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Gu M, Wang Y, Yu Y. Ovarian fibrosis: molecular mechanisms and potential therapeutic targets. J Ovarian Res 2024; 17:139. [PMID: 38970048 PMCID: PMC11225137 DOI: 10.1186/s13048-024-01448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/03/2024] [Indexed: 07/07/2024] Open
Abstract
Ovarian fibrosis, characterized by the excessive proliferation of ovarian fibroblasts and the accumulation of extracellular matrix (ECM), serves as one of the primary causes of ovarian dysfunction. Despite the critical role of ovarian fibrosis in maintaining the normal physiological function of the mammalian ovaries, research on this condition has been greatly underestimated, which leads to a lack of clinical treatment options for ovarian dysfunction caused by fibrosis. This review synthesizes recent research on the molecular mechanisms of ovarian fibrosis, encompassing TGF-β, extracellular matrix, inflammation, and other profibrotic factors contributing to abnormal ovarian fibrosis. Additionally, we summarize current treatment approaches for ovarian dysfunction targeting ovarian fibrosis, including antifibrotic drugs, stem cell transplantation, and exosomal therapies. The purpose of this review is to summarize the research progress on ovarian fibrosis and to propose potential therapeutic strategies targeting ovarian fibrosis for the treatment of ovarian dysfunction.
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Affiliation(s)
- Mengqing Gu
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Ministry of Education, Beijing, 100191, China
- Clinical Stem Cell Research Center, Peking University Third Hospital, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
| | - Yibo Wang
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Ministry of Education, Beijing, 100191, China.
- Clinical Stem Cell Research Center, Peking University Third Hospital, Beijing, 100191, China.
- Institute of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
| | - Yang Yu
- State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Ministry of Education, Beijing, 100191, China.
- Clinical Stem Cell Research Center, Peking University Third Hospital, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
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Whitney HM, Yoeli-Bik R, Abramowicz JS, Lan L, Li H, Longman RE, Lengyel E, Giger ML. AI-based automated segmentation for ovarian/adnexal masses and their internal components on ultrasound imaging. J Med Imaging (Bellingham) 2024; 11:044505. [PMID: 39114540 PMCID: PMC11301525 DOI: 10.1117/1.jmi.11.4.044505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/21/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose Segmentation of ovarian/adnexal masses from surrounding tissue on ultrasound images is a challenging task. The separation of masses into different components may also be important for radiomic feature extraction. Our study aimed to develop an artificial intelligence-based automatic segmentation method for transvaginal ultrasound images that (1) outlines the exterior boundary of adnexal masses and (2) separates internal components. Approach A retrospective ultrasound imaging database of adnexal masses was reviewed for exclusion criteria at the patient, mass, and image levels, with one image per mass. The resulting 54 adnexal masses (36 benign/18 malignant) from 53 patients were separated by patient into training (26 benign/12 malignant) and independent test (10 benign/6 malignant) sets. U-net segmentation performance on test images compared to expert detailed outlines was measured using the Dice similarity coefficient (DSC) and the ratio of the Hausdorff distance to the effective diameter of the outline (R HD - D ) for each mass. Subsequently, in discovery mode, a two-level fuzzy c-means (FCM) unsupervised clustering approach was used to separate the pixels within masses belonging to hypoechoic or hyperechoic components. Results The DSC (median [95% confidence interval]) was 0.91 [0.78, 0.96], andR HD - D was 0.04 [0.01, 0.12], indicating strong agreement with expert outlines. Clinical review of the internal separation of masses into echogenic components demonstrated a strong association with mass characteristics. Conclusion A combined U-net and FCM algorithm for automatic segmentation of adnexal masses and their internal components achieved excellent results compared with expert outlines and review, supporting future radiomic feature-based classification of the masses by components.
