadowing on Ultrasound Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:935-945. [PMID: 36114807 DOI: 10.1002/jum.16100] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Adnexal lesions are a common finding in women and pose a clinical challenge since ovarian cancer is a highly lethal disease. However, most adnexal masses are benign, benefiting from a more conservative approach. In preoperative assessment, transvaginal ultrasound plays a key role in evaluating morphologic features that correlate with the risk of malignancy. The acoustic shadow is the loss of echo behind sound-absorbing components, such as calcifications or fibrous tissues, which are predominantly found in benign lesions. However, recognizing the acoustic shadow is a difficult skill to master, and its usefulness may be underappreciated.
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Affiliation(s)
- Roni Yoeli-Bik
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Ernst Lengyel
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Kathryn A Mills
- Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, University of Chicago, Chicago, Illinois, USA
| | - Jacques S Abramowicz
- Department of Obstetrics and Gynecology/Section of Maternal Fetal Medicine, University of Chicago, Chicago, Illinois, USA
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Serum markers, morphological index, RMI, and ROMA in preoperative diagnosis of ovarian cancer. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.960550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gorski JW, Dietrich CS, Davis C, Erol L, Dietrich H, Per NJ, Ferrell EL, McDowell AB, Riggs MJ, Hutchcraft ML, Baldwin-Branch LA, Miller RW, DeSimone CP, Gallion HH, Ueland FR, van Nagell JR, Pavlik EJ. Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram. Diagnostics (Basel) 2022; 12:diagnostics12010144. [PMID: 35054310 PMCID: PMC8774702 DOI: 10.3390/diagnostics12010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1–19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5–29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2–93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7–178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration.
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Affiliation(s)
- Justin W. Gorski
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Charles S. Dietrich
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Caeli Davis
- Denison University, Granville, OH 43023, USA;
| | - Lindsay Erol
- Tripler Army Medical Center, Honolulu, HI 96859, USA;
| | | | - Nicholas J. Per
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Emily Lenk Ferrell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Anthony B. McDowell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - McKayla J. Riggs
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Megan L. Hutchcraft
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Lauren A. Baldwin-Branch
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Rachel W. Miller
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Christopher P. DeSimone
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Holly H. Gallion
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Frederick R. Ueland
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - John R. van Nagell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Edward J. Pavlik
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Correspondence:
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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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BARD1 Autoantibody Blood Test for Early Detection of Ovarian Cancer. Genes (Basel) 2021; 12:genes12070969. [PMID: 34201956 PMCID: PMC8305152 DOI: 10.3390/genes12070969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/17/2023] Open
Abstract
Background: Ovarian cancer (OC) is the most lethal gynaecological cancer. It is often diagnosed at an advanced stage with poor chances for successful treatment. An accurate blood test for the early detection of OC could reduce the mortality of this disease. Methods: Autoantibody reactivity to 20 epitopes of BARD1 and concentration of cancer antigen 125 (CA125) were assessed in 480 serum samples of OC patients and healthy controls. Autoantibody reactivity and CA125 were also tested for 261 plasma samples of OC with or without mutations in BRCA1/2, BARD1, or other predisposing genes, and healthy controls. Lasso statistic regression was applied to measurements to develop an algorithm for discrimination between OC and controls. Findings and interpretation: Measurement of autoantibody binding to a number of BARD1 epitopes combined with CA125 could distinguish OC from healthy controls with high accuracy. This BARD1-CA125 test was more accurate than measurements of BARD1 autoantibody or CA125 alone for all OC stages and menopausal status. A BARD1-CA125-based test is expected to work equally well for average-risk women and high-risk women with hereditary breast and ovarian cancer syndrome (HBOC). Although these results are promising, further data on well-characterised clinical samples shall be used to confirm the potential of the BARD1-CA125 test for ovarian cancer screening.
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Farràs Roca L, Alshehri ED, Goldberg HR, Amirabadi A, Kives S, Allen L, Navarro OM, Lam CZ. Diagnostic Performance of a Sonographic Volume and Solid Vascular Tissue Score (VSVTS) for Preoperative Risk Assessment of Pediatric and Adolescent Adnexal Masses. J Pediatr Adolesc Gynecol 2021; 34:377-382. [PMID: 33271292 DOI: 10.1016/j.jpag.2020.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE To evaluate the diagnostic performance of a Volume and Solid Vascular Tissue Score (VSVTS) for preoperative risk assessment of pediatric and adolescent adnexal masses. DESIGN A retrospective cohort study comprised of all female individuals who presented with an adnexal mass that was managed surgically between April 2011 and March 2016. SETTING The Hospital for Sick Children (Toronto, Ontario, Canada). PARTICIPANTS Female individuals 1-18 years of age who presented to a large tertiary pediatric hospital with an adnexal mass that was managed surgically. MAIN OUTCOME MEASURES Main outcome measures included diagnostic performance of the VSVTS for malignancy via sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and receiver operating characteristic area-under-the-curve (AUC) analysis. RESULTS A total of 179 masses in 169 subjects were included. The malignancy rate was 10.6%. The AUC for the VSTVS was 0.919. A VSTVS cut-off value of 4 achieved a sensitivity of 79% (95% CI 0.54-0.93), specificity of 88% (95% CI 0.82-0.93), PPV of 0.44 (95% CI 0.33-0.56), NPV of 0.97 (95% CI 0.94-0.99), LR+ of 6.77 (95% CI 4.18-10.97), and LR- of 0.24 (95% CI 0.10-0.57). CONCLUSIONS A sonographic scoring system based on the volume and presence of solid vascular tissue improves PPV for preoperative risk stratification of adnexal masses in the pediatric and adolescent population compared to existing ultrasound-only approaches. Further prospective research is needed to determine how best to incorporate components of such scoring systems into clinical management algorithms.
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Affiliation(s)
- Lara Farràs Roca
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ebtehaj D Alshehri
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Hanna R Goldberg
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sari Kives
- Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Lisa Allen
- Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada
| | - Oscar M Navarro
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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11
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Khalaf LMR, Desoky HHM, Seifeldein GS, Salah A, Amine MA, Hussien MT. Sonographic and Doppler predictors of malignancy in ovarian lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00172-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To determine the best sonographic (US) and/or Doppler features that the radiologist can use as predictors or risk factors for ovarian malignancy
Results
Among the examined 156 ovarian lesions, there were 53 malignant and 103 benign lesions. Most of the malignant ovarian lesions were noted in older age than in benign lesions p < 0.001. Majority of the malignant lesions had non-hyperechoic solid component (92.5%); it had the highest sensitivity of 92.5%, specificity of 97%, accuracy of 94.8%, positive predictive value of 94%, negative predictive value of 96%, and AUC of 0.94 in discrimination between benign and malignant ovarian lesions. The presence of papillary projection, the absence of wall definitions and thick wall, and thick septation were noted in 83%, 81%, and 53.8% of the malignant ovarian lesions respectively. Color flow Doppler shows neovascularity in 88.7% of the malignant lesions, 73.6% of them has central blood flow. The multivariate regression analysis revealed that the presence of non-hyperechoic solid component, new vascularity with central location of the blood flow, papillary projection, thick septa, and old age were the most significant parameters in predicting ovarian cancer in decreasing order of frequency according to their odds ratio (19.45, 7.55, 4.56, 3.45, and 1.45, respectively).
Conclusions
The non-hyperechoic solid component, new vascularity with central location of the blood flow, papillary projection, and thick septa were the most significant and consistent US and Doppler predictors of ovarian malignancy in addition to one clinical feature which is the old age ≥ 52 years.
