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Kapoor S, Singhal S, Dhamija E, Manchanda S, Malhotra N, Bhatla N. Diagnostic performance of ultrasound reporting systems in evaluation of adnexal masses: A prospective observational study. Eur J Obstet Gynecol Reprod Biol 2024; 301:186-193. [PMID: 39153388 DOI: 10.1016/j.ejogrb.2024.08.023] [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: 02/25/2024] [Revised: 08/07/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE(S) To evaluate and compare diagnostic performance of ultrasound-based reporting systems IOTA SR, ADNEX, GIRADS, ORADS for discrimination between benign and malignant adnexal masses. STUDY DESIGN A prospective observational study in a tertiary care hospital's Obstetrics and Gynaecology department evaluated pre-operative ultrasound imaging for adnexal masses in 80 cases, comparing various reporting systems' sensitivity and specificity against histopathology as gold standard using STATA version 17.0 for data analysis. RESULTS Among the 80 masses, 55 % (44/80) were confirmed as benign on histopathology, while 45 % were identified as malignant. The sensitivity and specificity of SR was 100 % (95 %CI: 90.0-100) and 97.1 % (95 %CI: 84.7-99.9) respectively. Eleven masses (13.8 %) were inconclusive, reducing specificity to 75 % (95 %CI:59.7-86.8).In ADNEX optimal cut-off for risk of malignancy was 34.1 % with sensitivity of 86.1 % (95 % CI: 70.5-95.3) and specificity of 90.9 % (95 % CI: 78.3-97.5). Considering GIRADS 4-5 and risk threshold of ≥10 % (ORADS 4-5) as predictors of malignancy sensitivity was 100 % (95 %CI: 90.3-100) and specificity was 70.5 % (95 %CI: 54.8-83.2) for GIRADS and ORADS. All reporting systems were comparable (p = 0.7). ADNEX identified 72.7 % (8/11) of inconclusive cases, outperforming GIRADS/ORADS which correctly classified 27.2 % (3/11) cases. When applied to misclassified GIRADS/ORADS 4-5 category, ADNEX demonstrated superior performance by correctly classifying 76.9 % (10/13) masses, while SR achieved correct classification in only 38.5 % (5/13) masses. CONCLUSION(S) All classification systems showed comparable accuracy in malignancy risk identification on imaging. GIRADS/ORADS tended to overestimate malignancy risk. The present study recommends a two-step strategy, leveraging higher specificity of ADNEX model for improved stratification of adnexal masses.
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Affiliation(s)
- Shagun Kapoor
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Seema Singhal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Ekta Dhamija
- Department of Radiodiagnosis, DrBRAIRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
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Pan RK, Zhang SQ, Zhang XY, Xu T, Cui XW, Li R, Yu M, Zhang B. Clinical value of ACR O-RADS combined with CA125 in the risk stratification of adnexal masses. Front Oncol 2024; 14:1369900. [PMID: 39281376 PMCID: PMC11392681 DOI: 10.3389/fonc.2024.1369900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Purpose To develop a combined diagnostic model integrating the subclassification of the 2022 version of the American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) with carbohydrate antigen 125 (CA125) and to validate whether the combined model can offer superior diagnostic efficacy than O-RADS alone in assessing adnexal malignancy risk. Methods A retrospective analysis was performed on 593 patients with adnexal masses (AMs), and the pathological and clinical data were included. According to the large differences in malignancy risk indices for different image features in O-RADS category 4, the lesions were categorized into groups A and B. A new diagnostic criterion was developed. Lesions identified as category 1, 2, 3, or 4A with a CA125 level below 35 U/ml were classified as benign. Lesions identified as category 4A with a CA125 level more than or equal to 35 U/ml and lesions with a category of 4B and 5 were classified as malignant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) of O-RADS (v2022), CA125, and the combined model in the diagnosis of AMs were calculated and compared. Results The sensitivity, specificity, PPV, NPV, accuracy, and AUCs of the combined model were 92.4%, 96.5%, 80.2%, 98.8%, 94.1%, and 0.945, respectively. The specificity, PPV, accuracy, and AUC of the combined model were significantly higher than those of O-RADS alone (all P < 0.01). In addition, both models had acceptable sensitivity and NPV, but there were no significant differences among them (P > 0.05). Conclusion The combined model integrating O-RADS subclassification with CA125 could improve the specificity and PPV in diagnosing malignant AMs. It could be a valuable tool in the clinical application of risk stratification of AMs.
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Affiliation(s)
- Rui-Ke Pan
- Department of Medical Ultrasound, Shanghai East Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Shu-Qin Zhang
- Department of Medical Ultrasound, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Xian-Ya Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Ming Yu
- Department of Medical Ultrasound, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Bo Zhang
- Department of Medical Ultrasound, Shanghai East Hospital, Nanjing Medical University, Shanghai, China
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Patel-Lippmann KK, Gupta A, Martin MF, Phillips CH, Maturen KE, Jha P, Sadowski EA, Stein EB. The Roles of Ovarian-Adnexal Reporting and Data System US and Ovarian-Adnexal Reporting and Data System MRI in the Evaluation of Adnexal Lesions. Radiology 2024; 312:e233332. [PMID: 39162630 DOI: 10.1148/radiol.233332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
The Ovarian-Adnexal Reporting and Data System (O-RADS) is an evidence-based clinical support system for ovarian and adnexal lesion assessment in women of average risk. The system has both US and MRI components with separate but complementary lexicons and assessment categories to assign the risk of malignancy. US is an appropriate initial imaging modality, and O-RADS US can accurately help to characterize most adnexal lesions. MRI is a valuable adjunct imaging tool to US, and O-RADS MRI can help to both confirm a benign diagnosis and accurately stratify lesions that are at risk for malignancy. This article will review the O-RADS US and MRI systems, highlight their similarities and differences, and provide an overview of the interplay between the systems. When used together, the O-RADS US and MRI systems can help to accurately diagnose benign lesions, assess the risk of malignancy in lesions suspicious for malignancy, and triage patients for optimal management.