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Affiliation(s)
- Heather M. Whitney
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Roni Yoeli-Bik
- The University of Chicago, Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, Chicago, Illinois, United States
| | - Jacques S. Abramowicz
- The University of Chicago, Department of Obstetrics and Gynecology/Section of Ultrasound, Genetics, and Fetal Neonatal Care Center, Chicago, Illinois, United States
| | - Li Lan
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Hui Li
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
| | - Ryan E. Longman
- The University of Chicago, Department of Obstetrics and Gynecology/Section of Ultrasound, Genetics, and Fetal Neonatal Care Center, Chicago, Illinois, United States
| | - Ernst Lengyel
- The University of Chicago, Department of Obstetrics and Gynecology/Section of Gynecologic Oncology, Chicago, Illinois, United States
| | - Maryellen L. Giger
- The University of Chicago, Department of Radiology, Chicago, Illinois, United States
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Han J, Wen J, Hu W. Comparison of O-RADS with the ADNEX model and IOTA SR for risk stratification of adnexal lesions: a systematic review and meta-analysis. Front Oncol 2024; 14:1354837. [PMID: 38756655 PMCID: PMC11096596 DOI: 10.3389/fonc.2024.1354837] [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: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose This study aims to systematically compare the diagnostic performance of the Ovarian-Adnexal Reporting and Data System with the International Ovarian Tumor Analysis Simple Rules and the Assessment of Different NEoplasias in the adneXa model for risk stratification of ovarian cancer and adnexal masses. Methods A literature search of online databases for relevant studies up to July 2023 was conducted by two independent reviewers. The summary estimates were pooled with the hierarchical summary receiver-operating characteristic model. The quality of the included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 and the Quality Assessment of Diagnostic Accuracy Studies-Comparative Tool. Metaregression and subgroup analyses were performed to explore the impact of varying clinical settings. Results A total of 13 studies met the inclusion criteria. The pooled sensitivity and specificity for eight head-to-head studies between the Ovarian-Adnexal Reporting and Data System and the Assessment of Different NEoplasias in the adneXa model were 0.96 (95% CI 0.92-0.98) and 0.82 (95% CI 0.71-0.90) vs. 0.94 (95% CI 0.91-0.95) and 0.83 (95% CI 0.77-0.88), respectively, and for seven head-to-head studies between the Ovarian-Adnexal Reporting and Data System and the International Ovarian Tumor Analysis Simple Rules, the pooled sensitivity and specificity were 0.95 (95% CI 0.93-0.97) and 0.75 (95% CI 0.62-0.85) vs. 0.91 (95% CI 0.82-0.96) and 0.86 (95% CI 0.76-0.93), respectively. No significant differences were found between the Ovarian-Adnexal Reporting and Data System and the Assessment of Different NEoplasias in the adneXa model as well as the International Ovarian Tumor Analysis Simple Rules in terms of sensitivity (P = 0.57 and P = 0.21) and specificity (P = 0.87 and P = 0.12). Substantial heterogeneity was observed among the studies for all three guidelines. Conclusion All three guidelines demonstrated high diagnostic performance, and no significant differences in terms of sensitivity or specificity were observed between the three guidelines.
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Affiliation(s)
- Jing Han
- Department of Radiology, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, China
| | - Jing Wen
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Wei Hu
- Department of Radiology, Yixing Traditional Chinese Medicine Hospital, Yixing, China
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Cabedo L, Sebastià C, Munmany M, Fusté P, Gaba L, Saco A, Rodriguez A, Paño B, Nicolau C. O-RADS MRI scoring system: key points for correct application in inexperienced hands. Insights Imaging 2024; 15:107. [PMID: 38609573 PMCID: PMC11014836 DOI: 10.1186/s13244-024-01670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To evaluate the efficacy of the O-RADS MRI criteria in the stratification of risk of malignancy of solid or sonographically indeterminate ovarian masses and assess the interobserver agreement of this classification between experienced and inexperienced radiologists. METHODS This single-centre retrospective study included patients from 2019 to 2022 with sonographically indeterminate or solid ovarian masses who underwent MRI with a specific protocol for characterisation according to O-RADS MRI specifications. Each study was evaluated using O-RADS lexicon by two radiologists, one with 17 years of experience in gynaecological radiology and another with 4 years of experience in general radiology. Findings were classified as benign, borderline, or malignant according to histology or stability over time. Diagnostic performance and interobserver agreement were assessed. RESULTS A total of 183 patients with US indeterminate or solid adnexal masses were included. Fifty-seven (31%) did not have ovarian masses, classified as O-RADS 1. The diagnostic performance for scores 2-5 was excellent with a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 96.2%, and 100%, respectively by the experienced radiologist and 96.1%, 92.0%, 93.9%, and 94.8% by the inexperienced radiologist. Interobserver concordance was very high (Kappa index 0.92). Almost all the misclassified cases were due to misinterpretation of the classification similar to reports in the literature. CONCLUSION The diagnostic performance of O-RADS MRI determined by either experienced or inexperienced radiologists is excellent, facilitating decision-making with high diagnostic accuracy and high reproducibility. Knowledge of this classification and use of assessment tools could avoid frequent errors due to misinterpretation. CRITICAL RELEVANCE STATEMENT Up to 31% of ovarian masses are considered indeterminate by transvaginal US and 32% of solid lesions considered malignant by transvaginal US are benign. The O-RADs MRI accurately classifies these masses, even when used by inexperienced radiologists, thereby avoiding incorrect surgical approaches. KEY POINTS • O-RADS MRI accurately classifies indeterminate and solid ovarian masses by ultrasound. • There is excellent interobserver agreement between experienced and non-experienced radiologists. • O-RADS MRI is a helpful tool to assess clinical decision-making in ovarian tumours.
