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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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Woo S, Andrieu PC, Abu-Rustum NR, Broach V, Zivanovic O, Sonoda Y, Chi DS, Aviki E, Ellis A, Carayon P, Hricak H, Vargas HA. Bridging Communication Gaps Between Radiologists, Referring Physicians, and Patients Through Standardized Structured Cancer Imaging Reporting: The Experience with Female Pelvic MRI Assessment Using O-RADS and a Simulated Cohort Patient Group. Acad Radiol 2024; 31:1388-1397. [PMID: 37661555 PMCID: PMC11206174 DOI: 10.1016/j.acra.2023.08.005] [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: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate whether implementing structured reporting based on Ovarian-Adnexal Reporting and Data System (O-RADS) magnetic resonance imaging (MRI) in women with sonographically indeterminate adnexal masses improves communication between radiologists, referrers, and patients/caregivers and enhances diagnostic performance for determining adnexal malignancy. MATERIALS AND METHODS We retrospectively analyzed prospectively issued MRI reports in 2019-2022 performed for characterizing adnexal masses before and after implementing O-RADS MRI; 56 patients/caregivers and nine gynecologic oncologists ("referrers") were surveyed about report interpretability/clarity/satisfaction; responses for pre- and post-implementation reports were compared using Fisher's exact and Chi-squared tests. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 123 reports from before and 119 reports from after O-RADS MRI implementation were included. Survey response rates were 35.7% (20/56) for patients/caregivers and 66.7% (6/9) for referrers. For patients/caregivers, O-RADS MRI reports were clearer (p < 0.001) and more satisfactory (p < 0.001) than unstructured reports, but interpretability did not differ significantly (p = 0.14), as 28.0% (28/100) of postimplementation and 38.0% (38/100) of preimplementation reports were considered difficult to interpret. For referrers, O-RADS MRI reports were clearer, more satisfactory, and easier to interpret (p < 0.001); only 1.3% (1/77) were considered difficult to interpret. For differentiating benign from malignant adnexal lesions, O-RADS MRI showed area under the curve of 0.92 (95% confidence interval [CI], 0.85-0.99), sensitivity of 0.81 (95% CI, 0.58-0.95), and specificity of 0.91 (95% CI, 0.83-0.96). Diagnostic performance of reports before implementation could not be calculated due to many different phrases used to describe the likelihood of malignancy. CONCLUSION Implementing standardized structured reporting using O-RADS MRI for characterizing adnexal masses improved clarity and satisfaction for patients/caregivers and referrers. Interpretability improved for referrers but remained limited for patients/caregivers.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.); Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.).
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.); Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (O.Z.)
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Emeline Aviki
- Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, Mineola, New York (E.A.)
| | - Annie Ellis
- Patient Family Advisory Council for Quality (PFACQ), Memorial Sloan Kettering Cancer Center, New York, New York (A.E.)
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin (P.C.)
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.)
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3
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Pavlik EJ, Lasher A, Harris LE, Solomon AL, Harbin LM, Raby L, Dietrich CS, Kryscio RJ, van Nagell JR. In Reply. Obstet Gynecol 2024; 143:e129-e130. [PMID: 38513249 DOI: 10.1097/aog.0000000000005542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Edward John Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky
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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 PMCID: PMC11070694 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
| | | | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Rosanne M. Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Mindy M. Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Steven L. Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Tatnai L. Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Eric M. Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
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Rose SL. When Less Is More: Using Ultrasound Guidelines to Reduce Unnecessary Follow-Up for Ovarian Cysts. Obstet Gynecol 2023; 142:1291-1292. [PMID: 37973066 DOI: 10.1097/aog.0000000000005436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Stephen L Rose
- Stephen L. Rose is from the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology at the University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
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Strachowski LM, Jha P, Phillips CH, Blanchette Porter MM, Froyman W, Glanc P, Guo Y, Patel MD, Reinhold C, Suh-Burgmann EJ, Timmerman D, Andreotti RF. O-RADS US v2022: An Update from the American College of Radiology's Ovarian-Adnexal Reporting and Data System US Committee. Radiology 2023; 308:e230685. [PMID: 37698472 DOI: 10.1148/radiol.230685] [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: 09/13/2023]
Abstract
First published in 2019, the Ovarian-Adnexal Reporting and Data System (O-RADS) US provides a standardized lexicon for ovarian and adnexal lesions, enables stratification of these lesions with use of a numeric score based on morphologic features to indicate the risk of malignancy, and offers management guidance. This risk stratification system has subsequently been validated in retrospective studies and has yielded good interreader concordance, even with users of different levels of expertise. As use of the system increased, it was recognized that an update was needed to address certain clinical challenges, clarify recommendations, and incorporate emerging data from validation studies. Additional morphologic features that favor benignity, such as the bilocular feature for cysts without solid components and shadowing for solid lesions with smooth contours, were added to O-RADS US for optimal risk-appropriate scoring. As O-RADS US 4 has been shown to be an appropriate cutoff for malignancy, it is now recommended that lower-risk O-RADS US 3 lesions be followed with US if not excised. For solid lesions and cystic lesions with solid components, further characterization with MRI is now emphasized as a supplemental evaluation method, as MRI may provide higher specificity. This statement summarizes the updates to the governing concepts, lexicon terminology and assessment categories, and management recommendations found in the 2022 version of O-RADS US.
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Affiliation(s)
- Lori M Strachowski
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Priyanka Jha
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Catherine H Phillips
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Misty M Blanchette Porter
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Wouter Froyman
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Phyllis Glanc
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Yang Guo
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Maitray D Patel
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Caroline Reinhold
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Elizabeth J Suh-Burgmann
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Dirk Timmerman
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
| | - Rochelle F Andreotti
- From the Department of Radiology and Biomedical Imaging and Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Ave, 1X57, San Francisco, CA 94110 (L.M.S.); Department of Radiology, Stanford University School of Medicine, Palo Alto, Calif (P.J.); Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.H.P.); Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine at the University of Vermont, Burlington, Vt (M.M.B.P.); Department of Obstetrics and Gynecology, University Hospitals and Department of Development and Regeneration, KU Leuven, Leuven, Belgium (W.F., D.T.); Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, Canada (P.G.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (Y.G.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); Department of Radiology, McGill University Health Centre, Montreal, Canada (C.R.); Department of Gynecologic Oncology, Kaiser Permanente Northern California, Walnut Creek, Calif (E.J.S.B.); and Department of Radiology and Radiological Sciences and Department of Obstetrics and Gynecology, Vanderbilt University College of Medicine, Nashville, Tenn (R.F.A.)