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12
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Role of Combining Colour Doppler and Grey Scale Ultrasound in Differentiating Benign from Malignant Ovarian Masses. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
The aim of this study was to evaluate ovarian masses with conventional grey scale ultrasonography and colour Doppler flow imaging and to assess the diagnostic reliability of these methods in differentiating benign and malignant ovarian masses.
We assessed 56 patients with an ovarian mass. Morphological characterisation of the mass was performed utilising the Sassone score. Colour Doppler parameters were recorded for each patient, and the Caruso vascular score was also applied. The results were compared with surgical/pathological and/or follow-up scans.
Using the Sassone score, overall reliability in differentiating ovarian masses had a sensitivity of 89.5% and a specificity of 78.4%. Using the Caruso score alone, we found a sensitivity of 89.5% and a specificity of 86.5%. Using the Sassone and Caruso scores together, we found a sensitivity of 94.7% and a specificity of 89.1%.
Combining both morphological and colour Doppler scores in the evaluation of ovarian masses obtained higher specificity, sensitivity, and accuracy than was obtained using a single score only.
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13
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Lawrence AE, Minneci PC, Deans KJ. Ovarian Masses and Torsion: New Approaches for Ovarian Salvage. Adv Pediatr 2020; 67:113-121. [PMID: 32591055 DOI: 10.1016/j.yapd.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Amy E Lawrence
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Peter C Minneci
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Katherine J Deans
- Department of Pediatric Surgery, Center for Surgical Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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14
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Terzic M, Rapisarda AMC, Della Corte L, Manchanda R, Aimagambetova G, Norton M, Garzon S, Riemma G, King CR, Chiofalo B, Cianci A. Diagnostic work-up in paediatric and adolescent patients with adnexal masses: an evidence-based approach. J OBSTET GYNAECOL 2020; 41:503-515. [DOI: 10.1080/01443615.2020.1755625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Milan Terzic
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda’s Endoscopic Centre, Pushawati Singhania Research Institute, Delhi, India
| | - Gulzhanat Aimagambetova
- Department of Obstetrics and Gynecology, National Research Center of Mother and Child Health, University Medical Center, Astana, Kazakhstan
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Melanie Norton
- Department of Urogynaecology, Whittington Hospital, London, UK
| | - Simone Garzon
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Cara Robinson King
- Obstetrics, Gynecology, and Womens Health Institute, Section of Minimally Invasive Gynecologic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, “Regina Elena” National Cancer Institute, Rome, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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15
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Abstract
Ovarian lesions are common and require a consistent approach to diagnosis and management for best patient outcomes. In the past 20 years, there has been an evolution in the approach to abnormal ovarian lesions, with increasing emphasis on reducing surgery for benign disease, standardizing terminology, assessing risk of malignancy through use of evidence-based scoring systems, and triaging suspicious abnormalities to dedicated oncology centers. This article provides an evidence-based review of how these changes in diagnosis and management of ultrasound-detected abnormal ovarian lesions have occurred. Current recommended practices are summarized. The current literature on transvaginal screening for ovarian cancer also is reviewed and summarized.
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16
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Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Frates MC, Goldstein SR, Hamper UM, Horrow MM, Hernanz-Schulman M, Reinhold C, Rose SL, Whitcomb BP, Wolfman WL, Glanc P. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology 2019; 294:168-185. [PMID: 31687921 DOI: 10.1148/radiol.2019191150] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes.
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Affiliation(s)
- Rochelle F Andreotti
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Dirk Timmerman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Lori M Strachowski
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Wouter Froyman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Beryl R Benacerraf
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Genevieve L Bennett
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Tom Bourne
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Douglas L Brown
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Beverly G Coleman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Mary C Frates
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Steven R Goldstein
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Ulrike M Hamper
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Mindy M Horrow
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Marta Hernanz-Schulman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Caroline Reinhold
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Stephen L Rose
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Brad P Whitcomb
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Wendy L Wolfman
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
| | - Phyllis Glanc
- From the Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, 1161 21st Ave S, #D3300, Nashville, Tenn 37232 (R.F.A.); Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium (D.T.); Department of Radiology, University of California, San Francisco, San Francisco, Calif (L.M.S.); Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F.); Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium (W.F.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brookline, Mass (B.R.B.); Department of Radiology, NYU Langone Health, New York, NY (G.L.B.); Department of Obstetrics and Gynecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, England (T.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.); Department of Radiology, Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.C.F.); Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Radiology, Einstein Medical Center, Philadelphia, Pa (M.M.H.); Department of Radiology and Radiological Sciences, Carell Children's Hospital at Vanderbilt, Nashville, Tenn (M.H.S.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wis (S.L.R.); Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, Conn (B.P.W.); Department of Obstetrics and Gynecology, Mt. Sinai Hospital, University of Toronto, Toronto, Canada (W.L.W.); and Department of Medical Imaging and Department of Obstetrics and Gynecology, University of Toronto, Sunnybrook Research Institute, Toronto, Canada (P.G.)
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Levine D, Patel MD, Suh-Burgmann EJ, Andreotti RF, Benacerraf BR, Benson CB, Brewster WR, Coleman BG, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow MM, Hur HC, Marnach ML, Pavlik E, Platt LD, Puscheck E, Smith-Bindman R, Brown DL. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology 2019; 293:359-371. [DOI: 10.1148/radiol.2019191354] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening. Obstet Gynecol 2019; 132:1091-1100. [PMID: 30303916 DOI: 10.1097/aog.0000000000002921] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of ultrasound screening on stage at detection and long-term disease-specific survival of at-risk women with epithelial ovarian cancer. METHODS Eligibility included all asymptomatic women 50 years of age or older and women 25 years of age or older with a documented family history of ovarian cancer. From 1987 to 2017, 46,101 women received annual ultrasound screening in a prospective cohort trial. Women with a persisting abnormal screen underwent tumor morphology indexing, serum biomarker analysis, and surgery. RESULTS Seventy-one invasive epithelial ovarian cancers and 17 epithelial ovarian tumors of low malignant potential were detected. No women with a low malignant potential tumor experienced recurrent disease. Stage distribution for screen-detected invasive epithelial ovarian cancers was stage I-30 (42%), stage II-15 (21%), stage III-26 (37%), and stage IV-0 (0%). Follow-up varied from 9.2 months to 27 years (mean 7.9 years). Disease-specific survival at 5, 10, and 20 years for women with invasive epithelial ovarian cancer detected by screening was 86±4%, 68±7%, and 65±7%, respectively, vs 45±2%, 31±2%, and 19±3%, respectively, for unscreened women with clinically detected ovarian cancer from the same geographic area who were treated at the same institution by the same treatment protocols (P<.001). Twenty-seven percent of screen-detected malignancies were type I and 73% were type II. The disease-specific survival of women with type I and type II screen-detected tumors was significantly higher than that of women with clinically detected type I and type II tumors and was related directly to earlier stage at detection. CONCLUSION Annual ultrasound screening of at-risk asymptomatic women was associated with lower stage at detection and increased 5-, 10-, and 20-year disease-specific survival of women with both type I and type II epithelial ovarian cancer. CLINICAL TRIAL REGISTRATION OnCore Clinical Trials Management System, NCI-2013-01954.