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Affiliation(s)
- Krupa K Patel-Lippmann
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Akshya Gupta
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Marisa F Martin
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Catherine H Phillips
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Katherine E Maturen
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Priyanka Jha
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Elizabeth A Sadowski
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
| | - Erica B Stein
- From the Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Medical Center North, 1161 21st Ave S, Nashville, TN 37232 (K.K.P.L., C.H.P.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (A.G.); Department of Radiology, University of Michigan, Ann Arbor, Mich (M.F.M., K.E.M., E.B.S.); Department of Radiology, Stanford University, Stanford, Calif (P.J.); and Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis (E.A.S.)
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Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, Eskander RN, Feldman MK, Jones LP, Martino MA, Patel MD, Patlas MN, Revzin MA, VanBuren W, Yashar CM, Kang SK. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update. J Am Coll Radiol 2024; 21:S79-S99. [PMID: 38823957 DOI: 10.1016/j.jacr.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Asymptomatic adnexal masses are commonly encountered in daily radiology practice. Although the vast majority of these masses are benign, a small subset have a risk of malignancy, which require gynecologic oncology referral for best treatment outcomes. Ultrasound, using a combination of both transabdominal, transvaginal, and duplex Doppler technique can accurately characterize the majority of these lesions. MRI with and without contrast is a useful complementary modality that can help characterize indeterminate lesions and assess the risk of malignancy is those that are suspicious. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Susan M Ascher
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ramez N Eskander
- University of California, San Diego, San Diego, California; American College of Obstetricians and Gynecologists
| | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin A Martino
- Ascension St. Vincent's, Jacksonville, Florida; University of South Florida, Tampa, Florida, Gynecologic oncologist
| | | | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margarita A Revzin
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | | | - Catheryn M Yashar
- University of California, San Diego, San Diego, California; Commission on Radiation Oncology
| | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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Recker F, Gembruch U, Strizek B. Clinical Ultrasound Applications in Obstetrics and Gynecology in the Year 2024. J Clin Med 2024; 13:1244. [PMID: 38592066 PMCID: PMC10931841 DOI: 10.3390/jcm13051244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Ultrasound imaging stands as a fundamental technology in the realms of obstetrics and gynecology, utilizing high-frequency sound waves to create detailed images of the internal structures of the body [...].
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (U.G.); (B.S.)
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Li Y, Shao G, Wu M, Zhang F, Zhang Y, Shao C. Evaluation of American College of Radiology Ovarian-Adnexal Reporting and Data System ultrasound to predict malignancy risk in adnexal lesions. J Obstet Gynaecol Res 2024; 50:225-232. [PMID: 37990446 DOI: 10.1111/jog.15831] [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: 07/13/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
AIMS To validate the diagnostic performance of Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound for preoperative adnexal lesions in an external center. The secondary aim was to evaluate the performance of a strategy test including O-RADS ultrasound evaluation and subjective assessment of higher malignant risk lesions. METHODS One hundred thirty patients with 158 ovarian-adnexal lesions were enrolled in the study. Each lesion was assigned an O-RADS score after real-time ultrasound examination by one experienced radiologist. A second subjective assessment by an expert was performed for O-RADS 4 and O-RADS 5 lesions. The histopathological diagnosis was used as the reference standard. RESULTS A total of 126 benign and 32 malignant adnexal masses were included in the study. The area under the receiver operating characteristic curve of O-RADS ultrasound was 0.950, with a cutoff value > O-RADS 3. The sensitivity, specificity, and negative and positive predictive values were 100% (95% confidence interval [CI], 0.867-1), 83.3% (95% CI, 0.754-0.892), 60.4% (95% CI, 0.460-0.732), and 100% (95% CI, 0.956-1), respectively. For the strategy test, the sensitivity, specificity, negative and positive predictive values were 100% (95% CI, 0.867-1), 92.1% (95% CI, 0.855-0.959), 76.2% (95% CI, 0.602-0.874), and 100% (95% CI, 0.960-1), respectively. In comparison with O-RADS ultrasound, the specificity and negative predictive value of the strategy test were slightly higher (p < 0.05). CONCLUSIONS Good diagnostic performance of the O-RADS ultrasound in adnexal lesions can be achieved by experienced radiologists in clinical practice. A second subjective assessment of sonographic findings can be applied to O-RADS 4 and 5 lesions.