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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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Roseland ME, Maturen KE, Shampain KL, Wasnik AP, Stein EB. Adnexal Mass Imaging: Contemporary Guidelines for Clinical Practice. Radiol Clin North Am 2023; 61:671-685. [PMID: 37169431 DOI: 10.1016/j.rcl.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Several recent guidelines have been published to improve accuracy and consistency of adnexal mass imaging interpretation and to guide management. Guidance from the American College of Radiology (ACR) Appropriateness Criteria establishes preferred adnexal imaging modalities and follow-up. Moreover, the ACR Ovarian-Adnexal Reporting Data System establishes a comprehensive, unified set of evidence-based guidelines for classification of adnexal masses by both ultrasound and MR imaging, communicating risk of malignancy to further guide management.
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Affiliation(s)
- Molly E Roseland
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA.
| | - Katherine E Maturen
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Kimberly L Shampain
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Ashish P Wasnik
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Erica B Stein
- Michigan Medicine, University of Michigan, University Hospital B1D502D, 1500 East Medical Center Dr., Ann Arbor, MI 48109, USA
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Koutras A, Perros P, Prokopakis I, Ntounis T, Fasoulakis Z, Pittokopitou S, Samara AA, Valsamaki A, Douligeris A, Mortaki A, Sapantzoglou I, Katrachouras A, Pagkalos A, Symeonidis P, Palios VC, Psarris A, Theodora M, Antsaklis P, Makrydimas G, Chionis A, Daskalakis G, Kontomanolis EN. Advantages and Limitations of Ultrasound as a Screening Test for Ovarian Cancer. Diagnostics (Basel) 2023; 13:2078. [PMID: 37370973 DOI: 10.3390/diagnostics13122078] [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: 03/24/2023] [Revised: 05/13/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Ovarian cancer (OC) is the seventh most common malignancy diagnosed among women, the eighth leading cause of cancer mortality globally, and the most common cause of death among all gynecological cancers. Even though recent advances in technology have allowed for more accurate radiological and laboratory diagnostic tests, approximately 60% of OC cases are diagnosed at an advanced stage. Given the high mortality rate of advanced stages of OC, early diagnosis remains the main prognostic factor. Our aim is to focus on the sonographic challenges in ovarian cancer screening and to highlight the importance of sonographic evaluation, the crucial role of the operator΄s experience, possible limitations in visibility, emphasizing the importance and the necessity of quality assurance protocols that health workers have to follow and finally increasing the positive predictive value. We also analyzed how ultrasound can be combined with biomarkers (ex. CA-125) so as to increase the sensitivity of early-stage OC detection or, in addition to the gold standard examination, the CT (Computed tomography) scan in OC follow-up. Improvements in the performance and consistency of ultrasound screening could reduce the need for repeated examinations and, mainly, ensure diagnostic accuracy. Finally, we refer to new very promising techniques such as liquid biopsies. Future attempts in order to improve screening should focus on the identification of features that are unique to OC and that are present in early-stage tumors.
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Affiliation(s)
- Antonios Koutras
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Paraskevas Perros
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Ioannis Prokopakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Thomas Ntounis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Savia Pittokopitou
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Athina A Samara
- Department of Embryology, University of Thessaly, Mezourlo, 41110 Larissa, Greece
| | - Asimina Valsamaki
- Department of Internal Medicine, General Hospital of Larisa, Tsakalof 1, 41221 Larisa, Greece
| | - Athanasios Douligeris
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Anastasia Mortaki
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Ioakeim Sapantzoglou
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Alexandros Katrachouras
- Department of Obstetrics and Gynecology, University General Hospital of Ioannina, University of Ioannina, Stavros Niarchos Str., 45500 Ioannina, Greece
| | - Athanasios Pagkalos
- Department of Obstetrics and Gynecology, General Hospital of Xanthi, Neapoli, 67100 Xanthi, Greece
| | - Panagiotis Symeonidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis-Makris, 68100 Alexandroupolis, Greece
| | | | - Alexandros Psarris
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Panos Antsaklis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - George Makrydimas
- Department of Obstetrics and Gynaecology, University of Ioannina, 45110 Ioannina, Greece
| | - Athanasios Chionis
- Department of Gynecology, Laiko General Hospital of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'ALEXANDRA', National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Emmanuel N Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis-Makris, 68100 Alexandroupolis, Greece
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10
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Hack K, Strachowski L, Andreotti RF, Ghandehari H, Jha P, Lim C, Patel C, Glanc P. O-RADS US Risk Stratification and Management System: Case-based Learning Approach for Daily Practice. Radiographics 2023; 43:e220079. [PMID: 36821507 DOI: 10.1148/rg.220079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Kalesha Hack
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Lori Strachowski
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Rochelle F Andreotti
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Hournaz Ghandehari
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Priyanka Jha
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Christopher Lim
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Chirag Patel
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
| | - Phyllis Glanc
- From the Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, MG160, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5 (K.H., H.G., C.L., C.P., P.G.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (L.S., P.J.); and Department of Radiology, Vanderbilt University, Nashville, Tenn (R.F.A.)