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Bullock RG, Smith A, Munroe DG, Ueland FR, Goodrich ST, Pappas TC, Fredericks TI, Bonato V. Combining A Second-Generation Multivariate Index Assay with Ovarian Imaging Improves the Preoperative Assessment of An Adnexal Mass. J Surg Oncol 2019. [DOI: 10.31487/j.jso.2019.03.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: To understand the relationship between imaging and the next generation multivariate index assay (MIA2G) in the preoperative assessment of an adnexal mass. Methods: Serum samples and imaging data from two previously published studies are reanalyzed using the MIA2G test. We calculated the clinical performance of MIA2G and discrete imaging features associated with malignant risk. Results: 878 women were eligible for this analysis, 48.3% post-menopausal and 51.7% pre-menopausal. The prevalence of having a malignant pathology was 18%. Ultrasound was the most frequently used imaging modality. The combination of MIA2G “or” ultrasound resulted in higher sensitivity than either test alone, 93.5% compared to 87.6% for MIA2G and 74.2% for ultrasound. The negative predictive value was high: 94.6% for ultrasound, 98.1% for MIA2G “or” ultrasound. MIA2G “and” ultrasound had higher specificity but lower sensitivity than MIA2G or ultrasound alone. Similar results were seen for CT scan when evaluated with MIA2G. Conclusion: MIA2G and pelvic imaging are complementary tests and interpreting them together can provide important information about the malignant risk of an ovarian tumor. For physicians making decisions about a referral to a specialist, the combination of MIA2G “or” ultrasound has the highest sensitivity in predicting ovarian malignancy.
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Singla V, Dawadi K, Singh T, Prabhakar N, Srinivasan R, Suri V, Khandelwal N. Multiparametric MRI Evaluation of Complex Ovarian Masses. Curr Probl Diagn Radiol 2019; 50:34-40. [PMID: 31399230 DOI: 10.1067/j.cpradiol.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the role of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the categorization of complex ovarian masses into benign and malignant. MATERIALS AND METHODS This prospective study was done on 33 complex ovarian masses. T1 and T2-weighted sequences, diffusion-weighted imaging, apparent diffusion coefficient, and dynamic contrast-enhanced magnetic resonance imaging were performed on 1.5 T MRI. Time-intensity curves, tissue signal intensity on unenhanced T1 images (SI0), maximum absolute contrast enhancement (SImax), time to reach SImax (Tmax), maximum relative SI (SIrel = [SImax - SI0]/SI0 ×100), maximum Slope (Slopemax = SIrel/Tmax ×100), and wash in rate (WIR = [SImax - SI0]/Tmax) were calculated. Histopathological diagnosis was taken as gold standard. RESULTS A total of 20/33 masses were benign, 2/33 were borderline tumors, and 11/33 were malignant. Diffusion restriction was seen in all malignant masses and 13/20 benign masses. The mean apparent diffusion coefficient values showed a significant difference between malignant and benign, with 81.8% sensitivity and 63.6% specificity. Type III curve showed 100% specificity for malignant lesions. Tmax and Slopemax were useful in differentiating benign and malignant masses; with Tmax cut-off at 73.5 seconds having a high specificity (81.8%) and Slopemax cut-off at 0.83%/s having high sensitivity (91%) and negative predictive value (94.4%). CONCLUSION Multiparametric MRI confers high diagnostic accuracy in stratifying complex ovarian masses.
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Affiliation(s)
- Veenu Singla
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India.
| | - Kapil Dawadi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education Research (PGIMER), Chandigarh, India
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Stukan M, Badocha M, Ratajczak K. Development and validation of a model that includes two ultrasound parameters and the plasma D-dimer level for predicting malignancy in adnexal masses: an observational study. BMC Cancer 2019; 19:564. [PMID: 31185938 PMCID: PMC6558858 DOI: 10.1186/s12885-019-5629-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/23/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pre-operative discrimination of malignant from benign adnexal masses is crucial for planning additional imaging, preparation, surgery and postoperative care. This study aimed to define key ultrasound and clinical variables and develop a predictive model for calculating preoperative ovarian tumor malignancy risk in a gynecologic oncology referral center. We compared our model to a subjective ultrasound assessment (SUA) method and previously described models. METHODS This prospective, single-center observational study included consecutive patients. We collected systematic ultrasound and clinical data, including cancer antigen 125, D-dimer (DD) levels and platelet count. Histological examinations served as the reference standard. We performed univariate and multivariate regressions, and Bayesian information criterion (BIC) to assess the optimal model. Data were split into 2 subsets: training, for model development (190 observations) and testing, for model validation (n = 100). RESULTS Among 290 patients, 52% had malignant disease, including epithelial ovarian cancer (72.8%), metastatic disease (14.5%), borderline tumors (6.6%), and non-epithelial malignancies (4.6%). Significant variables were included into a multivariate analysis. The optimal model, included three independent factors: solid areas, the color score, and the DD level. Malignant and benign lesions had mean DD values of 2.837 and 0.354 μg/ml, respectively. We transformed established formulae into a web-based calculator ( http://gin-onc-calculators.com/gynonc.php ) for calculating the adnexal mass malignancy risk. The areas under the curve (AUCs) for models compared in the testing set were: our model (0.977), Simple Rules risk calculation (0.976), Assessment of Different NEoplasias in the adneXa (ADNEX) (0.972), Logistic Regression 2 (LR2) (0.969), Risk of Malignancy Index (RMI) 4 (0.932), SUA (0.930), and RMI3 (0.912). CONCLUSIONS Two simple ultrasound predictors and the DD level (also included in a mathematical model), when used by gynecologist oncologist, discriminated malignant from benign ovarian lesions as well or better than other more complex models and the SUA method. These parameters (and the model) may be clinically useful for planning adequate management in the cancer center. The model needs substantial validation.
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Affiliation(s)
- Maciej Stukan
- Department of Gynecologic Oncology, Gdynia Oncology Center, Pomeranian Hospitals, Gdynia, Poland, Postal address: ul. Powstania Styczniowego 1, 81-519 Gdynia, Poland
| | - Michał Badocha
- Department of Physical Chemistry, Gdańsk University of Technology, Gdańsk, Poland, Postal address: ul. Gabriela Narutowicza 11/12, 80-233 Gdańsk, Poland
| | - Karol Ratajczak
- Karol Ratajczak Consulting, ul. Damroki 1A, 80-175, Gdańsk, Poland
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Abstract
Asymptomatic ovarian tumors in menopausal women do not always require surgical removal. Experts recommend an initial evaluation with transvaginal ultrasound to help characterize the tumor's malignant risk. Low-risk tumors can be monitored with ultrasound, whereas high-risk tumors should be referred to a gynecologic oncologist. Indeterminate tumors require secondary testing with the strategies outlined in this Practice Pearl.
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Kang SK, Reinhold C, Atri M, Benson CB, Bhosale PR, Jhingran A, Lakhman Y, Maturen KE, Nicola R, Pandharipande PV, Salazar GM, Shipp TD, Simpson L, Small W, Sussman BL, Uyeda JW, Wall DJ, Whitcomb BP, Zelop CM, Glanc P. ACR Appropriateness Criteria ® Staging and Follow-Up of Ovarian Cancer. J Am Coll Radiol 2019; 15:S198-S207. [PMID: 29724422 DOI: 10.1016/j.jacr.2018.03.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/12/2022]
Abstract
In the management of epithelial ovarian cancers, imaging is used for cancer detection and staging, both before and after initial treatment. The decision of whether to pursue initial cytoreductive surgery for ovarian cancer depends in part on accurate staging. Contrast-enhanced CT of the abdomen and pelvis (and chest where indicated) is the current imaging modality of choice for the initial staging evaluation of ovarian cancer. Fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT and MRI may be appropriate for problem-solving purposes, particularly when lesions are present on CT but considered indeterminate. In patients who achieve remission, clinical suspicion for relapse after treatment prompts imaging evaluation for recurrence. Contrast-enhanced CT is the modality of choice to assess the extent of recurrent disease, and fluorine-18-2-fluoro-2-deoxy-d-glucose PET/CT is also usually appropriate, as small metastatic foci may be identified. If imaging or clinical examination confirms a recurrence, the extent of disease and timing of disease recurrence then determines the choice of treatments, including surgery, chemotherapy, and radiation therapy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Stella K Kang
- Principal Author, New York University Medical Center, New York, New York.