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Affiliation(s)
- Ya Li
- Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Guangrui Shao
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Wu
- Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feixue Zhang
- Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuqing Zhang
- Department of Ultrasound, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chunchun Shao
- Center of Evidence-Based Medicine, Institute of Medicine Science, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Dang Thi Minh N, Nguyen Van T, Duong Duc H, Nguyen Tuan M, Duong Thi Tra G, Do Tuan D, Nguyen Tai D. IOTA simple rules: An efficient tool for evaluation of ovarian tumors by non-experienced but trained examiners - A prospective study. Heliyon 2024; 10:e24262. [PMID: 38293393 PMCID: PMC10827489 DOI: 10.1016/j.heliyon.2024.e24262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/03/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Objectives A simple and efficient tool for evaluating ovarian tumors in general hospitals where radiologists without experience in gynecological ultrasound is necessary. This study aims to evaluate the diagnostic performance of IOTA simple rules in initial classification of ovarian tumors by non-experienced examiners who have received simple training. Materials and method A prospective single-center study was conducted at Hanoi Obstetrics and Gynecology Hospital. Three resident gynecologists trained themselves for two weeks and then received hands-on practice under the supervision of experts for another two weeks. The examiners performed ultrasound on 424 eligible women scheduled for surgery for ovarian tumors and classified the tumors based on IOTA simple rules. The postoperative pathology of ovarian tumors was used as the gold standard. Results 90.8 % (385/424) of the tumors were benign. Simple rules were applicable in 399/424 (94.1 %) tumors, with a sensitivity of 84.8 % (95 % CI, 70.2-94.3), specificity of 98.9 % (95 % CI, 97.5-99.7), positive predictive value of 87.5 % (95 % CI, 73.3-95.9), and negative predictive value of 98.6 % (95 % CI, 97.1-99.5). The sensitivity of IOTA simple rules was higher in postmenopausal women (91.7 % vs. 81.0 %), while the specificity was higher in premenopausal women (99.4 % vs. 95.8 %). Accuracy was 100 % in all ten pregnant women were assessed using these rules. Conclusion In conclusion, in the hands of non-expert examiners who were trained thoroughly, IOTA simple rules are a simple and efficient tool for clinical practice in centers where expert radiologists in gynecology are not always available. The training program is simple and could be applied widely in other clinical centers. Further studies are necessary to evaluate the effectiveness of the IOTA simple rules in assessing ovarian tumors among pregnant women.
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Affiliation(s)
- Nguyet Dang Thi Minh
- Department of Obstetrics and Gynecology, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, 100000, Viet Nam
| | - Thi Nguyen Van
- Department of Quan Su Radiology, K Hospital 43 Quan su Street, Hoan Kiem district, Hanoi, 100000, Viet Nam
| | - Huu Duong Duc
- Department of Quan Su Radiology, K Hospital 43 Quan su Street, Hoan Kiem district, Hanoi, 100000, Viet Nam
| | - Minh Nguyen Tuan
- Department of Obstetrics and Gynecology, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, 100000, Viet Nam
| | - Giang Duong Thi Tra
- Department of Delivery, Hanoi Obstetrics and Gynecology Hospital, 929 La Thanh Street, Ba Dinh district, Hanoi, 100000, Viet Nam
| | - Dat Do Tuan
- Department of Obstetrics and Gynecology, Hanoi Medical University, 1 Ton That Tung Street, Dong Da District, Hanoi, 100000, Viet Nam
| | - Duc Nguyen Tai
- Prenatal screening and diagnostic center, Hanoi Obstetrics and Gynecology Hospital, 929 La Thanh Street, Ba Dinh district, Hanoi, 100000, Viet Nam
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Jost E, Kosian P, Jimenez Cruz J, Albarqouni S, Gembruch U, Strizek B, Recker F. Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology. J Clin Med 2023; 12:6833. [PMID: 37959298 PMCID: PMC10649694 DOI: 10.3390/jcm12216833] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Shadi Albarqouni
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
- Helmholtz AI, Helmholtz Munich, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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9
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Shi Y, Li H, Wu X, Li X, Yang M. O-RADS combined with contrast-enhanced ultrasound in risk stratification of adnexal masses. J Ovarian Res 2023; 16:153. [PMID: 37537697 PMCID: PMC10399045 DOI: 10.1186/s13048-023-01243-w] [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: 01/23/2023] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Ovarian-Adnexal Reporting and Data System (O-RADS) for ultrasound is a lexicon and risk stratification system that includes all risk categories and relevant management recommendation. It has high sensitivity in diagnosing malignant adnexal tumors, but the specificity is lower. OBJECTIVE To explore the value of O-RADS combined with contrast-enhanced ultrasound (CEUS) in risk stratification of adnexal masses. METHODS A retrospective study was performed on 85 patients with 100 adnexal masses that preoperatively underwent conventional ultrasound as well as CEUS examination and obtained the postoperative pathological results. The masses were classified into O-RADS2, 3, 4, and 5 by conventional ultrasound. After contrast enhancement, the classification of O-RADS was adjusted according to CEUS imaging features. The O-RADS 2 and 3 lesions with suspected malignant features like irregular blood vessels or internal inhomogeneous hyperenhancement were upgraded to O-RADS 4, and the O-RADS 4 lesions with the above features were upgraded to O-RADS 5. The O-RADS 4 lesions with suspicious benign angiographic features like a regular vessel, interior hypoenhancement or non-enhancement were downgraded to O-RADS 3; the O-RADS 5 lesions with rim ring-enhancement and interior non-enhancement were downgraded to O-RADS 3. The sensitivity, specificity, accuracy, PPV, NPV, and AUC of the two methods were compared, taking pathological results as the gold standard. RESULTS The sensitivity, specificity, accuracy, PPV, NPV, and AUC of O-RADS and O-RADS combined with CEUS in the diagnosis of malignant adnexal tumors were 96.6%, 66.2%, 75.0%, 53.8%, 97.9%, 0.910 and 96.6%, 91.5%, 93.0%, 82.4%, 98.5%, 0.962, respectively. The specificity, accuracy, PPV, and AUC of O-RADS combined with CEUS were considerably higher than those of O-RADS (P < 0.01). Furthermore, both methods had excellent sensitivity and NPV but there were no significant differences between them(P > 0.05). CONCLUSION Combination of O-RADS and CEUS can significantly improve the specificity and PPV in diagnosing malignant adnexal tumors. It seems promising in the clinical application of risk stratification of adnexal masses.