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Affiliation(s)
- Lledó Cabedo
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carmen Sebastià
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain.
| | - Meritxell Munmany
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Pere Fusté
- Department of Gynaecology and Obstetrics, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Lydia Gaba
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adela Rodriguez
- Department of Oncology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Paño
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
| | - Carlos Nicolau
- Department of Radiology, Hospital Clínic de Barcelona, C/Villarroel, Barcelona, 170 08036, Spain
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Thomassin-Naggara I, Dabi Y, Florin M, Saltel-Fulero A, Manganaro L, Bazot M, Razakamanantsoa L. O-RADS MRI SCORE: An Essential First-Step Tool for the Characterization of Adnexal Masses. J Magn Reson Imaging 2024; 59:720-736. [PMID: 37550825 DOI: 10.1002/jmri.28947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
The ovarian-adnexal reporting and data system on magnetic resonance imaging (O-RADS MRI) score is now a well-established tool to characterize pelvic gynecological masses based on their likelihood of malignancy. The main added value of O-RADS MRI over O-RADS US is to correctly reclassify lesions that were considered suspicious on US as benign on MRI. The crucial issue when characterizing an adnexal mass is to determine the presence/absence of solid tissue and thus need to perform gadolinium injection. O-RADS MR score was built on a multivariate analysis and must be applied as a step-by-step analysis: 1) Is the mass an adnexal mass? 2) Is there an associated peritoneal carcinomatosis? 3) Is there any significant amount of fatty content? 4) Is there any wall enhancement? 5) Is there any internal enhancement? 6) When an internal enhancement is detected, does the internal enhancement correspond to solid tissue or not? 7) Is the solid tissue malignant? With its high value to distinguish benign from malignant adnexal masses and its high reproducibility, the O-RADS MRI score could be a valuable tool for timely referral of a patient to an expert center for the treatment of ovarian cancers. Finally, to make a precise diagnosis allowing optimal personalized treatment, the radiologist in gynecological imaging will combine the O-RADS MRI score with many other clinical, biological, and other MR criteria to suggest a pathological hypothesis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- I Thomassin-Naggara
- Assistante Publique des Hôpitaux de Paris, Department of Radiology Imaging and Interventional Radiology (IRIS), Tenon Hospital, APHP, Sorbonne University, 75005, Paris, Paris, France
- Saint-Antoine Research Cancer Center, Sorbonne University, Paris, France
| | - Y Dabi
- Department of Obstetrics and Reproductive Medicine, Tenon Hospital, Paris, France
| | - M Florin
- Assistante Publique des Hôpitaux de Paris, Department of Radiology Imaging and Interventional Radiology (IRIS), Tenon Hospital, APHP, Sorbonne University, 75005, Paris, Paris, France
| | - A Saltel-Fulero
- Department of Radiology, Georges-Pompidou European Hospital, APHP, Paris, France
| | | | - M Bazot
- Assistante Publique des Hôpitaux de Paris, Department of Radiology Imaging and Interventional Radiology (IRIS), Tenon Hospital, APHP, Sorbonne University, 75005, Paris, Paris, France
| | - L Razakamanantsoa
- Assistante Publique des Hôpitaux de Paris, Department of Radiology Imaging and Interventional Radiology (IRIS), Tenon Hospital, APHP, Sorbonne University, 75005, Paris, Paris, France
- Saint-Antoine Research Cancer Center, Sorbonne University, Paris, France
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Chen W, Liu H, Huang X, Qian L, Chen L, Zhou Y, Liu Y, Liu Y, Wang Y, Zhang T, Zhou Y, Fang J, Yang J, Ni F, Guo C, Zhou Y. A single-cell landscape of pre- and post-menopausal high-grade serous ovarian cancer ascites. iScience 2023; 26:107712. [PMID: 37701567 PMCID: PMC10493500 DOI: 10.1016/j.isci.2023.107712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