| | | | - Mostafa Atri
- Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Anuja Jhingran
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yulia Lakhman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Refky Nicola
- State University of New York Upstate Medical University, Syracuse, New York
| | | | | | - Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American Congress of Obstetricians and Gynecologists
| | - Lynn Simpson
- Columbia University, New York, New York; American Congress of Obstetricians and Gynecologists
| | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | | | | | - Bradford P Whitcomb
- Tripler Army Medical Center, Honolulu, Hawaii; Society of Gynecologic Oncology
| | - Carolyn M Zelop
- Valley Hospital, Ridgewood, New Jersey, and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists
| | - Phyllis Glanc
- Specialty Chair, Sunnybrook Health Sciences Centre Bayview Campus, Toronto, Ontario, Canada
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Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review. J Pediatr Surg 2019; 54:369-377. [PMID: 30220452 DOI: 10.1016/j.jpedsurg.2018.08.058] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 08/13/2018] [Accepted: 08/29/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of ovarian masses in pediatric patients should balance appropriate surgical management with the preservation of future reproductive capability. Preoperative estimation of malignant potential is essential to planning an optimal surgical strategy. METHODS The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee drafted three consensus-based questions regarding the evaluation and treatment of ovarian masses in pediatric patients. A search of PubMed, the Cochrane Library, and Web of Science was performed and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles for review. RESULTS Preoperative tumor markers, ultrasound malignancy indices, and the presence or absence of the ovarian crescent sign on imaging can help estimate malignant potential prior to surgical resection. Frozen section also plays a role in operative strategy. Surgical staging is useful for directing chemotherapy and for prognostication. Both unilateral oophorectomy and cystectomy have been used successfully for germ cell and borderline ovarian tumors, although cystectomy may be associated with higher rates of local recurrence. CONCLUSIONS Malignant potential of ovarian masses can be estimated preoperatively, and fertility-sparing techniques may be appropriate depending on the type of tumor. This review provides recommendations based on a critical evaluation of recent literature. TYPE OF STUDY Systematic review of level 1-4 studies. LEVEL OF EVIDENCE Level 1-4 (mainly 3-4).
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GÜVEY H. Adneksiyal Kitlelere Yaklaşım. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2019. [DOI: 10.33631/duzcesbed.450500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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26
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Combination of Sonographic Morphology Score and Tumor Markers for Detecting Postoperative Recurrent Pelvic Ovarian Carcinoma: Compared With MRI Assessment. Ultrasound Q 2019; 35:45-53. [PMID: 30672869 DOI: 10.1097/ruq.0000000000000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To assess the efficacy of the combination of sonographic morphology score (SMS) with CA125 and HE4 for detecting recurrent pelvic ovarian carcinoma (OC). Data of 58 OC patients treated in our hospital between 2014 and 2016 were analyzed. After cytoreductive surgery and routine chemotherapy, all patients were followed up by transvaginal ultrasound examination (SMS for pelvic masses based on volume and structure scores) and tumor marker (serum CA125 and HE4) detection. Clinical diagnosis of recurrent OC was based on physical examination, magnetic resonance imaging, and punctured pathology for pelvic masses. Receiver operating characteristic (ROC) curves of SMS and the tumor markers were generated, and areas under the curve (AUC) values were assessed. There were 26 patients with tumor recurrence and 32 cases with no recurrence. Magnetic resonance imaging had 100% sensitivity and specificity. The areas under the ROC curves of SMS, CA125, HE4, and SMS-CA125-HE4 were 0.816, 0.825, 0.737, and 0.903, respectively. There was no significant difference in AUC values between SMS and CA125 or HE4. There were significant differences in AUC values between SMS-CA125-HE4 and SMS (Z = 2.48, P = 0.042), CA125 (Z = 2.38, P = 0.046), and HE4 (Z = 6.48, P = 0.016), respectively. With a cutoff value of SMS, 5; CA125, 35 U/mL; HE4, 105 pmol/L, the sensitivity, specificity, positive prognostic value, and negative prognostic value of SMS-CA125-HE4 for recurrent OC assessment were 0.9231, 0.8438, 0.8276, and 0.931, respectively. SMS-CA125-HE4 was correlated with recurrent OC (χ = 30.7428, P < 0.0001). Ultrasound combined with tumor markers may improve the diagnostic efficiency of recurrent OC.
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Can Presurgical Ultrasound Predict Survival in Women With Ovarian Masses? Ultrasound Q 2018; 35:39-44. [PMID: 30516730 DOI: 10.1097/ruq.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to determine the ability of ultrasound to predict survival and detect more aggressive tumors in women with ovarian masses. MATERIALS AND METHODS Institutional review board approval was obtained. A total of 167 patients who presented with adnexal mass/masses were included. These were documented as benign or malignant on ultrasound. Age, date of diagnosis and date of death, type of tumor, and tumor marker cancer antigen 125 (CA-125) values were recorded. A CA-125 value of less than 35 U/mL was considered normal. All cases underwent surgery. Pathologic findings were considered as reference standard. The 2 × 2 cross-tabulations were used to correlate dichotomized CA-125, US diagnosis (benign vs malignant), and pathologic status. Difference of distributions was tested using the Wilcoxon rank sum test, and their association was tested using the Fisher exact test. All tests were 2-sided, and P values of 0.05 or less were considered statistically significant. Kaplan-Meir curves were generated to estimate survival. RESULTS There was a statistically significant difference in patients with benign versus malignant tumors based on pathology (P < 0.0001) and ultrasound (P < 0.0003). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound were 55%, 86%, 90% and 46%, and 81%. Patients diagnosed as having malignant tumors based on ultrasound had statistically significant worse overall survival. Probability of survival based on pathologic diagnosis of malignancy was statistically significant at P < 0.0003; based on ultrasound, P < 0.0001; and based on CA-125, P < 0.041. CONCLUSION Patients who had ultrasound-based prediction of ovarian malignancy had overall worse survival probability (P < 0.0001) compared with CA-125- or pathology-based prediction.
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Andreotti RF, Timmerman D, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Frates MC, Froyman W, Goldstein SR, Hamper UM, Horrow MM, Hernanz-Schulman M, Reinhold C, Strachowski LM, Glanc P. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol 2018; 15:1415-1429. [DOI: 10.1016/j.jacr.2018.07.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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29
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Abstract
Early detection of ovarian cancer could reduce mortality by 10% to 30%. Effective screening requires high sensitivity (>75%) and extremely high specificity (99.7%). Clinical trials suggest the best specificity is achieved with 2-stage strategies in which increasing serum CA125 level triggers transvaginal sonography to detect a malignant pelvic mass, although evidence for such approaches improving overall survival has been limited. Screening may be improved by combining CA125 with novel biomarkers, such as autoantibodies, circulating tumor DNA, or microRNAs. In order to detect premetastatic ovarian cancers originating in the distal fallopian tube, more sensitive approaches to diagnostic imaging are required.