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Affiliation(s)
- Yanyun Shi
- Department of Ultrasonography, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Xinglong Lane, Changzhou, China
| | - Huan Li
- Department of Ultrasonography, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Xinglong Lane, Changzhou, China.
| | - Xiuhua Wu
- Department of Ultrasonography, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Xinglong Lane, Changzhou, China
| | - Xiaoqin Li
- Department of Ultrasonography, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Xinglong Lane, Changzhou, China
| | - Min Yang
- Department of Ultrasonography, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Xinglong Lane, Changzhou, China
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10
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Sadowski EA, Rockall A, Thomassin-Naggara I, Barroilhet LM, Wallace SK, Jha P, Gupta A, Shinagare AB, Guo Y, Reinhold C. Adnexal Lesion Imaging: Past, Present, and Future. Radiology 2023; 307:e223281. [PMID: 37158725 DOI: 10.1148/radiol.223281] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Currently, imaging is part of the standard of care for patients with adnexal lesions prior to definitive management. Imaging can identify a physiologic finding or classic benign lesion that can be followed up conservatively. When one of these entities is not present, imaging is used to determine the probability of ovarian cancer prior to surgical consultation. Since the inclusion of imaging in the evaluation of adnexal lesions in the 1970s, the rate of surgery for benign lesions has decreased. More recently, data-driven Ovarian-Adnexal Reporting and Data System (O-RADS) scoring systems for US and MRI with standardized lexicons have been developed to allow for assignment of a cancer risk score, with the goal of further decreasing unnecessary interventions while expediting the care of patients with ovarian cancer. US is used as the initial modality for the assessment of adnexal lesions, while MRI is used when there is a clinical need for increased specificity and positive predictive value for the diagnosis of cancer. This article will review how the treatment of adnexal lesions has changed due to imaging over the decades; the current data supporting the use of US, CT, and MRI to determine the likelihood of cancer; and future directions of adnexal imaging for the early detection of ovarian cancer.
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Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Lisa M Barroilhet
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Sumer K Wallace
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Akshya Gupta
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Atul B Shinagare
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Yang Guo
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B., S.K.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI 53792-3252; Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, UK (A.R.); Department of Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France (I.T.N.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (P.J.); Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A.B.S., Y.G.); Augmented Imaging Precision Health Laboratory (AIPHL), Research Institute of the McGill University Health Centre, and Department of Radiology, McGill University, Montreal, Canada (C.R.); and Montreal Imaging Experts, Montreal, Canada (C.R.)
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11
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Nougaret S, Lakhman Y, Bahadir S, Sadowski EA, Thomassin-Naggara I, Reinhold C. Ovarian-Adnexal Reporting and Data System for Magnetic Resonance Imaging (O-RADS MRI): Genesis and Future Directions. Can Assoc Radiol J 2023; 74:370-381. [PMID: 36250435 PMCID: PMC11058407 DOI: 10.1177/08465371221121738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Imaging plays an important role in characterizing and risk-stratifying commonly encountered adnexal lesions. Recently, the American College of Radiology (ACR) released the Ovarian-Adnexal Reporting and Data System (O-RADS) for ultrasound and subsequently for magnetic resonance imaging (MRI). The goal of the recently developed ACR O-RADS MRI risk stratification system is to improve the quality of imaging reports as well as the reproducibility of evaluating adnexal lesions on MRI. This review focuses on exploring this new system and its future refinements.
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Affiliation(s)
- Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute (ICM), Montpellier, France
- Montpellier Cancer Research institute (IRCM), INSERM U1194, University of Montpellier, Montpellier, France
| | - Yulia Lakhman
- Departments of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Suzan Bahadir
- Department of Radiology, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Elizabeth A. Sadowski
- Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252
| | - Isabelle Thomassin-Naggara
- Service d’Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Center (MUHC)
- Department of Obstetrics and Gynecology, McGill University Health Center (MUHC)
- Co-Director Augmented Intelligence Precision Laboratory (AIPHL), MUHC Research Institute, Department of Radiology, 1001 Decarie Boul.Montreal, Quebec, H4A 3J1
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12
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Bourgioti C, Konidari M, Moulopoulos LA. Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI. Cancers (Basel) 2023; 15:cancers15072106. [PMID: 37046767 PMCID: PMC10093428 DOI: 10.3390/cancers15072106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
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13
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Gong LP, Li XY, Wu YN, Dong S, Zhang S, Feng YN, Lv YE, Guo XJ, Peng YQ, Du XS, Tian JW, Sun CX, Sun LT. Nomogram based on the O-RADS for predicting the malignancy risk of adnexal masses with complex ultrasound morphology. J Ovarian Res 2023; 16:57. [PMID: 36945000 PMCID: PMC10029304 DOI: 10.1186/s13048-023-01133-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE The accurate preoperative differentiation of benign and malignant adnexal masses, especially those with complex ultrasound morphology, remains a great challenge for junior sonographers. The purpose of this study was to develop and validate a nomogram based on the Ovarian-Adnexal Reporting and Data System (O-RADS) for predicting the malignancy risk of adnexal masses with complex ultrasound morphology. METHODS A total of 243 patients with data on adnexal masses with complex ultrasound morphology from January 2019 to December 2020 were selected to establish the training cohort, while 106 patients with data from January 2021 to December 2021 served as the validation cohort. Univariate and multivariate analyses were used to determine independent risk factors for malignant tumors in the training cohort. Subsequently, a predictive nomogram model was developed and validated in the validation cohort. The calibration, discrimination, and clinical net benefit of the nomogram model were assessed separately by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Finally, we compared this model to the O-RADS. RESULTS The O-RADS category, an elevated CA125 level, acoustic shadowing and a papillary projection with color Doppler flow were the independent predictors and were incorporated into the nomogram model. The area under the ROC curve (AUC) of the nomogram model was 0.958 (95% CI, 0.932-0.984) in the training cohort. The specificity and sensitivity were 0.939 and 0.893, respectively. This nomogram also showed good discrimination in the validation cohort (AUC = 0.940, 95% CI, 0.899-0.981), with a sensitivity of 0.915 and specificity of 0.797. In addition, the nomogram model showed good calibration efficiency in both the training and validation cohorts. DCA indicated that the nomogram was clinically useful. Furthermore, the nomogram model had higher AUC and net benefit than the O-RADS. CONCLUSION The nomogram based on the O-RADS showed a good predictive ability for the malignancy risk of adnexal masses with complex ultrasound morphology and could provide help for junior sonographers.