High-grade serous ovarian cancer (HGSOC) is a hormone-related cancer with high mortality and poor prognosis. Based on the transcriptome of 57,444 cells in ascites from 10 patients with HGSOC (including 5 pre-menopausal and 5 post-menopausal patients), we identified 14 cell clusters which were further classified into 6 cell types, including T cells, B cells, NK cells, myeloid cells, epithelial cells, and stromal cells. We discovered an increased proportion of epithelial cells and a decreased proportion of T cells in pre-menopausal ascites compared with post-menopausal ascites. GO analysis revealed the pre-menopausal tumor microenvironments (TME) are closely associated with viral infection, while the post-menopausal TME are mostly related to the IL-17 immune pathway. SPP1/CD44-mediated crosstalk between myeloid cells and B cells, NK cells, and stromal cells mainly present in the pre-menopausal group, while SPP1/PTGER4 -mediated crosstalk between myeloid cells and epithelial cells mostly present in the post-menopausal group.
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Affiliation(s)
- Wenying Chen
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Hanyuan Liu
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Xinya Huang
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Lili Qian
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Liang Chen
- Department of Cardiology, The First Affiliated Hospital of USTC, the CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Basic Medical Sciences, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yonggang Zhou
- The CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Basic Medical Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Institute of Immunology, University of Science and Technology of China, Hefei, China
| | - Yi Liu
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yujie Liu
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yingying Wang
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Tianjiao Zhang
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Youyang Zhou
- HanGene Biotech, Xiaoshan Innovation Polis, Hangzhou, Zhejiang 31200, China
| | - Jingwen Fang
- Department of Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230021, China
- HanGene Biotech, Xiaoshan Innovation Polis, Hangzhou, Zhejiang 31200, China
| | - Jiaxuan Yang
- HanGene Biotech, Xiaoshan Innovation Polis, Hangzhou, Zhejiang 31200, China
| | - Fang Ni
- The CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Basic Medical Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Institute of Immunology, University of Science and Technology of China, Hefei, China
- Department of Hematology, The First Affiliated Hospital of USTC, Hefei, Anhui, China
| | - Chuang Guo
- Department of Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230021, China
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Zhou
- Department of Obstetrics and Gynecology, Core Facility Center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
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Yoeli-Bik R, Longman RE, Wroblewski K, Weigert M, Abramowicz JS, Lengyel E. Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort. JAMA Netw Open 2023; 6:e2323289. [PMID: 37440228 PMCID: PMC10346125 DOI: 10.1001/jamanetworkopen.2023.23289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023] Open
Abstract
Importance Ultrasonography-based risk models can help nonexpert clinicians evaluate adnexal lesions and reduce surgical interventions for benign tumors. Yet, these models have limited uptake in the US, and studies comparing their diagnostic accuracy are lacking. Objective To evaluate, in a US cohort, the diagnostic performance of 3 ultrasonography-based risk models for differentiating between benign and malignant adnexal lesions: International Ovarian Tumor Analysis (IOTA) Simple Rules with inconclusive cases reclassified as malignant or reevaluated by an expert, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX), and Ovarian-Adnexal Reporting and Data System (O-RADS). Design, Setting, and Participants This retrospective diagnostic study was conducted at a single US academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically or conservatively between January 2017 and October 2022. Exposure Evaluation of adnexal lesions using the Simple Rules, ADNEX, and O-RADS. Main Outcomes and Measures The main outcome was diagnostic performance, including area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Surgery or follow-up were reference standards. Secondary analyses evaluated the models' performances stratified by menopause status and race. Results The cohort included 511 female patients with a 15.9% malignant tumor