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Affiliation(s)
- Kevin M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Jing Guo
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA; Department of Gynecology and Obstetrics, Shanghai Tenth People's Hospital, Tongji University, 301 Yanchang Road, Jingan, Shanghai 200072, China
| | - Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Ore RM, Chen Q, DeSimone CP, Miller RW, Baldwin LA, van Nagell JR, Huang B, Tucker TC, Johnson MS, Fredericks TI, Ueland FR. Population-Based Analysis of Patient Age and Other Disparities in the Treatment of Ovarian Cancer in Central Appalachia and Kentucky. South Med J 2018; 111:333-341. [DOI: 10.14423/smj.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The limited oncogenic potential of unilocular adnexal cysts: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:101-109. [DOI: 10.1016/j.ejogrb.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
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Reinert T, Nogueira-Rodrigues A, Kestelman FP, Ashton-Prolla P, Graudenz MS, Bines J. The Challenge of Evaluating Adnexal Masses in Patients With Breast Cancer. Clin Breast Cancer 2018; 18:e587-e594. [PMID: 29680194 DOI: 10.1016/j.clbc.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
Abstract
This narrative literature review addresses the problem of an adnexal mass discovered during the course of breast cancer (BC) care, which may represent a benign condition, a metastatic process, or a primary ovarian cancer (OC), clinical scenarios associated with distinct physiopathology and prognosis. Furthermore, the coexistence of BC and OC in the same patient may be owing to a hereditary disorder, deserving specific management strategies and counseling. The initial detection and evaluation of an adnexal mass in a patient with BC requires a high index of suspicion, and the initial workup should include a thorough medical history and physical examination, measurement of tumor markers, complete blood count, and imaging tests. Transvaginal ultrasonography remains the standard tool, and findings suggestive of malignancy include bilateral tumors, thick septations, predominance of a solid component, Doppler flow to the solid component, and ascites. From the pathology point of view, features that are suggestive of metastatic disease include bilaterality, mild ovarian enlargement, vascular emboli, no omental deposits, and the absence of transition from benign to malignant epithelium. Although there is a considerable overlap in OC and BC immunohistochemical profiles, BC usually stain positive for GCDFP-15 and negative for vimentine, PAX8, and WT1, and OC often stain positive for CK7, PAX8, WT1, and to mesothelin. Genetic counselling should always be indicated in this clinical scenario. In conclusion, diagnostic spectrum of an ovarian mass in a patient with BC is broad, and a systematic multi-professional strategy is necessary to conduct these challenging cases.
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Affiliation(s)
- Tomás Reinert
- Hospital do Câncer Mãe de Deus, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Angélica Nogueira-Rodrigues
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil; Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil; DOM Oncologia, Minas Gerais, Brazil
| | | | - Patricia Ashton-Prolla
- Departamento de Genética e Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratório de Medicina Genômica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Márcia Silveira Graudenz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Departamento de Patologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Instituto de Patologia, Porto Alegre, Brazil
| | - José Bines
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil.
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Maturen KE, Blaty AD, Wasnik AP, Patel-Lippmann K, Robbins JB, Barroilhet L, Huffman LB, Sadowski EA. Risk Stratification of Adnexal Cysts and Cystic Masses: Clinical Performance of Society of Radiologists in Ultrasound Guidelines. Radiology 2017; 285:650-659. [DOI: 10.1148/radiol.2017161625] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Nikolova T, Zivadinovic R, Evtimovska N, Klisarovska V, Stanojevic M, Georgievska J, Nikolova N. Diagnostic performance of human epididymis protein 4 compared to a combination of biophysical and biochemical markers to differentiate ovarian endometriosis from epithelial ovarian cancer in premenopausal women. J Obstet Gynaecol Res 2017; 43:1870-1879. [DOI: 10.1111/jog.13466] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/04/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Tanja Nikolova
- Department for Gynecological Oncology; University Clinic of Obstetrics and Gynecology; Skopje Macedonia
| | - Radomir Zivadinovic
- Department for Gynecological Oncology, Clinic of Obstetrics and Gynecology; University Clinical Center; Nis Serbia
| | - Nina Evtimovska
- Biochemical Laboratory; University Clinic of Oncology and Radiotherapy; Skopje Macedonia
| | - Violeta Klisarovska
- Department for Gynecological Oncology; University Clinic of Oncology and Radiotherapy; Skopje Macedonia
| | - Marko Stanojevic
- Department for Gynecological Oncology, Clinic of Obstetrics and Gynecology; University Clinical Center; Nis Serbia
| | - Jadranka Georgievska
- Department for Urgent Gynecology; University Clinic of Obstetrics and Gynecology; Skopje Macedonia
| | - Natasha Nikolova
- Department for Gynecological Oncology; University Clinic of Obstetrics and Gynecology; Skopje Macedonia
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Stanković ZB, Sedlecky K, Savić D, Lukač BJ, Mažibrada I, Perovic S. Ovarian Preservation from Tumors and Torsions in Girls: Prospective Diagnostic Study. J Pediatr Adolesc Gynecol 2017; 30:405-412. [PMID: 28137453 DOI: 10.1016/j.jpag.2017.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To develop a new decision tree system (DTS) for the management of adnexal masses in prepubertal and adolescent girls, aimed to improve the distinction between benign and malignant masses, help preserve affected ovaries during surgery, and reduce the rate of surgical management of uncomplicated functional ovarian cysts. DESIGN A prospective diagnostic study using clinical and ultrasound data collected for all patients younger than 19 years of age with adnexal masses managed between 2006 and 2015. SETTING Mother and Child Health Institute of Serbia 'Dr Vukan Čupić' (Belgrade, Serbia). PARTICIPANTS Patients (N = 1499) with adnexal masses, of whom 318 were surgically treated. INTERVENTIONS AND MAIN OUTCOME MEASURES Ultrasonographic characteristics (Ueland's Morphology Index [MI] and the ovarian crescent sign [OCS]). Patients were managed expectantly or surgically, in line with 3 rules of the DTS. Rule 1: asymptomatic patients having a mass with MI of 4 or less and OCS present, were managed expectantly. Rule 2 (emergency): malignancy was suspected if the MI was 7 or more and no edema of the OCS was present. Rule 3 (nonemergency): malignancy was suspected if the OCS was absent and MI was 5 or more. The diagnostic accuracy was assessed using sensitivity and specificity (P < .05). RESULTS No malignancy was found in the group of 1236 patients selected according to the DTS rule 1. Torsion was confirmed in 36% of surgically treated masses (n = 115). The OCS was present in 96% of benign masses in the non-emergency group (n = 149) and in three with microscopic malignancy. In predicting malignancy, the DTS (rules 2 and 3) showed a sensitivity of 93 (95% confidence interval [C.I.]: 82-98); and a specificity of 97 (C.I.: 95-99). Ovarian tissue was preserved from benign (n = 254, 93%) and malignant tumors (n = 3, 7%). Only five (2%) uncomplicated ovarian cysts were surgically treated. CONCLUSION The DTS with 3 rules is a very accurate diagnostic tool in the differentiation between benign and malignant ovarian masses. The DTS rule 1 reduces the number of surgical procedures on functional cysts, rules 2 and 3 are very useful in choosing the optimal treatment of adnexal masses, whether or not they are twisted.