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Affiliation(s)
- Li-Ping Gong
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Xiao-Ying Li
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Ying-Nan Wu
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Shuang Dong
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Shuang Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
| | - Ya-Nan Feng
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Ya-Er Lv
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Xi-Juan Guo
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Yan-Qing Peng
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China
| | - Xiao-Shan Du
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
| | - Jia-Wei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang Province, China
| | - Cong-Xin Sun
- Department of Ultrasound, Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, 050011, Hebei Province, China.
| | - Li-Tao Sun
- Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, 310014, Zhejiang Province, China.
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14
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Alcázar JL, Rodriguez-Guzman L, Vara J, Amor F, Diaz L, Vaccaro H. Gynecologic Imaging and Reporting Data System for classifying adnexal masses. Minerva Obstet Gynecol 2023; 75:69-79. [PMID: 36790399 DOI: 10.23736/s2724-606x.22.05122-3] [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: 06/18/2023]
Abstract
INTRODUCTION To perform a systematic review and meta-analysis of the diagnostic performance of the so-called Gynecologic Imaging and Report Data System (GI-RADS) for classifying adnexal masses. EVIDENCE ACQUISITION A search for studies reporting about the use of GI-RADS system for classifying adnexal masses from January 2009 to December 2021 was performed in Medline (Pubmed), Google Scholar, Scopus, Cochrane, and Web of Science databases. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odd ratio (DOR) were calculated. Studies' quality was evaluated using QUADAS-2. EVIDENCE SYNTHESIS We identified 510 citations. Ultimately, 26 studies comprising 7350 masses were included. Mean prevalence of ovarian malignancy was 26%. The risk of bias was high in eight studies for domain "patient selection" and low for "index test," "reference test" domains for all studies. Overall, pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and DOR of GI-RADS system for classifying adnexal masses were 94% (95% confidence interval [CI]=91-96%), 90% (95% CI=87-92%), 9.1 (95% CI=7.0-11.9), and 0.07 (95% CI=0.05-0.11), and 132 (95% CI=78-221), respectively. Heterogeneity was high for both sensitivity and specificity. Meta-regression showed that multiple observers and study's design explained this heterogeneity among studies. CONCLUSIONS GI-RADS system has a good diagnostic performance for classifying adnexal masses.
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Affiliation(s)
- Juan L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain -
| | | | - Julio Vara
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Amor
- Panoramic Ultrasonic Ultrasound Center, Santiago, Chile
| | - Linder Diaz
- AGB Ultrasonography Center, Clínica Sanatorio Alemán S.A., Concepción, Chile
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15
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Arezzo F, Cormio G, La Forgia D, Santarsiero CM, Mongelli M, Lombardi C, Cazzato G, Cicinelli E, Loizzi V. A machine learning approach applied to gynecological ultrasound to predict progression-free survival in ovarian cancer patients. Arch Gynecol Obstet 2022; 306:2143-2154. [PMID: 35532797 PMCID: PMC9633520 DOI: 10.1007/s00404-022-06578-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023]
Abstract
In a growing number of social and clinical scenarios, machine learning (ML) is emerging as a promising tool for implementing complex multi-parametric decision-making algorithms. Regarding ovarian cancer (OC), despite the standardization of features that can support the discrimination of ovarian masses into benign and malignant, there is a lack of accurate predictive modeling based on ultrasound (US) examination for progression-free survival (PFS). This retrospective observational study analyzed patients with epithelial ovarian cancer (EOC) who were followed in a tertiary center from 2018 to 2019. Demographic features, clinical characteristics, information about the surgery and post-surgery histopathology were collected. Additionally, we recorded data about US examinations according to the International Ovarian Tumor Analysis (IOTA) classification. Our study aimed to realize a tool to predict 12 month PFS in patients with OC based on a ML algorithm applied to gynecological ultrasound assessment. Proper feature selection was used to determine an attribute core set. Three different machine learning algorithms, namely Logistic Regression (LR), Random Forest (RFF), and K-nearest neighbors (KNN), were then trained and validated with five-fold cross-validation to predict 12 month PFS. Our analysis included n. 64 patients and 12 month PFS was achieved by 46/64 patients (71.9%). The attribute core set used to train machine learning algorithms included age, menopause, CA-125 value, histotype, FIGO stage and US characteristics, such as major lesion diameter, side, echogenicity, color score, major solid component diameter, presence of carcinosis. RFF showed the best performance (accuracy 93.7%, precision 90%, recall 90%, area under receiver operating characteristic curve (AUROC) 0.92). We developed an accurate ML model to predict 12 month PFS.