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11
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Phillips CH, Guo Y, Strachowski LM, Jha P, Reinhold C, Andreotti RF. The Ovarian/Adnexal Reporting and Data System for Ultrasound: From Standardized Terminology to Optimal Risk Assessment and Management. Can Assoc Radiol J 2023; 74:44-57. [PMID: 35831958 DOI: 10.1177/08465371221108057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon and risk assessment tool for ultrasound (US) provides a framework for characterization of ovarian and adnexal pathology with the ultimate goal of harmonizing reporting and patient management strategies. Since the first O-RADS US publication in 2018, multiple validation studies have shown O-RADS US to have excellent diagnostic accuracy, with the majority of these studies using O-RADS 4 as the optimal cut-off for detecting ovarian cancer. Most of the existing validation studies include a dedicated training phase and confirm that ORADS US categories and lexicon descriptors are associated with high level inter-read agreement, regardless of radiologist training level or practice experience. O-RADS US has a similar inter-reader agreement when compared to Gynecologic Imaging Reporting and Data System (GIRADS), Assessment of Different Neoplasias in the adnexa (ADNEX), and International Tumor Analysis Group (IOTA) simple rules. System descriptors have been shown to correlate with expected malignancy rates and the O-RADS US risk stratification system has been shown to perform in the expected range of malignancy risk per category. Further directions will focus on clarifying governing concepts and lexicon terminology as well as further refining risk stratification categories based on data from published validation studies.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology and Radiological Sciences, 612495Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yang Guo
- Department of Radiology, 381760Brigham and Women's Hospital, Boston, MA, USA
| | - Loretta M Strachowski
- Department of Radiology and Biomedical Imaging, Department of Obstetrics, Gynecology, and Reproductive Sciences, 192653University of California, San Francisco, CA, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, 192653University of California, San Francisco, CA, USA
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, 54473McGill University, Montreal, QC, Canada.,Co-Director, Augmented Intelligence Precision Health Laboratory, Research Institute of the McGill University Health Center, Montreal, Canada.,Montreal Imaging Experts Inc., Montreal, Canada
| | - Rochelle F Andreotti
- Department of Radiology and Radiological Sciences, Department of Obstetrics and Gynecology, 612495Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Levine D, Patel MD. Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement. Can Assoc Radiol J 2023; 74:18-19. [PMID: 36113072 DOI: 10.1177/08465371221126045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Deborah Levine
- Department of Radiology, Harvard Medical School, 1859Beth Israel Deaconess Medical School, Boston, MA, USA
| | - Maitray D Patel
- Department of Radiology, Associate Chair of Education, 384840Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
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13
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Mansour S, Hamed S, Kamal R. Spectrum of Ovarian Incidentalomas: Diagnosis and Management. Br J Radiol 2023; 96:20211325. [PMID: 35142537 PMCID: PMC9975533 DOI: 10.1259/bjr.20211325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 01/27/2023] Open
Abstract
Incidental ovarian lesions are asymptomatic lesions that are accidentally discovered during a CT or MRI examinations that involves the pelvic cavity or during a routine obstetric ultrasound study. Incidental ovarian masses are usually benign with a very low risk of malignancy yet underlying malignant pathology may be discovered during the diagnostic work-up of these lesions. Suspicion of malignancy is directly correlating with the increase in the patient's age, the increase in the size of the lesion, the presence of the solid components or thick septa and a high color scale of the ovarian mass. Following standard reporting and management protocols are essential to choose the proper work-up of these lesions to avoid unnecessary additional imaging and operative intervention. In this article, we will provide a review of the characteristic imaging features of some incidental and yet commonly encountered ovarian lesions. We will also summarize the recently published algorithms that are important for consistent reporting and standard management of these lesions.
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Affiliation(s)
| | - Soha Hamed
- Women’s Imaging Unit – Kasr El Ainy Hospital- Cairo University, Cairo, Egypt
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14
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Cheng M, Causa Andrieu P, Kim TH, Gangai N, Sonoda Y, Hricak H, Lakhman Y, Vargas HA, Woo S. Fat-containing adnexal masses on MRI: solid tissue volume and fat distribution as a guide for O-RADS Score assignment. Abdom Radiol (NY) 2023; 48:358-366. [PMID: 36173552 PMCID: PMC11149608 DOI: 10.1007/s00261-022-03688-x] [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: 07/02/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore ways to improve O-RADS MRI scoring for fat-containing adnexal masses, by investigating methods for quantifying solid tissue volume and fat distribution and evaluating their associations with malignancy. METHODS This retrospective, single-center study included patients with fat-containing adnexal masses on MRI during 2008-2021. Two radiologists independently reviewed overall size (Sizeoverall), size of any solid tissue (Sizeanysolid), size of solid tissue that was not Rokitansky nodule (Sizenon-Rokitansky), and fat distribution. Wilcoxon test, Fisher-exact test, and ROC curve analysis were performed. Reference standard was pathology or follow-up > 24 months. RESULTS 188 women (median age 35 years) with 163 benign and 25 malignant lesions were included. Sizeoverall (R1, 9.9 cm vs 5.9 cm; R2, 12.4 cm vs 6.0 cm), Sizeanysolid (R1, 5.1 cm vs 1.2 cm; R2, 3.2 cm vs 0.0 cm), Sizenon-Rokitansky (R1, 5.1 cm vs 0.0 cm; R2, 3.1 cm vs 0.0 cm), and fat distribution differed significantly between malignant and benign lesions (p < 0.01). Area under ROC curve was greatest using Sizenon-Rokitansky (R1, 0.83; R2, 0.86) vs Sizeoverall (R1, 0.78; R2, 0.81) or Sizeanysolid (R1, 0.79; R2, 0.81), though differences were non-significant (p = 0.48-0.93). Cutoffs for Sizenon-Rokitansky (R1, ≥ 1.2 cm; R2, ≥ 1.0 cm) yielded sensitivity and specificity of 0.72 and 0.93 (R1) and 0.76 and 0.95 (R2). Among immature teratomas, 85.7% displayed scattered fat. CONCLUSION Overall size, size of (any or non-Rokitansky-nodule) solid tissue, and fat distribution differed between benign and malignant fat-containing adnexal masses. Incorporating these would constitute simple and practical approaches to refining O-RADS MRI scoring.
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Affiliation(s)
- Monica Cheng
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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15
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Antil N, Raghu PR, Shen L, Tiyarattanachai T, Chang EM, Ferguson CWK, Ho AA, Lutz AM, Mariano AJ, Morimoto LN, Kamaya A. Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses. Abdom Radiol (NY) 2022; 47:3318-3326. [PMID: 35763052 PMCID: PMC9388428 DOI: 10.1007/s00261-022-03580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.
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Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Preethi R Raghu
- Department of Radiology, University of CA - San Francisco, San Francisco, CA, USA.
| | - Luyao Shen
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | | | - Edwina M Chang
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Craig W K Ferguson
- Department of Radiology, University of Alberta Hostpial, Edmonton, Alberta, Canada
| | - Amanzo A Ho
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Amelie M Lutz
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Aladin J Mariano
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - L Nayeli Morimoto
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Aya Kamaya
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA, USA
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16
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Suh-Burgmann E, Nakhaei M, Gupta S, Brook A, Hecht J, Hung YY, Levine D. Ovarian Cystadenomas: Growth Rate and Reliability of Imaging Measurements. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2157-2167. [PMID: 34846072 DOI: 10.1002/jum.15895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the growth rate of benign ovarian cystadenomas and the degree of variability in ultrasound measurements. METHODS Two independent retrospective cohorts of women found to have benign cystadenomas at surgery were identified. To assess growth rate, ultrasounds on women in a community-based health system were reviewed and the growth rate was determined based on the maximum reported size dimension using a mixed effect model. To assess measurement variability, two radiologists independently measured presurgical adnexal imaging findings for women in a tertiary care referral setting. Interobserver, intra-observer, and intermodality (cine clip versus still images) variability in measurements was determined using correlation coefficients (CC) and Bland-Altman analysis, with the proportion of measurements varying by more than 1 cm calculated. RESULTS For growth rate assessment, 405 women with 1412 ultrasound examinations were identified. The median growth rate was 0.65 cm/year with mucinous cystadenomas growing faster at 0.83 cm/year compared to 0.51 cm/year for serous cystadenomas (median test P < .0001). To evaluate measurement variability, 75 women were identified with 176 ultrasound studies. The within-subject standard deviations for ultrasound measurements were 0.74 cm for cine clip images and 0.41 cm for static images, with 11% of measurements overall differing by more than 1 cm. CONCLUSIONS Cystadenomas grow on average 0.65 cm/year, which is similar in magnitude to the inherent error observed in measurement on ultrasound, suggesting that repeat ultrasound at intervals of longer than a year will often be needed to accurately assess growth if a cyst represents a benign cystadenoma.
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Affiliation(s)
- Elizabeth Suh-Burgmann
- Division of Gynecologic Oncology, The Permanente Medical Group, Walnut Creek, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Masoud Nakhaei
- Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA
| | - Sonia Gupta
- Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA
| | - Alexander Brook
- Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA
| | - Jonathan Hecht
- Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Deborah Levine
- Department of Radiology, Beth Israel Lahey Health, Boston, MA, USA
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17
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Bullock B, Larkin L, Turker L, Stampler K. Management of the Adnexal Mass: Considerations for the Family Medicine Physician. Front Med (Lausanne) 2022; 9:913549. [PMID: 35865172 PMCID: PMC9294310 DOI: 10.3389/fmed.2022.913549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023] Open
Abstract
Ovarian cancer is the most deadly gynecological cancer, so proper assessment of a pelvic mass is necessary in order to determine which are at high risk for malignancy and should be referred to a gynecologic oncologist. However, in a family medicine setting, evaluation and treatment of these masses can be challenging due to a lack of resources. A number of risk assessment tools are available to family medicine physicians, including imaging techniques, imaging systems, and blood-based biomarker assays each with their respective pros and cons, and varying ability to detect malignancy in pelvic masses. Effective utilization of these assessment tools can inform the care pathway for patients which present with an adnexal mass, such as expectant management for those with a low risk of malignancy, or referral to a gynecologic oncologist for surgery and staging, for those at high risk of malignancy. Triaging patients to the appropriate care pathway improves patient outcomes and satisfaction, and family medicine physicians can play a key role in this decision-making process.
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Affiliation(s)
| | - Lisa Larkin
- Lisa Larkin, MD, and Associates, Cincinnati, OH, United States
- Ms. Medicine Healthcare Organization, Cincinnati, OH, United States
- Cincinnati Sexual Health Consortium, Cincinnati, OH, United States
| | | | - Kate Stampler
- Einstein Healthcare Network, Philadelphia, PA, United States
- *Correspondence: Kate Stampler,
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18
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Jha P, Gupta A, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski EA. Diagnostic Performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) Ultrasound Risk Score in Women in the United States. JAMA Netw Open 2022; 5:e2216370. [PMID: 35679042 PMCID: PMC9185186 DOI: 10.1001/jamanetworkopen.2022.16370] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk scoring system has been studied in a selected population of women referred for suspected or known adnexal lesions. This population has a higher frequency of malignant neoplasms than women presenting to radiology departments for pelvic ultrasonography for a variety of indications, potentially impacting the diagnostic performance of the risk scoring system. OBJECTIVE To evaluate the risk of malignant neoplasm and diagnostic performance of O-RADS US risk scoring system in a multi-institutional, nonselected cohort. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional cohort study included a population of nonselected women in the United States who presented to radiology departments for routine pelvic ultrasonography between 2011 and 2014, with pathology confirmation imaging follow up or 2 years of clinical follow up. EXPOSURE Analysis of 1014 adnexal lesions using the O-RADS US risk stratification system. MAIN OUTCOMES AND MEASURES Frequency of ovarian cancer and diagnostic performance of the O-RADS US risk stratification system. RESULTS This study included 913 women with 1014 adnexal lesions. The mean (SD) age of the patients was 42.4 (13.9 years), and 674 of 913 (73.8%) were premenopausal. The overall frequency of malignant neoplasm was 8.4% (85 of 1014 adnexal lesions). The frequency of malignant neoplasm for O-RADS US 2 was 0.5% (3 of 657 lesions; <1% expected); O-RADS US 3, 4.5% (5 of 112 lesions; <10% expected); O-RADS US 4, 11.6% (18 of 155; 10%-50% expected); and O-RADS 5, 65.6% (59 of 90 lesions; >50% expected). O-RADS US 4 was the optimum cutoff for diagnosing cancer with sensitivity of 90.6% (95% CI, 82.3%-95.9%), specificity of 81.9% (95% CI, 79.3%-84.3%), positive predictive value of 31.4% (95% CI, 25.7%-37.7%) and negative predictive value of 99.0% (95% CI, 98.0%-99.6%). CONCLUSIONS AND RELEVANCE In this cohort study of a nonselected patient population, the O-RADS US risk stratification system performed within the expected range as published by the ACR O-RADS US committee. The frequency of malignant neoplasm was at the lower end of the published range, partially because of the lower prevalence of cancer in a nonselected population. However, a high negative predictive value was maintained, and when a lesion can be classified as an O-RADS US 2, the risk of cancer is low, which is reassuring for both clinician and patient.