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Affiliation(s)
- Zoran B Stanković
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia.
| | - Katarina Sedlecky
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Djordje Savić
- Department of Pediatric Abdominal Surgery, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Branislav J Lukač
- Department of Radiology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ilijana Mažibrada
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
| | - Svetlana Perovic
- Department of Pediatric and Adolescent Gynecology, Mother and Child Health Institute of Serbia 'Dr Vukan Čupić', Belgrade, Serbia
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Ormsby EL, Pavlik EJ, McGahan JP. Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials. Diagnostics (Basel) 2017; 7:diagnostics7020025. [PMID: 28452952 PMCID: PMC5489945 DOI: 10.3390/diagnostics7020025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 11/16/2022] Open
Abstract
Women that are positive for an ovarian abnormality in a clinical setting can have either a malignancy or a benign tumor with probability favoring the benign alternative. Accelerating the abnormality to surgery will result in a high number of unnecessary procedures that will place cost burdens on the individual and the health delivery system. Surveillance using serial ultrasonography is a reasonable alternative that can be used to discover if changes in the ovarian abnormality will occur that favor either a malignant or benign interpretation. Several ovarian cancer screening trials have had extensive experiences with changes in subclinical ovarian abnormalities in normal women that can define growth, stability or resolution and give some idea of the time frame over which changes occur. The present report examines these experiences and relates them to the current understanding of ovarian cancer ontology, presenting arguments related to the benefits of surveillance.
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Affiliation(s)
- Eleanor L Ormsby
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
- Department of Radiology, Kaiser Permanente Sacramento, 2025 Morse Ave, CA 95825, USA.
| | - Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536, USA.
| | - John P McGahan
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
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Baldwin LA, Chen Q, Tucker TC, White CG, Ore RN, Huang B. Ovarian Cancer Incidence Corrected for Oophorectomy. Diagnostics (Basel) 2017; 7:E19. [PMID: 28368298 PMCID: PMC5489939 DOI: 10.3390/diagnostics7020019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023] Open
Abstract
Current reported incidence rates for ovarian cancer may significantly underestimate the true rate because of the inclusion of women in the calculations who are not at risk for ovarian cancer due to prior benign salpingo-oophorectomy (SO). We have considered prior SO to more realistically estimate risk for ovarian cancer. Kentucky Health Claims Data, International Classification of Disease 9 (ICD-9) codes, Current Procedure Terminology (CPT) codes, and Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Data were used to identify women who have undergone SO in Kentucky, and these women were removed from the at-risk pool in order to re-assess incidence rates to more accurately represent ovarian cancer risk. The protective effect of SO on the population was determined on an annual basis for ages 5-80+ using data from the years 2009-2013. The corrected age-adjusted rates of ovarian cancer that considered SO ranged from 33% to 67% higher than age-adjusted rates from the standard population. Correction of incidence rates for ovarian cancer by accounting for women with prior SO gives a better understanding of risk for this disease faced by women. The rates of ovarian cancer were substantially higher when SO was taken into consideration than estimates from the standard population.
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Affiliation(s)
- Lauren A Baldwin
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Quan Chen
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Thomas C Tucker
- Department of Epidemiology, College of Public Health & Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Connie G White
- Kentucky Department for Public Health, Frankfort, KY 40601, USA.
| | - Robert N Ore
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Bin Huang
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
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A Perspective on Ovarian Cancer Biomarkers: Past, Present and Yet-To-Come. Diagnostics (Basel) 2017; 7:diagnostics7010014. [PMID: 28282875 PMCID: PMC5373023 DOI: 10.3390/diagnostics7010014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/15/2017] [Accepted: 02/23/2017] [Indexed: 12/18/2022] Open
Abstract
The history of biomarkers and ultrasonography dates back over more than 50 years. The present status of biomarkers used in the context of ovarian cancer is addressed. Attention is given to new interpretations of the etiology of ovarian cancer. Cancer antigen 125 (CA125) and multivariate index assays (Ova1, Risk of Ovarian Malignancy Algorithm, Overa) are biomarker-driven considerations that are presented. Integration of biomarkers into ovarian cancer diagnostics and screening are presented in conjunction with ultrasound. Consideration is given to the serial application of both biomarkers and ultrasound, as well as morphology-based indices. Attempts are made to foresee how individualized molecular signatures may be able to both provide an alert of the potential for ovarian cancer and to provide molecular treatments tailored to a personalized genetic signature. In the future, an annual pelvic ultrasound and a comprehensive serum biomarker screening/diagnostic panel may replace the much maligned bimanual examination as part of the annual gynecologic examination. Taken together, it is likely that a new medical specialty for screening and early diagnostics will emerge for physicians and epidemiologists, a field of study that is independent of patient gender, organ, or the subspecialties of today.
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Guraslan H, Dogan K. Management of unilocular or multilocular cysts more than 5 centimeters in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2016; 203:40-3. [DOI: 10.1016/j.ejogrb.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/25/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
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Endometrial evaluation with transvaginal ultrasonography for the screening of endometrial hyperplasia or cancer in premenopausal and perimenopausal women. Obstet Gynecol Sci 2016; 59:192-200. [PMID: 27200309 PMCID: PMC4871935 DOI: 10.5468/ogs.2016.59.3.192] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/18/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of our study is to determine clinical factors and sonographic findings associated with endometrial hyperplasia or cancer (EH+) in premenopausal and perimenopausal women. Methods A total of 14,340 transvaginal ultrasonography examinations of 9,888 healthy premenopausal and perimenopausal women were included in this retrospective study. One hundred sixty-two subjects underwent endometrial biopsy based on abnormal uterine bleeding (AUB), sonographic endometrial abnormalities (thickened endometrium, endometrial mass, or endometrial stripe abnormality), or both. The clinical factors and sonographic endometrial abnormalities were evaluated with regard to EH+. Results Histologically verified EH+ was found in fourteen subjects (8.6%); ten cases of endometrial hyperplasia (EH) without atypia, three cases of EH with atypia (AEH), and one case of endometrial cancer. Neither clinical factors nor AUB were associated with EH+ (P=0.32) or AEH+ (P=0.72). Of sonographic findings, endometrial stripe abnormality was significantly associated with EH+ (P=0.003) and marginally associated with AEH+ (P=0.05), but a thickened endometrium was not associated with EH+ (P=0.43). Conclusion Endometrial stripe abnormality is a significant factor to predict EH+ in healthy premenopausal and perimenopausal women with and without AUB. However, simple measurement of endometrial thickness has a limited role in this capacity.
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Evaluation and Management of Ultrasonographically Detected Ovarian Tumors in Asymptomatic Women. Obstet Gynecol 2016; 127:848-858. [DOI: 10.1097/aog.0000000000001384] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Shen ZY, He AQ, Xia GL, Wu MF, Li J, Ding YS. New sonographic morphology score for the differentiation of malignant from benign ovarian tumors. J Obstet Gynaecol Res 2016; 42:1000-12. [PMID: 27125323 DOI: 10.1111/jog.13009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to explore the efficacy of a new sonographic morphology score (SMS) to differentiate malignant from benign ovarian tumors. METHODS Data on 84 ovarian tumors in patients hospitalized in our hospital between 2013 and 2014 were retrospectively analyzed. We established a new sonographic morphology score for ovarian tumors based on volume and structure scores. The efficacy of the new SMS was compared with that of Ueland's index (the old SMS). Receiver-operator curves (ROC) of the two SMS were constructed, and the areas under the curve were calculated and compared. The ROC of the new SMS was also compared with those for the patients' CA-125 and CA-72-4 levels. RESULTS The area under the ROC of the new SMS for ovarian tumors was 0.836, while for the old SMS for ovarian tumors it was 0.709. By Z-test (Z = 2.452, P = 0.0384), there was a significant difference between the new SMS and the old SMS in the diagnosis of ovarian tumors. There was no significant difference in the area under the ROC between the new SMS and CA-125 and CA-72-4 in the diagnosis of ovarian tumors. With a cut-off value of 6, the sensitivity, specificity, positive prognostic value, and negative prognostic value of the new SMS were 0.797, 0.85, 0.944, and 0.567, respectively. CONCLUSION The new SMS may be used to differentiate malignant ovarian carcinomas from benign tumors except in the case of ovarian thecoma.