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Affiliation(s)
- Francesca Arezzo
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Daniele La Forgia
- Department of Breast Radiology, Giovanni Paolo II I.R.C.C.S. Cancer Institute, via Orazio Flacco 65, 70124 Bari, Italy
| | - Carla Mariaflavia Santarsiero
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Michele Mongelli
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Claudio Lombardi
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vera Loizzi
- Interdisciplinar Department of Medicine, Obstetrics and Gynecology Unit, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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16
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IETA Ultrasonic Features Combined with GI-RADS Classification System and Tumor Biomarkers for Surveillance of Endometrial Carcinoma: An Innovative Study. Cancers (Basel) 2022; 14:cancers14225631. [PMID: 36428723 PMCID: PMC9688181 DOI: 10.3390/cancers14225631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: We were the first to combine IETA ultrasonic features with GI-RADS and tumor biomarkers for the surveillance of endometrial carcinoma. The aim was to evaluate the efficacy of single IETA ultrasonography GI-RADS classification and combined tumor biomarkers in differentiating benign and malignant lesions in the uterine cavity and endometrium. Methods: A total of 497 patients with intrauterine and endometrial lesions who had been treated surgically between January 2017 and December 2021 were enrolled; all of them had undergone ultrasound examinations before surgery. We analyzed the correlation between the terms of ultrasonic signs of the uterine cavity and endometrial lesions defined by the expert consensus of IETA and the benign and malignant lesions and then classified these ultrasonic signs by GI-RADS. In addition, the tumor biomarkers CA125, CA15-3, CA19-9 and HE4 were combined by adjusting the classification. The results of the comprehensive analysis were compared with pathological results to analyze their diagnostic efficacy. Results: (1) The statistic analysis confirmed that there were seven independent predictors of malignant lesions, including thickened endometrium (premenopause ≥ 18.5 mm, postmenopause ≥ 15.5 mm), non-uniform endometrial echogenicity (heterogeneous with irregular cysts), endometrial midline appearance (not defined), the endometrial-myometrial junction (interrupted or not defined), intracavitary fluid (ground glass or "mixed" echogenicity), color score (3~4 points) and vascular pattern (focal origin multiple vessels or multifocal origin multiple vessels). (2) In traditional ultrasound GI-RADS (U-T-GI-RADS), if category 4a was taken as the cut-off value of benign and malignant, the diagnostic sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97.2%, 65.2%, 44.0%, 98.8% and 72.2%, respectively, and the area under the ROC curve (AUC) was 0.812. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 88.1%, 92.0%, 75.6%, 96.5% and 91.2%, 0.900, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.5%, 93.2%, 93.4%, 93.4% and 0.868, respectively, when taking category 5 as the cutoff point. In modified ultrasound GI-RADS (U-M-GI-RADS), if 4a was taken as the cut-off value, The diagnostic efficacy was the same as U-T-GI-RADS. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV, diagnostic accuracy and AUC were 88.1%, 92.3%, 76.2%, 96.5%, 91.3% and 0.902, respectively. If 4c was taken as the cutoff point, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.7%, 94.3%, 93.4%, 93.6% and 0.870, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 66.1%, 99.7%, 98.6%, 91.3%, 92.4% and 0.829, respectively, if taking category 5 as the cutoff point. (3) In the comprehensive diagnostic method of U-T-GI-RADS combined tumor biomarkers results, the AUC of class 4a, 4b and 5 as the cutoff value was 0.877, 0.888 and 0.738, respectively. The AUC of class 4a, 4b, 4c and 5 as the cutoff value in the comprehensive diagnostic method of U-M-GI-RADS combined tumor biomarkers results was 0.877, 0.888, 0.851 and 0.725, respectively. There was no significant difference in diagnostic efficiency between the two comprehensive diagnostic methods. Conclusions: In this study, no matter which diagnostic method was used, the best cutoff value for predicting malignant EC was ≥GI-RADS 4b. The GI-RADS classification had good performance in discriminating EC. The tumor biomarkers, CA125, CA19-9, CA15-3 and HE4, could improve the diagnostic efficacy for preoperative endometrial carcinoma assessment.
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Chen GY, Hsu TF, Chan IS, Liu CH, Chao WT, Shih YC, Jiang LY, Chang YH, Wang PH, Chen YJ. Comparison of the O-RADS and ADNEX models regarding malignancy rate and validity in evaluating adnexal lesions. Eur Radiol 2022; 32:7854-7864. [PMID: 35583711 DOI: 10.1007/s00330-022-08803-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to compare the ability of the O-RADS and ADNEX models to classify benign or malignant adnexal lesions. METHODS This retrospective single-center study included women who underwent surgery for adnexal lesions. Two gynecologists independently categorized the adnexal lesions according to the O-RADS and ADNEX models. Four additional readers were included to validate the new quick-access O-RADS flowchart. RESULTS Among the 322 patients included in this study, 264 (82.0%) had a benign diagnosis, and 58 (18.0%) had a malignant diagnosis. The malignant rates of O-RADS 2, O-RADS 3, O-RADS 4, and O-RADS 5 were 0%, 3.0%, 37.7%, and 78.9%, respectively. The AUC of the O-RADS in the 322 patients was 0.93. On comparing the O-RADS and ADNEX models in the remaining 281 patients, the AUCs of the O-RADS, ADNEX model with CA125, and ADNEX model without CA125 were 0.92, 0.95, and 0.94, respectively. When setting a uniform cutoff of ≥ 10% (≥ O-RADS 4) to predict malignancy, the O-RADS had higher sensitivity than the ADNEX model (96.6% vs. 91.4%), and relatively similar specificity. In addition, the readers with the quick-access flowchart spent less time categorizing O-RADS than the readers with only the original O-RADS table (mean analysis time: 99 min 15 s vs. 111 min 55 s). CONCLUSIONS The O-RADS classification of the adnexal lesions as benign or malignant was comparable to that of the ADNEX model and had higher sensitivity at the 10% cutoff value. A quick-access O-RADS flowchart was helpful in O-RADS categorization and might shorten the analysis time. KEY POINTS • Both O-RADS and ADNEX models had good diagnostic performance in distinguishing adnexal malignancy, and O-RADS had higher sensitivity than ADNEX model in uniform 10% cutoff to predict malignancy. • Quick-access O-RADS flowchart was developed to help review O-RADS classification and might help reduce the analysis time.