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Affiliation(s)
- Priyanka Jha
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | - Aya Kamaya
- Stanford University, Stanford, California
| | - Neha Antil
- Stanford University, Stanford, California
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19
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Levine D. O-RADS US: A Retrospective Assessment of Prediction of Malignancy in a High-Risk Setting. Radiology 2022; 304:121-122. [PMID: 35438569 DOI: 10.1148/radiol.213128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Levine
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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20
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Gupta A, Jha P, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski E. Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US. Radiology 2022; 303:603-610. [PMID: 35315722 DOI: 10.1148/radiol.212338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Several US risk stratification schemas for assessing adnexal lesions exist. These multiple-subcategory systems may be more multifaceted than necessary for isolated adnexal lesions in average-risk women. Purpose To explore whether a US-based classification scheme of classic versus nonclassic appearance can be used to help appropriately triage women at average risk of ovarian cancer without compromising diagnostic performance. Materials and Methods This retrospective multicenter study included isolated ovarian lesions identified at pelvic US performed between January 2011 and June 2014, reviewed between September 2019 and September 2020. Lesions were considered isolated in the absence of ascites or peritoneal implants. Lesions were classified as classic or nonclassic based on sonographic appearance. Classic lesions included simple cysts, hemorrhagic cysts, endometriomas, and dermoids. Otherwise, lesions were considered nonclassic. Outcomes based on histopathologic results or clinical or imaging follow-up were recorded. Diagnostic performance and frequency of malignancy were calculated. Frequency of malignancy between age groups was compared using the χ2 test, and Poisson regression was used to explore relationships between imaging features and malignancy. Results A total of 970 isolated lesions in 878 women (mean age, 42 years ± 14 [SD]) were included. The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant. The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow (P < .001). For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow (P = .004). The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema was 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy. Conclusion Using a US classification schema of classic- or nonclassic-appearing adnexal lesions resulted in high sensitivity and specificity in the diagnosis of malignancy in ovarian cancer. The highest risk of cancer was in isolated nonclassic lesions with blood flow in women older than 60 years. © RSNA, 2022 See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Akshya Gupta
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Priyanka Jha
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Timothy M Baran
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Katherine E Maturen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Krupa Patel-Lippmann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Hanna M Zafar
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Aya Kamaya
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Neha Antil
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Lisa Barroilhet
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Elizabeth Sadowski
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
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21
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Affiliation(s)
- Deborah A Baumgarten
- From the Department of Radiology, Mayo Clinic Jacksonville, 4500 San Pablo Rd S, Jacksonville, FL 32224
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22
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Wang PS, Schoeck OG, Horrow MM. Benign-appearing Incidental Adnexal Cysts at US, CT, and MRI: Putting the ACR, O-RADS, and SRU Guidelines All Together. Radiographics 2022; 42:609-624. [PMID: 35061515 DOI: 10.1148/rg.210091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Adnexal cysts are a common incidental finding at US, CT, and MRI but have historically caused a diagnostic dilemma for determining when to follow up and how to manage them. Characteristic imaging features of simple adnexal cysts include a simple fluid collection with smooth walls and no solid or vascular components. Day-to-day practice guidelines were recently updated to reflect the overwhelming evidence that incidental cystic adnexal masses are almost always benign. Three major consensus articles on adnexal cystic masses were published between 2019 and 2020: the Society of Radiologists in Ultrasound (SRU) consensus update on adnexal cysts, the Ovarian-Adnexal Reporting and Data System (O-RADS) US consensus guideline, and the American College of Radiology (ACR) white paper on the management for incidental adnexal findings at CT and MRI. All three standardize reporting terminology, are based on evidence-based data and institutional practice patterns, and apply to nonpregnant women of average risk for ovarian cancer. While there are small differences in follow-up recommendations based on size thresholds, the goal of each is the same-to limit unnecessary imaging follow-up and, by doing so, save the patient time, money, and anxiety. For the diagnostic radiologist to use these guidelines, it is essential that the entire mass is visualized well. Without adequate visualization, further characterization of the mass may be necessary. To put it all together, the SRU consensus guideline and ACR white paper are easily applied in day-to-day practice for masses that are O-RADS 2 and below. An invited commentary by Patel is available online. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Peter S Wang
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098
| | - Otto G Schoeck
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098
| | - Mindy M Horrow
- From the Department of Diagnostic Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141-3098
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23
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Patel MD. Invited Commentary: Categorizing Adnexal Masses at US, CT, and MRI-the Radiologist's Not-Impossible Mission. Radiographics 2022; 42:E77-E79. [PMID: 35061518 DOI: 10.1148/rg.210196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054
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24
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Esquivel Villabona AL, Rodríguez JN, Ayala N, Buriticá C, Gómez AC, Velandia AM, Rodríguez N, Alcázar JL. Two-Step Strategy for Optimizing the Preoperative Classification of Adnexal Masses in a University Hospital, Using International Ovarian Tumor Analysis Models: Simple Rules and Assessment of Different NEoplasias in the adneXa Model. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:471-482. [PMID: 33890698 DOI: 10.1002/jum.15728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the performance of a two-step strategy compared with the International Ovarian Tumor Analysis (IOTA) - Assessment of Different NEoplasias in the adneXa (ADNEX) model for preoperative classification of adnexal masses. METHODS An ambispective diagnostic accuracy study based on ultrasound data collected at one university hospital between 2012 and 2018. Two ultrasonographers classified the adnexal masses using IOTA Simple Rules (first step). Not classifiable masses were evaluated using the IOTA ADNEX model (second step). Also, all masses were classified using the IOTA ADNEX model. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), and receiver operating characteristic (ROC) curve were estimated. A P value of <.05 was used to determine statistical significance. RESULTS The study included 548 patients and 606 masses. Patients' median age was 41 years with an interquartile range between 32 and 51 years. In the first step, 89 (14%) masses were not classifiable. In the second step, 55 (61.8%) masses were classified as malignant. Furthermore, for the totality of 606 masses, the IOTA ADNEX model estimated the probability that 126 (20.8%) masses were malignant. The two-step strategy had a sensitivity, specificity, PPV, NPV, LR+, LR-, and ROC curve of 86.8%, 91.01%, 51.9%, 98.4%, 9.7, 0.1, and 0.889, respectively; compared to IOTA ADNEX model that had values of 91.8%, 87.16%, 44.4%, 99%, 7.1, 0.09, and 0.895, respectively. CONCLUSION The two-step strategy shows a similar diagnostic performance when compared to the IOTA ADNEX model. The IOTA ADNEX model involves only one step and can be more practical, and thus would be recommended to use.