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Affiliation(s)
- Zhi Yong Shen
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
| | - Ai Qin He
- Department of Gynecology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
| | - Gan Lin Xia
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
| | - Ming Feng Wu
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
| | - Jun Li
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
| | - Yong Sheng Ding
- Department of Radiology, Nantong University Affiliated Nantong Tumor Hospital, Nantong, China
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Retrospective analysis of suspicious pelvic masses using the Pelvic Mass Index (PMI) scoring system from 2007 to 2014. Eur J Obstet Gynecol Reprod Biol 2016; 201:79-84. [PMID: 27082132 DOI: 10.1016/j.ejogrb.2016.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aims to validate the accuracy of the Pelvic Mass Index (PMI) by comparing it with Risk of Malignancy Index (RMI) in a large patient cohort. STUDY DESIGN This retrospective study used data of women with ovarian masses collected from 2007 to 2014, referred to the Pelvic Mass Clinic (PMC) at University Hospital of Wales in Cardiff. The locally developed PMI was used to triage patients for surgery, surveillance or discharge. Performance measures for PMI, RMI and CA125 are reported as sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), receiver operating characteristic (ROC) curves and area under the curve (AUC) for premenopausal and postmenopausal women alike. RESULTS PMI was calculated on 1468 patients of whom 497 underwent surgery, 176 (71.0%) were in the high risk group, 63 (68.0%) intermediate and 258 (23%) amongst low risk women. Compared to RMI, PMI had a higher sensitivity (90.4%) and NPV (96.9%) for the entire cohort, as well as in the premenopausal (88.9%; 97.6%) and postmenopausal (91.5%; 95.6%) subcategories. ROC curves indicated better performance in the total group (AUC 0.823 vs. 0.770) and the premenopausal group (AUC 0.847 vs. 0.728), though AUC in the postmenopausal group was similar (0.779 vs. 0.791) - likely due to increased specificity of CA125 after menopause. Histology revealed PMI significantly outperforms RMI in diagnosing malignancy, missing only 1 compared to 20 cancers. CONCLUSIONS The high sensitivity and NPV of PMI makes it a useful tool in triaging patients with suspicious ovarian masses.
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Bozdag H, Guzin K, Gocmen A, Kabaca S, Usta A, Akdeniz Duran E. The diagnostic value of frozen section for borderline ovarian tumours. J OBSTET GYNAECOL 2016; 36:626-30. [DOI: 10.3109/01443615.2015.1133574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Halenur Bozdag
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Kadir Guzin
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Ahmet Gocmen
- Department of Obstetrics and Gynecology, Faculty of Medicine, İstanbul Medeniyet University, Istanbul, Turkey and
| | - Sedef Kabaca
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Akın Usta
- Department of Obstetrics and Gynecology, Göztepe Teaching and Research Hospital, İstanbul Medeniyet University, Istanbul, Turkey,
| | - Esra Akdeniz Duran
- Department of Statistics, Faculty of Sciences, İstanbul Medeniyet University, Istanbul, Turkey
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Pereira E, Camacho-Vanegas O, Anand S, Sebra R, Catalina Camacho S, Garnar-Wortzel L, Nair N, Moshier E, Wooten M, Uzilov A, Chen R, Prasad-Hayes M, Zakashansky K, Beddoe AM, Schadt E, Dottino P, Martignetti JA. Personalized Circulating Tumor DNA Biomarkers Dynamically Predict Treatment Response and Survival In Gynecologic Cancers. PLoS One 2015. [PMID: 26717006 DOI: 10.1371/journal.pone.0145754] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High-grade serous ovarian and endometrial cancers are the most lethal female reproductive tract malignancies worldwide. In part, failure to treat these two aggressive cancers successfully centers on the fact that while the majority of patients are diagnosed based on current surveillance strategies as having a complete clinical response to their primary therapy, nearly half will develop disease recurrence within 18 months and the majority will die from disease recurrence within 5 years. Moreover, no currently used biomarkers or imaging studies can predict outcome following initial treatment. Circulating tumor DNA (ctDNA) represents a theoretically powerful biomarker for detecting otherwise occult disease. We therefore explored the use of personalized ctDNA markers as both a surveillance and prognostic biomarker in gynecologic cancers and compared this to current FDA-approved surveillance tools. METHODS AND FINDINGS Tumor and serum samples were collected at time of surgery and then throughout treatment course for 44 patients with gynecologic cancers, representing 22 ovarian cancer cases, 17 uterine cancer cases, one peritoneal, three fallopian tube, and one patient with synchronous fallopian tube and uterine cancer. Patient/tumor-specific mutations were identified using whole-exome and targeted gene sequencing and ctDNA levels quantified using droplet digital PCR. CtDNA was detected in 93.8% of patients for whom probes were designed and levels were highly correlated with CA-125 serum and computed tomography (CT) scanning results. In six patients, ctDNA detected the presence of cancer even when CT scanning was negative and, on average, had a predictive lead time of seven months over CT imaging. Most notably, undetectable levels of ctDNA at six months following initial treatment was associated with markedly improved progression free and overall survival. CONCLUSIONS Detection of residual disease in gynecologic, and indeed all cancers, represents a diagnostic dilemma and a potential critical inflection point in precision medicine. This study suggests that the use of personalized ctDNA biomarkers in gynecologic cancers can identify the presence of residual tumor while also more dynamically predicting response to treatment relative to currently used serum and imaging studies. Of particular interest, ctDNA was an independent predictor of survival in patients with ovarian and endometrial cancers. Earlier recognition of disease persistence and/or recurrence and the ability to stratify into better and worse outcome groups through ctDNA surveillance may open the window for improved survival and quality and life in these cancers.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/genetics
- Breast Neoplasms/blood
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- CA-125 Antigen/blood
- DNA, Neoplasm/blood
- DNA, Neoplasm/genetics
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/mortality
- Exome/genetics
- Female
- Genital Neoplasms, Female/blood
- Genital Neoplasms, Female/drug therapy
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/mortality
- Humans
- Middle Aged
- Mutation/genetics
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/genetics
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
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Affiliation(s)
- Elena Pereira
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Olga Camacho-Vanegas
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sanya Anand
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sandra Catalina Camacho
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leopold Garnar-Wortzel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Navya Nair
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Erin Moshier
- Department of Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Melissa Wooten
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Andrew Uzilov
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rong Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Monica Prasad-Hayes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Konstantin Zakashansky
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ann Marie Beddoe
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Eric Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Peter Dottino
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - John A Martignetti
- Department of Obstetrics, Gynecology and Reproductive Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Personalized Circulating Tumor DNA Biomarkers Dynamically Predict Treatment Response and Survival In Gynecologic Cancers. PLoS One 2015; 10:e0145754. [PMID: 26717006 PMCID: PMC4696808 DOI: 10.1371/journal.pone.0145754] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023] Open
Abstract
Background High-grade serous ovarian and endometrial cancers are the most lethal female reproductive tract malignancies worldwide. In part, failure to treat these two aggressive cancers successfully centers on the fact that while the majority of patients are diagnosed based on current surveillance strategies as having a complete clinical response to their primary therapy, nearly half will develop disease recurrence within 18 months and the majority will die from disease recurrence within 5 years. Moreover, no currently used biomarkers or imaging studies can predict outcome following initial treatment. Circulating tumor DNA (ctDNA) represents a theoretically powerful biomarker for detecting otherwise occult disease. We therefore explored the use of personalized ctDNA markers as both a surveillance and prognostic biomarker in gynecologic cancers and compared this to current FDA-approved surveillance tools. Methods and Findings Tumor and serum samples were collected at time of surgery and then throughout treatment course for 44 patients with gynecologic cancers, representing 22 ovarian cancer cases, 17 uterine cancer cases, one peritoneal, three fallopian tube, and one patient with synchronous fallopian tube and uterine cancer. Patient/tumor-specific mutations were identified using whole-exome and targeted gene sequencing and ctDNA levels quantified using droplet digital PCR. CtDNA was detected in 93.8% of patients for whom probes were designed and levels were highly correlated with CA-125 serum and computed tomography (CT) scanning results. In six patients, ctDNA detected the presence of cancer even when CT scanning was negative and, on average, had a predictive lead time of seven months over CT imaging. Most notably, undetectable levels of ctDNA at six months following initial treatment was associated with markedly improved progression free and overall survival. Conclusions Detection of residual disease in gynecologic, and indeed all cancers, represents a diagnostic dilemma and a potential critical inflection point in precision medicine. This study suggests that the use of personalized ctDNA biomarkers in gynecologic cancers can identify the presence of residual tumor while also more dynamically predicting response to treatment relative to currently used serum and imaging studies. Of particular interest, ctDNA was an independent predictor of survival in patients with ovarian and endometrial cancers. Earlier recognition of disease persistence and/or recurrence and the ability to stratify into better and worse outcome groups through ctDNA surveillance may open the window for improved survival and quality and life in these cancers.