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Affiliation(s)
- Guan-Yeu Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Teh-Fu Hsu
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-San Chan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Chu Shih
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Hou Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,The Female Cancer Foundation, Taipei, Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Application of O-RADS Ultrasound Lexicon-Based Logistic Regression Analysis Model in the Diagnosis of Solid Component-Containing Ovarian Malignancies. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7187334. [PMID: 36330455 PMCID: PMC9626203 DOI: 10.1155/2022/7187334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/11/2022] [Indexed: 12/02/2022]
Abstract
Objective To use the logistic regression model to evaluate the value of ultrasound characteristics in the Ovarian-Adnexal Reporting and Data System ultrasound lexicon in determining ovarian solid component-containing mass benignancy/malignancy. Methods We retrospectively analyzed the data of 172 patients with adnexal masses discovered by ultrasound, and diagnosis was confirmed by postoperative pathological tests from January 2019 to December 2021. Thirteen ovarian tumor-related parameters in the benign and malignant ovarian tumor groups were selected for univariate analyses. Statistically significant parameters were included in multivariate logistic regression analyses to construct a logistic regression diagnosis model, and the diagnostic performance of the model in predicting ovarian malignancies was calculated. Results Of the 172 adnexal tumors, 104 were benign, and 68 were malignant. There were differences in cancer antigen 125, maximum mass diameter, maximum solid component diameter, multilocular cyst with solid component, external contour, whether acoustic shadows were present in the solid component, number of papillae, vascularity, presence/absence of ascites, and presence/absence of peritoneal thickening or nodules between the benign ovarian tumor and malignancy groups (p < 0.05). Logistic regression analyses showed that maximum solid component diameter, whether acoustic shadows were present in the solid component, number of papillae, and presence/absence of ascites were included in the logistic regression model, and the area under the receiver operating characteristic curve for this regression model in predicting ovarian malignancy was 0.962 (95% confidence interval: 0.933~0.990; p < 0.001). Logit (p) ≥ −0.02 was used as the cutoff value, and the prediction accuracy, sensitivity, specificity, positive predictive value, and negative predictive values were 93.6%, 86.8%, 98.1%, 96.7%, and 91.9%, respectively. Conclusion The logistic regression model containing the maximum solid component diameter, whether acoustic shadows were present in the solid component, number of papillae, and presence/absence of ascites can help in determining the benignancy/malignancy of solid component-containing masses.
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Shentu W, Zhang Y, Gu J, Wang F, Zhao W, Liu C, Lin Z, Wang Y, Liu C, Chen Y, Fan Q, Wang H. Contrast-enhanced ultrasonography for differential diagnosis of adnexal masses. Front Oncol 2022; 12:968759. [PMID: 36338700 PMCID: PMC9632442 DOI: 10.3389/fonc.2022.968759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Quantitative contrast-enhanced ultrasonography parameters are affected by various factors. We evaluated corrected quantitative contrast enhanced ultrasonography in differentiating benign adnexal tumors from malignant tumors. Methods Patients with adnexal masses who underwent conventional and contrast-enhanced ultrasonography were included. Contrast-enhanced ultrasonography parameters such as base intensity, arrival time, peak intensity, time to peak intensity, ascending slope, and descending slope were measured. Corrected (time to peak intensity − arrival time) mass/(time to peak intensity − arrival time) uterus and (peak intensity − base intensity) mass/(peak intensity − base intensity) uterus were calculated. Lesions were confirmed by pathologic examination of surgical specimens. Results This study included 31 patients with 35 adnexal lesions including 20 (57.10%) benign and 15 (42.90%) malignant lesions. The corrected contrast-enhanced ultrasonography quantitative parameters in lesions were statistically different between malignant and benign groups (P<0.05). The optimal cut-off value for (time to peak intensity − arrival time) mass/(time to peak intensity − arrival time) uterus, ascending slope, and (peak intensity − base intensity) mass/(peak intensity − base intensity) uterus, and descending slope for differentiating malignant adnexal masses from benign tumors were 1.05 (area under curve: 0.93, P<0.05), 1.11 (area under curve: 0.83, P<0.05), 0.82 (area under curve: 0.73, P<0.05), and −0.27 (area under curve: 0.66, P=0.16), with sensitivity and specificity of 93.33% and 85.00%, 86.67% and 75.00%, 86.67% and 60.00%, and 54.55% and 66.67%, respectively. Conclusions Corrected contrast-enhanced ultrasonography parameters provide practical differential diagnosis value of adnexal lesions with high reliability for sonologists.
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Affiliation(s)
- Weihui Shentu
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yin Zhang
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiaojiao Gu
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fa Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhao
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chunmei Liu
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zimei Lin
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Wang
- Department of Medical Ultrasonics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Liu
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yunyu Chen
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Yunyu Chen, ; Qiyun Fan, ; Hongying Wang,
| | - Qiyun Fan
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Yunyu Chen, ; Qiyun Fan, ; Hongying Wang,
| | - Hongying Wang
- Department of Medical Ultrasonics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Yunyu Chen, ; Qiyun Fan, ; Hongying Wang,
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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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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: 30] [Impact Index Per Article: 15.0] [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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22
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Lai HW, Lyu GR, Kang Z, Li LY, Zhang Y, Huang YJ. Comparison of O-RADS, GI-RADS, and ADNEX for Diagnosis of Adnexal Masses: An External Validation Study Conducted by Junior Sonologists. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1497-1507. [PMID: 34549454 DOI: 10.1002/jum.15834] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To externally validate the Ovarian-adnexal Reporting and Data System (O-RADS) and evaluate its performance in differentiating benign from malignant adnexal masses (AMs) compared with the Gynecologic Imaging Reporting and Data System (GI-RADS) and Assessment of Different NEoplasias in the adneXa (ADNEX). METHODS A retrospective analysis was performed on 734 cases from the Second Affiliated Hospital of Fujian Medical University. All patients underwent transvaginal or transabdominal ultrasound examination. Pathological diagnoses were obtained for all the included AMs. O-RADS, GI-RADS, and ADNEX were used to evaluate AMs by two sonologists, and the diagnostic efficacy of the three systems was analyzed and compared using pathology as the gold standard. We used the kappa index to evaluate the inter-reviewer agreement (IRA). RESULTS A total of 734 AMs, including 564 benign masses, 69 borderline masses, and 101 malignant masses were included in this study. O-RADS (0.88) and GI-RADS (0.90) had lower sensitivity than ADNEX (0.95) (P < .05), and the PPV of O-RADS (0.98) was higher than that of ADNEX (0.96) (P < .05). These three systems showed good IRA. CONCLUSION O-RADS, GI-RADS, and ADNEX showed little difference in diagnostic performance among resident sonologists. These three systems have their own characteristics and can be selected according to the type of center, access to patients' clinical data, or personal comfort.
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Affiliation(s)
- Hong-Wei Lai
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Guo-Rong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Quanzhou Medical College, Quanzhou, China
| | - Zhuo Kang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Li-Ya Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Ying Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Jun Huang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Xiao F, Zhang L, Yang S, Peng K, Hua T, Tang G. Quantitative analysis of the MRI features in the differentiation of benign, borderline, and malignant epithelial ovarian tumors. J Ovarian Res 2022; 15:13. [PMID: 35062992 PMCID: PMC8783416 DOI: 10.1186/s13048-021-00920-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Objective This study aims to investigate the value of the quantitative indicators of MRI in the differential diagnoses of benign, borderline, and malignant epithelial ovarian tumors (EOTs). Materials and methods The study population comprised 477 women with 513 masses who underwent MRI and operation, including benign EOTs (BeEOTs), borderline EOTs (BEOTs), and malignant EOTs (MEOTs). The clinical information and MRI findings of the three groups were compared. Then, multivariate logistic regression analysis was performed to find the independent diagnostic factors. The receiver operating characteristic (ROC) curves were also used to evaluate the diagnostic performance of the quantitative indicators of MRI and clinical information in differentiating BeEOTs from BEOTs or differentiating BEOTs from MEOTs. Results The MEOTs likely involved postmenopausal women and showed higher CA-125, HE4 levels, ROMA indices, peritoneal carcinomatosis and bilateral involvement than BeEOTs and BEOTs. Compared with BEOTs, BeEOTs and MEOTs appeared to be more frequently oligocystic (P < 0.001). BeEOTs were more likely to show mild enhancement (P < 0.001) and less ascites (P = 0.003) than BEOTs and MEOTs. In the quantitative indicators of MRI, BeEOTs usually showed thin-walled cysts and no solid component. BEOTs displayed irregular thickened wall and less solid portion. MEOTs were more frequently characterized as solid or predominantly solid mass (P < 0.001) than BeEOTs and BEOTs. The multivariate logistic regression analysis showed that volume of the solid portion (P = 0.006), maximum diameter of the solid portion (P = 0.038), enhancement degrees (P < 0.001), and peritoneal carcinomatosis (P = 0.011) were significant indicators for the differential diagnosis of the three groups. The area under the curves (AUCs) of above indicators and combination of four image features except peritoneal carcinomatosis for the differential diagnosis of BeEOTs and BEOTs, BEOTs and MEOTs ranged from 0.74 to 0.85, 0.58 to 0.79, respectively. Conclusion In this study, the characteristics of MRI can provide objective quantitative indicators for the accurate imaging diagnosis of three categories of EOTs and are helpful for clinical decision-making. Among these MRI characteristics, the volume, diameter, and enhancement degrees of the solid portion showed good diagnostic performance.
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Ultrasound Assessment of Adnexal Pathology: Standardized Methods and Different Levels of Experience. ACTA ACUST UNITED AC 2021; 57:medicina57070708. [PMID: 34356989 PMCID: PMC8304887 DOI: 10.3390/medicina57070708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/18/2021] [Accepted: 07/04/2021] [Indexed: 12/03/2022]
Abstract
Background and objectives: An expert’s subjective assessment is still the most reliable evaluation of adnexal pathology, thus raising the need for methods less dependent on the examiner’s experience. The aim of this study was to evaluate the performance of standardized methods when applied by examiners with different levels of experience and to suggest the most suitable method for less-experienced gynecologists. Materials and methods: This single-center retrospective study included 50 cases of histologically proven first-time benign or malignant adnexal pathology. Three examiners evaluated the same transvaginal ultrasound images: an expert (level III), a 4th year resident in gynecology (level I), and a final year medical student after basic training (labeled as level 0). The assessment methods included subjective evaluation, Simple Rules (SR) with and without algorithm, ADNEX and Gynecologic Imaging Reporting and Data System (GI-RADS) models. Sensitivity, specificity, accuracy, positive and negative predictive values with 95% confidence interval were calculated. Results: Out of 50 cases, 33 (66%) were benign and 17 (34%) were malignant adnexal masses. Using only SR, level III could classify 48 (96%), level I—41 (82%) and level 0—40 (80%) adnexal lesions. Using SR and algorithm, the performance improved the most for all levels and yielded sensitivity and specificity of 100% for level III, 100% and 97% for level I, 94.4% and 100% for level 0, respectively. Compared to subjective assessment, ADNEX lowered the accuracy of level III evaluation from 97.9% to 88% and GI-RADS had no impact. ADNEX and GI-RADS improved the sensitivity up to 100% for the less experienced; however, the specificity and accuracy were notably decreased. Conclusions: SR and SR+ algorithm have the most potential to improve not only sensitivity, but also specificity and accuracy, irrespective of the experience level. ADNEX and GI-RADS can yield sensitivity of 100%; however, the accuracy is decreased.
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25
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:148-168. [PMID: 33794043 DOI: 10.1002/uog.23635] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumors, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Planchamp
- Clinical Research Unit, Institut Bergonie, Bordeaux, France
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Metabolism, