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ACR Appropriateness Criteria ® Clinically Suspected Adnexal Mass, No Acute Symptoms. J Am Coll Radiol 2020; 16:S77-S93. [PMID: 31054761 DOI: 10.1016/j.jacr.2019.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
There are approximately 9.1 pelvic surgeries performed for every histologically confirmed adnexal malignancy in the United States, compared to 2.3 surgeries per malignancy (in oncology centers) and 5.9 surgeries per malignancy (in other centers) in Europe. An important prognostic factor in the long-term survival in patients with ovarian malignancy is the initial management by a gynecological oncologist. With high accuracy of imaging for adnexal mass characterization and consequent appropriate triage to subspecialty referral, the better use of gynecologic oncology can improve treatment outcomes. Ultrasound, including transabdominal, transvaginal, and duplex ultrasound, combined with MRI with contrast can diagnose adnexal masses as benign with specific features (ie, functional masses, dermoid, endometrioma, fibroma, pedunculated fibroid, hydrosalpinx, peritoneal inclusion cyst, Tarlov cyst), malignant, or indeterminate. 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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Elsherif SB, Zheng S, Ganeshan D, Iyer R, Wei W, Bhosale PR. Does dual-energy CT differentiate benign and malignant ovarian tumours? Clin Radiol 2020; 75:606-614. [PMID: 32252992 DOI: 10.1016/j.crad.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/09/2020] [Indexed: 01/19/2023]
Abstract
AIM To assess the ability of dual-energy computed tomography (DECT) to distinguish benign from malignant ovarian tumours (OTs). MATERIALS AND METHODS Following approval of the institutional review board, the institutional database was mined for treatment-naive patients who underwent primary cytoreduction for OT. Thirty-seven patients were included and divided into those with benign OTs (n = 11) and malignant OTs (n = 26), including high-grade (n = 20) and low-grade (n = 6) malignant OTs. Advanced processing and region of interest delineation on the ovarian mass were performed using the preoperative staging DECT examination using the Advantage Workstation. The pixel-level data of the CT attenuation values at 50, 70, and 120 keV and the effective atomic number (Zeff), water content (WC), and iodine content (IC) in the ovarian mass were recorded. The Wilcoxon rank-sum test was used to compare CT attenuation data at different voltages, Zeff, and WC and IC levels between benign and malignant OTs and between high- and low-grade malignant OTs. Simple logistic regression was used to correlate the imaging characteristics with malignant status and grade. RESULTS Malignant OTs had significantly higher Zeff and IC compared with benign OTs. The threshold values for the diagnosis of malignant OT were IC≥9.74 (100 μg/cm3) with 81% sensitivity and 73% specificity and Zeff ≥8.16 with 85% sensitivity and 73% specificity. High-grade OTs had significantly higher WC compared with low-grade OTs, and a threshold of ≥1,013.92 mg/cm3 differentiated them with 80% sensitivity and 83% specificity. CONCLUSION DECT may be a tool to help distinguish malignant and benign OTs and predict tumour grade.
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Affiliation(s)
- S B Elsherif
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA.
| | - S Zheng
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston McGovern Medical School, MSB 2.130B, 6431 Fannin Street, Houston, TX 77030 Houston, Texas, USA
| | - D Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - R Iyer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - W Wei
- Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
| | - P R Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX 77030, USA
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Abstract
OBJECTIVE The purpose of this article is to review the imaging findings and genomics of granulosa cell tumors (GCTs) in order to aid in diagnosis and management of GCTs. GCTs are the most common type of sex cord-stromal tumors of the ovary. They are usually diagnosed initially with ultrasound and are subsequently further characterized with CT and MRI. PET/CT is often ordered as well to measure the extent of disease and for follow-up, but its usefulness is in question as some GCTs lack FDG avidity. There is significant variability in imaging phenotypes of GCTs, ranging from mostly cystic to almost solid. More resources have recently been dedicated to understanding the genetics and molecular mechanisms of GCT development. Current research shows that the main cause of GCT carcinogenesis is the FOXL2 mutation, but there are several other noteworthy mutations that contribute to the pathogenesis of this disease. Certain mutations, like GATA4, are known to be associated with more aggressive disease and higher rates of recurrence. CONCLUSION Using this information, imaging protocols can be altered depending on the genotype of the tumor. Further understanding of the genetic alterations that underpin the development of GCTs is indicated as genotypic knowledge could be used to guide optimal imaging and management strategies.
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Elsherif S, Javadi S, Viswanathan C, Faria S, Bhosale P. Low-grade epithelial ovarian cancer: what a radiologist should know. Br J Radiol 2019; 92:20180571. [PMID: 30604635 DOI: 10.1259/bjr.20180571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ovarian cancer accounts for the death of over 100,000 females every year and is the most lethal gynecological malignancy. Low-grade serous ovarian carcinoma (LGSOC) and high-grade serous ovarian carcinoma (HGSOC) have been found to represent two distinct entities based on their molecular differences, clinical course, and response to chemotherapy. Currently, all ovarian cancers are staged according to the revised staging system of the International Federation of Gynecology and Obstetrics (FIGO). Imaging plays an integral role in the diagnosis, staging, and follow-up of ovarian cancers. This review will be based on the two-tier grading system of epithelial ovarian cancers, with the main emphasis on serous ovarian cancer, and the role of imaging to characterize low-grade vs high-grade tumors and monitor disease recurrence during follow-up.
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Affiliation(s)
- Sherif Elsherif
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Sanaz Javadi
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Chitra Viswanathan
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Silvana Faria
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Priya Bhosale
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center , Houston, TX , USA
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Abbas AM, Sheha AM, Salem MN, Altraigey A. Three-dimensional power Doppler ultrasonography in evaluation of adnexal masses. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Guerriero S, Saba L, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Sedda F, Peddes C, Fabbri P, Pilla F, Zajicek M, Giuseppina P, Melis GB. Past, present and future ultrasonographic techniques for analyzing ovarian masses. ACTA ACUST UNITED AC 2016; 11:369-83. [PMID: 26102474 DOI: 10.2217/whe.15.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ultrasonography is today the method of choice for distinguishing between benign and malignant adnexal pathologies. Using pattern recognition several types of tumors can be recognized according to their characteristic appearance on gray-scale imaging. Color Doppler imaging should be used only to perform a semiquantitative color score or evaluate the flow location. International Ovarian Tumor Analysis group had standardized definitions characterizing adnexal masses and suggested the use of 'simple rules' in premenopausal women. Recently, the use of 3D vascular indices has been proposed but its potential use in clinical practice is debated. Also computerized aided diagnosis algorithms showed encouraging results to be confirmed in the future.
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Affiliation(s)
- Stefano Guerriero
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Luca Saba
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics & Gynecology, University of Navarra, Pamplona, Spain
| | | | - Silvia Ajossa
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Maura Perniciano
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Alba Piras
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Sedda
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Cristina Peddes
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Paola Fabbri
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Federica Pilla
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
| | - Michal Zajicek
- Department of Obstetrics & Gynecology, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Parodo Giuseppina
- Department of Obstetrics & Gynecology, University of Cagliari, Cagliari, Italy
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Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis. Eur J Cancer 2016; 58:17-29. [DOI: 10.1016/j.ejca.2016.01.007] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/08/2016] [Accepted: 01/14/2016] [Indexed: 11/21/2022]
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Abstract
OBJECTIVE It is now recognized that ovarian cancer includes a heterogeneous group of malignant epithelial tumors originating from the ovaries, fallopian tubes, or peritoneum. This development has prompted the International Federation of Gynecology and Obstetrics (FIGO) to issue a revised staging system that can provide prognostic information and guidance on personalized management of ovarian cancer. CONCLUSION We review the epidemiology of ovarian cancer, the new FIGO staging system, and the role of imaging in the assessment, staging, and follow-up of ovarian cancer.
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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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Kaijser J, Sayasneh A, Van Hoorde K, Ghaem-Maghami S, Bourne T, Timmerman D, Van Calster B. Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2013; 20:449-62. [PMID: 24327552 DOI: 10.1093/humupd/dmt059] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Characterizing ovarian pathology is fundamental to optimizing management in both pre- and post-menopausal women. Inappropriate referral to oncology services can lead to unnecessary surgery or overly radical interventions compromising fertility in young women, whilst the consequences of failing to recognize cancer significantly impact on prognosis. By reflecting on recent developments of new diagnostic tests for preoperative identification of malignant disease in women with adnexal masses, we aimed to update a previous systematic review and meta-analysis. METHODS An extended search was performed in MEDLINE (PubMed) and EMBASE (OvidSp) from March 2008 to October 2013. Eligible studies provided information on diagnostic test performance of models, designed to predict ovarian cancer in a preoperative setting, that contained at least two variables. Study selection and extraction of study characteristics, types of bias, and test performance was performed independently by two reviewers. Quality was assessed using a modified version of the QUADAS assessment tool. A bivariate hierarchical random effects model was used to produce summary estimates of sensitivity and specificity with 95% confidence intervals or plot summary ROC curves for all models considered. RESULTS Our extended search identified a total of 1542 new primary articles. In total, 195 studies were eligible for qualitative data synthesis, and 96 validation studies reporting on 19 different prediction models met the predefined criteria for quantitative data synthesis. These models were tested on 26 438 adnexal masses, including 7199 (27%) malignant and 19 239 (73%) benign masses. The Risk of Malignancy Index (RMI) was the most frequently validated model. The logistic regression model LR2 with a risk cut-off of 10% and Simple Rules (SR), both developed by the International Ovarian Tumor Analysis (IOTA) study, performed better than all other included models with a pooled sensitivity and specificity, respectively, of 0.92 [95% CI 0.88-0.95] and 0.83 [95% CI 0.77-0.88] for LR2 and 0.93 [95% CI 0.89-0.95] and 0.81 [95% CI 0.76-0.85] for SR. A meta-analysis of centre-specific results stratified for menopausal status of two multicentre cohorts comparing LR2, SR and RMI-1 (using a cut-off of 200) showed a pooled sensitivity and specificity in premenopausal women for LR2 of 0.85 [95% CI 0.75-0.91] and 0.91 [95% CI 0.83-0.96] compared with 0.93 [95% CI 0.84-0.97] and 0.83 [95% CI 0.73-0.90] for SR and 0.44 [95% CI 0.28-0.62] and 0.95 [95% CI 0.90-0.97] for RMI-1. In post-menopausal women, sensitivity and specificity of LR2, SR and RMI-1 were 0.94 [95% CI 0.89-0.97] and 0.70 [95% CI 0.62-0.77], 0.93 [95% CI 0.88-0.96] and 0.76 [95% CI 0.69-0.82], and 0.79 [95% CI 0.72-0.85] and 0.90 [95% CI 0.84-0.94], respectively. CONCLUSIONS An evidence-based approach to the preoperative characterization of any adnexal mass should incorporate the use of IOTA Simple Rules or the LR2 model, particularly for women of reproductive age.
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Affiliation(s)
- Jeroen Kaijser
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Terzic MM, Dotlic J, Likic I, Ladjevic N, Brndusic N, Arsenovic N, Maricic S, Mihailovic T, Andrijasevic S. Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis? Chin J Cancer Res 2013; 25:55-62. [PMID: 23372342 DOI: 10.3978/j.issn.1000-9604.2013.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/17/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.
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Affiliation(s)
- Milan M Terzic
- Clinic of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade 11000, Serbia; ; School of Medicine, University of Belgrade, Belgrade 11000, Serbia
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The role of 3-dimensional power Doppler imaging in the assessment of ovarian teratoma in pregnancy: a case report. Case Rep Med 2011; 2011:896396. [PMID: 21876702 PMCID: PMC3162982 DOI: 10.1155/2011/896396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 11/29/2022] Open
Abstract
Background. Conventional sonography is the primary imaging tool for these pregnant women who present with an ovarian teratoma. In some cases, however, sonography diagnosis is difficult. We report a case of ovarian teratoma during pregnancy diagnosed by three-dimensional Power Doppler. The cyst was removed via laparotomy without fetal or maternal complications. Three-dimensional ultrasound with multiplanar view can better discriminate a benign ovarian teratoma from complex ovarian lesions or malignant tumors. Its role is significant especially during pregnancy as it may assist in determining which patients are requiring surgery and which are not. The results of three-dimensional sonography and magnetic resonance (MR) were equal but the role of MR imaging is limited in early pregnancy. Conclusions. Three-dimensional technique is a reliable diagnostic modality for preoperative assessment of an ovarian teratoma as it can be performed during the first trimester of pregnancy.
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Alcázar JL, Jurado M. Three-dimensional ultrasound for assessing women with gynecological cancer: A systematic review. Gynecol Oncol 2011; 120:340-6. [DOI: 10.1016/j.ygyno.2010.10.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 10/19/2010] [Indexed: 12/26/2022]
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Pérez-López FR, Chedraui P, Troyano-Luque JM. Peri- and post-menopausal incidental adnexal masses and the risk of sporadic ovarian malignancy: new insights and clinical management. Gynecol Endocrinol 2010; 26:631-43. [PMID: 20500106 DOI: 10.3109/09513590.2010.487611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Adnexal masses are common among peri- and post-menopausal women. Although ovarian cancer is a significant cause of mortality in menopausal women, large population-based studies demonstrate that the majority of adnexal masses are benign. Despite this, the appearance of an adnexal mass is a concern for the patient and an insight exercise for physicians. In most cases, an adnexal enlargement is an incidental finding, generally corresponding to a benign cyst and easily diagnosed by conventional ultrasound. Exceptionally an ovarian tumour may be malignant and should be treated as early as possible. When conventional ultrasound renders complex morphology other diagnostic tools must be used such as: colour Doppler and functional tumour vessel properties, serum CA 125 levels, nuclear magnetic resonance imaging and in some cases laparoscopy. Several new tumour markers are being studied for clinical application, although there are presently no clear recommendations. Adnexal masses with benign morphological and functional properties must be periodically monitored as an alternative to surgery since malignant transformation is exceptional.
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Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, Facultad de Medicina, Universidad de Zaragoza, Hospital Clínico de Zaragoza, Zaragoza 50009, Spain.
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