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Ultrasound follow up of an adnexal mass has the potential to save lives. Am J Obstet Gynecol 2015; 213:657-61, 657.e1. [PMID: 26116103 DOI: 10.1016/j.ajog.2015.06.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/23/2022]
Abstract
Ovarian cancer is among the most dreaded cancers since it is often found at a late stage where the opportunity for extended survival is poor. Ultrasound has been utilized in several ovarian cancer screening trials in asymptomatic women in order to detect ovarian cancer at early stages where survival rates are high. Efforts to improve screening for ovarian cancer are ongoing. While ovarian cancer screening in asymptomatic women is not recommended for clinical application currently, the care of women with adnexal masses found by ultrasound in clinical practice can benefit from close evaluation of the evidence obtained from large prospective ovarian cancer screening trials and by relating this evidence to recent advances in the understanding of different types of ovarian cancer. Post-menopausal women who have an adnexal mass discovered by ultrasound have a much higher risk of developing ovarian cancer than women with normal ultrasound. The preponderance of reported evidence indicates that ultrasound monitoring of an adnexal mass is safe, cost effective and can achieve an improved positive predictive value in detecting ovarian cancer when ovarian abnormalities resolve during surveillance. Proposals to arbitrarily discontinue ultrasound monitoring can negatively impact patient care and generate medical-legal actions, especially because there is no evidence to support safe discontinuation. In this review, we outline a rationale for continuing ultrasound surveillance of ovarian abnormalities.
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Abbas PI, Elder SC, Mehollin-Ray AR, Braverman RM, Lopez ME, Francis JA, Dietrich JE. Ovarian lesion volumes as a screening tool for malignancy in adolescent ovarian tumors. J Pediatr Surg 2015; 50:1933-6. [PMID: 26242572 DOI: 10.1016/j.jpedsurg.2015.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preoperative evaluation of ovarian tumors for malignancy is essential to determine appropriate treatment. Our study assessed the utility of ovarian lesion volumes to screen for malignancy in adolescent ovarian lesions. METHODS A retrospective chart review of adolescent patients (8-18years) who underwent an ovarian operation from January 2008 to December 2012. Data included demographics, ultrasonographic volume measurements, and tumor markers. Volumes were calculated using the prolate ellipsoid formula. Data are presented as medians. RESULTS One hundred twenty-three females were included at a median age of 13.7years (IQR 12.5-16). Eight patients had malignancies. The median benign lesion volume was significantly smaller than malignant [152cm3 (IQR 57-592)vs. 1548cm(3) (IQR 627-2105), p=0.001]. A receiver operating characteristic (ROC) curve analysis (AUC 0.84, p=0.001) revealed a threshold ovarian lesion volume of <184cm(3) (100% sensitivity, 54% specificity, NPV 100%, PPV 13%) to accurately screen for malignancy. This held true when applied to our dataset as none of the 62 girls with volumes <184cm(3) had malignant pathology. CONCLUSIONS This is the first documented use of ovarian lesion volumes as a screening tool in adolescent ovarian lesions. This should be used in conjunction with tumor markers and other imaging features to better screen for malignancy.
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Affiliation(s)
- Paulette I Abbas
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Simone C Elder
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Amy R Mehollin-Ray
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Richard M Braverman
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Monica E Lopez
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jessica A Francis
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
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Stukan M, Dudziak M, Ratajczak K, Grabowski JP. Usefulness of diagnostic indices comprising clinical, sonographic, and biomarker data for discriminating benign from malignant ovarian masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:207-217. [PMID: 25614393 DOI: 10.7863/ultra.34.2.207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to review the accuracy of indices combining several diagnostic variables, in comparison to other models, sonography alone, and biomarker assays, for predicting benign or malignant ovarian lesions. Different single modalities were reviewed. The most useful complex models were International Ovarian Tumor Analysis (IOTA) sonographic logistic regression model 2 (area under the curve, 0.949), risk of malignancy index-cancer antigen 125-human epididymis protein 4 (0.950), risk of malignancy algorithm (0.953), pelvic mass score (0.960), non-IOTA logistic regression model (0.970), and histoscanning score logistic regression model (0.970). None of the indices was superior to an expert subjective sonographic assessment (0.968). For women with adnexal tumors, indices with high accuracy are available that are applicable in clinical practice and comparable to an expert subjective sonographic assessment for discriminating benign from malignant masses.
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Affiliation(s)
- Maciej Stukan
- Department of Gynecological Oncology, Gdynia Oncology Center, Gdynia, Poland (M.S., M.D.); Information Technology Department, Business Consulting Center, Gdansk, Poland (K.R.); and Department of Gynecology and Gynecological Oncology, Kliniken-Essen-Mitte, Essen, Germany (J.P.G.).
| | - Miroslaw Dudziak
- Department of Gynecological Oncology, Gdynia Oncology Center, Gdynia, Poland (M.S., M.D.); Information Technology Department, Business Consulting Center, Gdansk, Poland (K.R.); and Department of Gynecology and Gynecological Oncology, Kliniken-Essen-Mitte, Essen, Germany (J.P.G.)
| | - Karol Ratajczak
- Department of Gynecological Oncology, Gdynia Oncology Center, Gdynia, Poland (M.S., M.D.); Information Technology Department, Business Consulting Center, Gdansk, Poland (K.R.); and Department of Gynecology and Gynecological Oncology, Kliniken-Essen-Mitte, Essen, Germany (J.P.G.)
| | - Jacek P Grabowski
- Department of Gynecological Oncology, Gdynia Oncology Center, Gdynia, Poland (M.S., M.D.); Information Technology Department, Business Consulting Center, Gdansk, Poland (K.R.); and Department of Gynecology and Gynecological Oncology, Kliniken-Essen-Mitte, Essen, Germany (J.P.G.)
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Hermans AJ, Kluivers KB, Massuger LF, Coppus SF. External validation of the paediatric risk of malignancy index. BJOG 2015; 123:448-52. [DOI: 10.1111/1471-0528.13253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- AJ Hermans
- Department of Obstetrics & Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - KB Kluivers
- Department of Obstetrics & Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - LF Massuger
- Department of Obstetrics & Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
| | - SF Coppus
- Department of Obstetrics & Gynaecology; Radboud University Medical Center; Nijmegen the Netherlands
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