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Affiliation(s)
- Alba Liliana Esquivel Villabona
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Medical School, Universidad de los Andes, Bogotá, Colombia
| | - Juan Nicolás Rodríguez
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nathalia Ayala
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Medical School, Universidad de los Andes, Bogotá, Colombia
| | - Catalina Buriticá
- Medical School, Universidad de los Andes, Bogotá, Colombia
- Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | | | - Nadiezhda Rodríguez
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Medical School, Universidad de los Andes, Bogotá, Colombia
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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25
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Affiliation(s)
- Deborah Levine
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02493
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26
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Lin R, Hung YY, Cheng J, Suh-Burgmann E. Accuracy of Magnetic Resonance Imaging for Identifying Ovarian Cancer in a Community-Based Setting. WOMEN'S HEALTH REPORTS 2022; 3:43-48. [PMID: 35136876 PMCID: PMC8812505 DOI: 10.1089/whr.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
Introduction: Many ovarian or adnexal masses have an indeterminate appearance on ultrasound that can raise concerns about cancer. Although magnetic resonance imaging (MRI) has been reported to reliably distinguish between benign and malignant masses, studies evaluating the accuracy of MRI in community-based practice settings are lacking. Methods: Women who underwent MRI to further evaluate an ultrasound-detected adnexal mass in 2016–2017 within a large community-based health system were identified. MRI reports were classified as favoring malignancy, benign disease, or indeterminate, blinded to pathological outcome. With a minimum of 2 years of follow-up, all ovarian cancers and borderline tumors were identified, and the accuracy of MRI assessment was determined. Results: Among 338 women who had MRI to evaluate an adnexal mass, 144 (42.6%) subsequently underwent surgery. MRI favored malignancy in 7 (4.9%) cases, benign disease in 89 (62.2%) cases, and was indeterminate in 48 (33.6%) cases. Of the seven cases in which MRI favored malignancy, two cancers and five benign tumors were found. An additional 10 cases of cancer or borderline tumor were found among women who had MRI reports that were read as indeterminate (n = 6) or that favored benign disease (n = 4). The sensitivity, specificity, positive predictive value, and negative predictive value of an MRI favoring malignancy were 16.7%, 96.2%, 28.5%, and 92.7%, respectively. Discussion: In a large community-based setting, an MRI favoring malignancy was more likely to be associated with benign disease than cancer and identified only 16.7% of true malignant cases. The findings suggest that the ability of MRI to differentiate between benign and malignant adnexal masses in community-based practice settings is currently limited.
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Affiliation(s)
- Ruby Lin
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California, USA
| | - Yun-Yi Hung
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Julia Cheng
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Elizabeth Suh-Burgmann
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Division of Gynecologic Oncology, The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California, USA
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27
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Kaya HE, Kerimoğlu Ü. Frequency of potential causes of lower back pain and incidental findings in patients with suspected sacroiliitis: retrospective analysis of 886 patients with negative sacroiliac MRI examination for sacroiliitis. Acta Radiol 2021; 62:1358-1364. [PMID: 33121265 DOI: 10.1177/0284185120968565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In a majority of patients with suspected sacroiliitis (SI) who underwent sacroiliac magnetic resonance imaging (MRI), imaging studies may be normal, may depict other causes for pain, or may show clinically irrelevant incidental findings. PURPOSE To determine the prevalence of possible etiologies other than SI and frequency of incidental findings demonstrated on sacroiliac MRI examinations in a cohort of patients with lower back pain and suspected SI. MATERIAL AND METHODS Sacroiliac MRI examinations of 1421 patients with suspected SI were retrospectively reviewed. In patients without SI findings, other potential causes for lower back pain and incidental findings were documented. RESULTS SI was present in 535 of 1421 patients (37.6%). In 886 of the patients whose MRI studies were negative for SI, other possible causes for lower back pain or incidental findings were seen in 386 (43.5%). The most common musculoskeletal (MSK) finding was lumbosacral transitional vertebra (8.6%) followed by findings suggesting piriformis syndrome (4.2%), spondylosis (3.7%), and sacral insufficiency fractures (1.8%). The most common non-MSK findings were follicular cysts (15.3%) and uterine fibroids (4.9%). CONCLUSION In patients with suspected SI but negative MRI examinations for SI, some other possible causes for lower back pain and several incidental findings can be seen on imaging. The presence of these findings may explain the patient's symptoms, and awareness of these conditions may be helpful in patient management and individualizing treatment.
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Affiliation(s)
- Hasan Emin Kaya
- Department of Radiology, Tokat State Hospital, Tokat, Turkey
| | - Ülkü Kerimoğlu
- Department of Radiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Frederick RP, Patel AG, Young SW, Dahiya N, Patel MD. Growth Rate of Ovarian Serous Cystadenomas and Cystadenofibromas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2123-2130. [PMID: 33320368 DOI: 10.1002/jum.15597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We analyzed growth rates of benign ovarian serous cystadenomas and cystadenofibromas to understand what percentage would show a volume doubling time (DT) of less than 3 years, between 3 and 5 years, or greater than 5 years. METHODS We retrospectively reviewed pathology records (January 1, 2014, to June 30, 2019) to find all surgically excised ovarian serous cystadenomas and cystadenofibromas. Imaging records were then reviewed to identify those that had been confidently identified with ultrasound imaging, magnetic resonance imaging, or computed tomography at least twice before surgical removal, with at least a 60-day interval between studies. Three orthogonal measurements were recorded on the first and last imaging studies on which the mass was detected, with volume calculations by the prolate formula (product of 3 measurements multiplied by 0.52). The volume DT was calculated and grouped into 1 of 5 categories: (1) DT of less than 1 year; (2) DT of 1 to 3 years; (3) DT of 3 to 5 years; (4) DT of 5 to 10 years; and (5) no growth (any mass with a DT >10 years or showing a decrease in volume). RESULTS A total of 102 of 536 cystadenomas and 44 of 227 cystadenofibromas met inclusion criteria. Of the 146 tumors, 40 (27.4%) had a DT of less than 1 year; 38 (26.0%) had a DT of 1 to 3 years; 22 (15.1%) had a DT of 3 to 5 years; 10 (6.8%) had a DT of 5 to 10 years; and 36 (24.7%) showed no growth. CONCLUSIONS A total of 53.4% of ovarian serous cystadenomas/cystadenofibromas have a DT of less than 3 years; 15.1% have a DT between 3 and 5 years; and 31.5% have a DT of greater than 5 years or show no growth.