prevalence (81 patients). Mean (SD) ages of patients with benign and malignant adnexal lesions were 44.1 (14.4) and 52.5 (15.2) years, respectively, and 200 (39.1%) were postmenopausal. In the ROC analysis, the AUCs for discriminative performance of the ADNEX and O-RADS models were 0.96 (95% CI, 0.93-0.98) and 0.92 (95% CI, 0.90-0.95), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.93 (95% CI, 0.90-0.96), which was similar to that for O-RADS. The Simple Rules combined with expert reevaluation had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 91.9% specificity (95% CI, 88.9%-94.3%), and the Simple Rules combined with malignant classification had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 88.1% specificity (95% CI, 84.7%-91.0%). At a 10% risk threshold, ADNEX had 91.4% sensitivity (95% CI, 83.0%-96.5%) and 86.3% specificity (95% CI, 82.7%-89.4%) and O-RADS had 98.8% sensitivity (95% CI, 93.3%-100%) and 74.4% specificity (95% CI, 70.0%-78.5%). The specificities of all models were significantly lower in the postmenopausal group. Subgroup analysis revealed high performances independent of race. Conclusions and Relevance In this diagnostic study of a US cohort, the Simple Rules, ADNEX, and O-RADS models performed well in differentiating between benign and malignant adnexal lesions; this outcome has been previously reported primarily in European populations. Risk stratification models can lead to more accurate and consistent evaluations of adnexal masses, especially when used by nonexpert clinicians, and may reduce unnecessary surgeries.
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Affiliation(s)
- Roni Yoeli-Bik
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Ryan E. Longman
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Melanie Weigert
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | | | - Ernst Lengyel
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
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Younis JS, Izhaki I. At what age endometriosis-associated ovarian cancer is diagnosed? The implications for women in the reproductive age. Front Oncol 2023; 13:1193123. [PMID: 37287920 PMCID: PMC10242000 DOI: 10.3389/fonc.2023.1193123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel
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Miyakawa R, Kobayashi M, Sugimoto K, Endo Y, Kojima M, Kobayashi Y, Furukawa S, Honda T, Watanabe T, Asano S, Soeda S, Hashimoto Y, Fujimori K, Chiba H. SPON1 is an independent prognostic biomarker for ovarian cancer. J Ovarian Res 2023; 16:95. [PMID: 37179355 PMCID: PMC10182672 DOI: 10.1186/s13048-023-01180-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Ovarian cancer has the worst outcome among gynecological malignancies; therefore, biomarkers that could contribute to the early diagnosis and/or prognosis prediction are urgently required. In the present study, we focused on the secreted protein spondin-1 (SPON1) and clarified the prognostic relevance in ovarian cancer. METHODS We developed a monoclonal antibody (mAb) that selectively recognizes SPON1. Using this specific mAb, we determined the expression of SPON1 protein in the normal ovary, serous tubal intraepithelial carcinoma (STIC), and ovarian cancer tissues, as well as in various normal adult tissues by immunohistochemistry, and verified its clinicopathological significance in ovarian cancer. RESULTS The normal ovarian tissue was barely positive for SPON1, and no immunoreactive signals were detected in other healthy tissues examined, which was in good agreement with data obtained from gene expression databases. By contrast, upon semi-quantification, 22 of 242 ovarian cancer cases (9.1%) exhibited high SPON1 expression, whereas 64 (26.4%), 87 (36.0%), and 69 (28.5%) cases, which were designated as SPON1-low, possessed the moderate, weak, and negative SPON1 expression, respectively. The STIC tissues also possessed SPON1-positive signals. The 5-year recurrence-free survival (RFS) rate in the SPON1-high group (13.6%) was significantly lower than that in the SPON1-low group (51.2%). In addition, high SPON1 expression was significantly associated with several clinicopathological variables. Multivariable analysis revealed that high SPON1 was an independent prognostic factor for RFS of ovarian cancer. CONCLUSIONS SPON1 represents a prognostic biomarker for ovarian cancer, and the anti-SPON1 mAb could be valuable as an outcome predictor.
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Affiliation(s)
- Ryoya Miyakawa
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960- 1295, Japan
| | - Makoto Kobayashi
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960- 1295, Japan.
| | - Kotaro Sugimoto
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960- 1295, Japan
| | - Yuta Endo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Gynecologic Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Manabu Kojima
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Gynecologic Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Yasuyuki Kobayashi
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Medical Support for Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Tsuyoshi Honda
- Department of Regional Medical Support for Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Iwaki City Medical Center, Iwaki, 973-8555, Japan
| | - Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Gynecologic Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Shigeyuki Asano
- Department of Pathology, Iwaki City Medical Center, Iwaki, 973-8555, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Gynecologic Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Gynecologic Oncology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
- Department of Regional Medical Support for Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan
| | - Hideki Chiba
- Department of Basic Pathology, Fukushima Medical University School of Medicine, Fukushima, 960- 1295, Japan.
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10
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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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11
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Lee SI, Kang SK. MRI Improves the Characterization of Incidental Adnexal Masses Detected at Sonography. Radiology 2023; 307:e222866. [PMID: 36413134 PMCID: PMC10068880 DOI: 10.1148/radiol.222866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Susanna I. Lee
- From the Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, 55 Fruit St, White Bldg, Room 270, Boston, MA 02114
(S.I.L.); and Department of Radiology, New York University Grossman School of
Medicine, New York, NY (S.K.K.)
| | - Stella K. Kang
- From the Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, 55 Fruit St, White Bldg, Room 270, Boston, MA 02114
(S.I.L.); and Department of Radiology, New York University Grossman School of
Medicine, New York, NY (S.K.K.)
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12
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Sertic M, Devins KM, Oliva E, Lee SI, Kilcoyne A. Sex Cord-Stromal Tumors of the Ovary. Radiol Clin North Am 2023; 61:595-608. [PMID: 37169426 DOI: 10.1016/j.rcl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Ovarian sex cord-stromal tumors (OSCSTs) are a rare group of ovarian neoplasms that can be benign or malignant. They are classified into pure sex cord tumors, pure stromal tumors, and mixed SCST. The most common malignant OSCSTs are adult granulosa cell tumors. In contrast to the more common ovarian epithelial malignancies, OSCSTs present in younger patients, often at early stages, with better prognoses. Imaging features are variable, and pathology is required for diagnosis. However, certain tumors demonstrate characteristic imaging appearances that can be useful in narrowing the differential diagnosis.
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13
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Younis JS. Endometriosis-Associated Ovarian Cancer: What Are the Implications for Women with Intact Endometrioma Planning for a Future Pregnancy? A Reproductive Clinical Outlook. Biomolecules 2022; 12:1721. [PMID: 36421735 PMCID: PMC9688199 DOI: 10.3390/biom12111721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 08/16/2023] Open
Abstract
Endometriosis is a chronic, universal, and prevalent disease estimated to affect up to 1:10 women of reproductive age. Endometriosis-associated ovarian cancer (EAOC) developing at reproductive age is challenging and of concern for women and practitioners alike. This outlook review focuses on the occurrence of EAOC, especially in infertile women or those planning for a future pregnancy, from the perspective of a reproductive endocrinologist, based on recent evidence. Contemporary pathogenesis, genetic profiles, evidence of causality, clinical diagnosis, prognosis, and up-to-date management are discussed. EAOC seems to be merely associated with endometrioma and includes clear-cell and endometrioid ovarian carcinoma. Although endometrioma is frequently found in women of reproductive age (up to 1:18 of women), EAOC appears to be a rare occurrence. These women are of more advanced reproductive age, nulliparous, and hyperestrogenic, with a large-sized unilateral endometrioma (>9 cm) containing solid components and papillary projections. Each case suspected to have EAOC has specific characteristics, and a multidisciplinary discussion and appropriate patient counseling should be conducted to reach an optimal therapeutic plan. Since most of these cases are diagnosed at an early stage with a favorable prognosis, fertility-sparing surgery may be feasible. The pros and cons of fertility preservation techniques should be discussed.
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Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel; ; Tel.: +972-505286981; Fax: +972-46737478
- Azrieli Faculty of Medicine in Galilee, Bar-Ilan University, Safed 1311502, Israel
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14
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Sisodia RC, Del Carmen MG. Lesions of the Ovary and Fallopian Tube. Reply. N Engl J Med 2022; 387:1723-1724. [PMID: 36322863 DOI: 10.1056/nejmc2212426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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