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Affiliation(s)
- Ross P Frederick
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anika G Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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29
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Bastianelli C, Farris M, Rosato E, Varliero F, Del Savio MC, Facchinetti F, Grandi G. The use of different doses levonorgestrel-releasing intrauterine system (LNG-IUS): real-world data from a multicenter Italian study. EUR J CONTRACEP REPR 2021; 27:16-22. [PMID: 34528867 DOI: 10.1080/13625187.2021.1975269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Current research fails to adequately inform about the differential use of available levonorgestrel-releasing intrauterine systems (LNG-IUSs) in real life. Aim of our study was to compare the characteristics, satisfaction, continuation rates, and adverse effects between users of the high-dose LNG-IUS (52 mg) and of the low dose LNG-IUS (13.5 mg and 19.5 mg). MATERIALS AND METHODS A prospective cohort study was performed in two Services for Family Planning in normal menstruating women with the inclusion of all new prescriptions of LNG-IUS for contraception. Women were followed for a mean of 9.1 ± 2.6 months after placement. RESULTS 109 women (mean age of 39.8 ± 8.7 years old) were included, 69.7% using a high dose LNG-IUS and 30.3% using a low dose LNG-IUS. Women with a low dose LNG-IUS were significantly younger, thinner, more nulliparous, with fewer vaginal deliveries and C-sections, with a lower menstrual flow length and with more previous use of short-acting reversible contraceptives (p < 0.05). LNG-IUS continuation was similar and very high at the last follow-up: 100 vs. 94.7% in the low and high dose LNG-IUS groups, respectively (p = 0.18). Satisfaction with treatment at the end of the study was similar between different LNG-IUS doses (p = 0.85), with 78.9% being satisfied/very satisfied. Bleeding patterns were significantly different between the two LNG-IUS doses (p < 0.0001). Diagnosis of dysfunctional cysts was more frequent in women with high dose compared to low dose LNG-IUS (22.2 vs. 12.1%), albeit not significantly. CONCLUSIONS We have shown a clear differential use of available LNG-IUS in clinical practice, both as baseline characteristics and as different outcomes, primarily for bleeding patterns. However, all these systems were associated with a very high rate of satisfaction and continuation.
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Affiliation(s)
- Carlo Bastianelli
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Manuela Farris
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Elena Rosato
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, Rome, Italy
| | - Federico Varliero
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Maria Chiara Del Savio
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
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30
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Revzin MV, Sailer A, Moshiri M. Incidental Ovarian and Uterine Findings on Cross-sectional Imaging. Radiol Clin North Am 2021; 59:661-692. [PMID: 34053612 DOI: 10.1016/j.rcl.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Incidental adnexal masses and uterine findings occur with a high frequency on cross-sectional imaging examinations, particularly in postmenopausal women in whom imaging is performed for a different reason. These incidentalomas encompass a gamut of potential pelvic gynecologic disorders. Most are benign ovarian cysts; however, other less commonly encountered disorders and improperly positioned gynecologic devices may be seen. A knowledge of the management recommendations for such pelvic incidental findings is critical to avoid unnecessary imaging and surgical interventions, as well as to avoid failure in diagnosis and management of some of these conditions.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA.
| | - Anne Sailer
- Department of Radiology and Biomedical Imaging, Abdominal Imaging and Emergency Radiology, Yale School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT 06520, USA
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Box 357115, Seattle, WA 98195, USA
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31
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Park H, Qin L, Guerra P, Bay CP, Shinagare AB. Decoding incidental ovarian lesions: use of texture analysis and machine learning for characterization and detection of malignancy. Abdom Radiol (NY) 2021; 46:2376-2383. [PMID: 32728871 DOI: 10.1007/s00261-020-02668-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare CT texture features of benign and malignant ovarian lesions and to build a machine learning model to detect malignancy in incidental ovarian lesions. METHODS In this IRB-approved, HIPAA-compliant, retrospective study, 427 consecutive patients with incidental ovarian lesions detected on contrast-enhanced CT (348, 81.5% benign and 79, 18.5% malignant) were included. The following CT texture features were analyzed using commercially available software (TexRAD, Feedback Plc, Cambridge, UK): total pixel, mean, standard deviation (SD), entropy, mean value of positive pixels (MPP), skewness, kurtosis and entropy. Three machine learning models were created by combining texture features and patients' age, and performance of these models was assessed using tenfold cross-validation. Receiver operating characteristics (ROC) were constructed to assess sensitivity and specificity. The cutoff value was picked using a cost-weighted method. RESULTS Total pixels, mean, SD, entropy, MPP, and skewness were significantly different between benign and malignant groups (p < 0.05). With a selected 10 as a cost factor to optimize cutoff value selection, sensitivity 92%, specificity 60% in the random forest (RF) model, sensitivity 91%, specificity 69% in SVM model, and sensitivity 92%, specificity 61% in the logistic regression, respectively. CONCLUSION CT texture analysis could provide objective imaging analysis of incidental ovarian lesions and ML models using CT texture features and age demonstrated high sensitivity and moderate specificity for detection of malignant lesions.
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Stein EB, Roseland ME, Shampain KL, Wasnik AP, Maturen KE. Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update. Abdom Radiol (NY) 2021; 46:2127-2139. [PMID: 33079254 DOI: 10.1007/s00261-020-02812-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
Incidental adnexal masses are commonly encountered at ultrasound, computed tomography, and magnetic resonance imaging. Since many of these lesions are surgically resected and ultimately found to be benign, patients may be exposed to personal and economic costs related to unnecessary oophorectomy. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. Multiple consensus guidelines in radiology have been published to assist in characterization of these masses as benign, indeterminate, or likely malignant. In the last two years, several new and updated stratification systems for assessment of incidental adnexal masses have been published. The purpose of this article is to offer a concise review of four recent publications: ACR 2020 update on the management of incidental adnexal findings on CT and MRI, SRU 2019 consensus update on simple adnexal cysts, O-RADS ultrasound risk stratification system (2020), and O-RADS MRI risk stratification system (2020).
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Affiliation(s)
- Erica B Stein
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Molly E Roseland
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Kimberly L Shampain
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Ashish P Wasnik
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Katherine E Maturen
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
- Department of Obstetrics & Gynecology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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Pitfalls in Renal Ultrasound. Ultrasound Q 2020; 36:300-313. [PMID: 33298769 DOI: 10.1097/ruq.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound (US) is replete with pitfalls in technique and interpretation, and renal imaging is no exception. Because US of the kidneys is a very common initial and follow-up imaging examination, it is important to be aware of both common and unusual sources of potential error. This essay will review optimal technique and discuss common overcalls, under calls, and misinterpretations with respect to renal size, hydronephrosis, calculi, cysts, masses, and collections.
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Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity Level. J Am Coll Radiol 2020; 18:10-18. [PMID: 33096089 DOI: 10.1016/j.jacr.2020.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. METHODS A decision-analytic Markov model was developed to estimate LE benefits. Hypothetical cohorts of postmenopausal women with simple ovarian cysts were evaluated, with varied age (66-80 years) and comorbidity level (none, mild, moderate, severe). For each cohort, imaging "follow-up" (2 years) and "no-follow-up" strategies were compared. Consistent with current evidence, increased cancer risk in patients with cysts was not assumed; however, incident ovarian cancers could be detected during follow-up. To estimate theoretical maximal LE gains from follow-up, perfect ovarian cancer detection and treatment during follow-up were assumed. This and other key assumptions were varied in sensitivity analysis. RESULTS Projected LE gains from follow-up were limited. For 66-, 70-, 75-, and 80-year-old women with no comorbidities, LE gains were 5.1, 5.1, 4.5, and 3.7 days; with severe comorbidities, they were 3.5, 3.2, 2.7, and 2.1 days. With sensitivity of 50% for cancer detection, they were 3.7 days for 66-year-old women with no comorbidities and 1.3 days for 80-year-old women with severe comorbidities. When cancer risk for women with cysts was assumed to be elevated (1.1 times average risk), LE gains increased only modestly (5.6 and 2.3 days for analogous cohorts). CONCLUSIONS Even in the circumstance of perfect ovarian cancer detection and treatment, surveillance of postmenopausal women (≥66 years of age) with simple cysts affords limited benefits, particularly in women with advanced age and comorbidities.
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Patel MD, Horrow MM, Kamaya A, Frates MC, Dahiya N, Golding L, Chong WK, Gerena M, Ghate S, Glanc P, Goldbach AR, Gupta S, Hill PA, Johnson SI, Kocher MR, Rubin E, Sohaey R, Waltz JT, Wolfman DJ, Middleton WD. Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound. J Am Coll Radiol 2020; 18:42-52. [PMID: 33007309 DOI: 10.1016/j.jacr.2020.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
Current descriptions of ultrasound evaluations, including use of the term "point-of-care ultrasound" (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness. Details of this classification scheme are elaborated, including important clarifications regarding what ensures comprehensiveness and completeness. Practical implications of this framework for future research and reimbursement paradigms are highlighted.
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Affiliation(s)
- Maitray D Patel
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Mindy M Horrow
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Aya Kamaya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Stanford Medical Center, Stanford, California
| | - Mary C Frates
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nirvikar Dahiya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Division Chair, Ultrasound, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Lauren Golding
- Triad Radiology Associates, Winston Salem, North Carolina; Chair, American College of Radiology Commission on Ultrasound, Reston, Virginia
| | - Wui K Chong
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Chair, American College of Radiology Economics Committee on Ultrasound, Reston, Virginia
| | - Marielia Gerena
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Quality and Patient Safety, Department of Radiology and Biomedical Sciences, Loyola University Medical Center, Maywood, Illinois
| | - Sujata Ghate
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Duke University Medical Center, Durham, North Carolina; Treasurer, North Carolina Radiological Society, Lewisville, North Carolina
| | - Phyllis Glanc
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alyssa R Goldbach
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sonia Gupta
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Paul A Hill
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen I Johnson
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Section Head, Ultrasound, Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Madison R Kocher
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Eric Rubin
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Crozer-Keystone Health System, Springfield, Pennsylvania; Chair, American College of Radiology Commission on Human Resources, Reston, Virginia
| | - Roya Sohaey
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey T Waltz
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Darcy J Wolfman
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Johns Hopkins School of Medicine, Washington, District of Columbia; Chair, American College of Radiology Ultrasound Accreditation Committee, Reston, Virginia
| | - William D Middleton
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Kania LM, Guglielmo F, Mitchell D. Interpreting body MRI cases: classic findings in pelvic MRI. Abdom Radiol (NY) 2020; 45:2916-2930. [PMID: 32607649 DOI: 10.1007/s00261-020-02615-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
The high contrast resolution provided by magnetic resonance imaging (MRI) compared to all other modalities allows the interpreting radiologist to make a specific diagnosis for many common and uncommon findings. In some cases, the diagnosis can be so certain that there is no differential diagnosis. In this article, we review the most classically recognized findings when interpreting MRI of the pelvis including the following: Ovaries: Simple cyst, hemorrhagic cyst, corpus luteum, dermoid, fibroma/fibrothecoma. Uterus: C-section scar, adenomyosis, endometriosis, fibroid, congenital uterine anomalies. Cervix: nabothian cyst, cervical cancer. Vagina/Vulva: Gardener's duct cyst, Bartholin's gland cyst. Urethra: skene gland cyst, urethral diverticulum. Prostate: utricle cyst, Mullerian duct cyst, benign prostatic hyperplasia, prostate cancer.
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Recent Updates in Female Pelvic Ultrasound. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
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Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
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Patel MD, Ascher SM, Horrow MM, Pickhardt PJ, Poder L, Goldman M, Berland LL, Pandharipande PV, Maturen KE. Management of Incidental Adnexal Findings on CT and MRI: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2020; 17:248-254. [DOI: 10.1016/j.jacr.2019.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022]
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40
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Grant EG. The SRU Consensus Statement on Simple Adnexal Cysts: Updatedgues Guidelines for the Practitioner. Radiology 2019; 293:372-373. [PMID: 31550207 DOI: 10.1148/radiol.2019191894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Edward G Grant
- From the Department of Radiology, University of Southern California Keck School of Medicine, 1500 San Pablo St, Los Angeles, Calif 90033
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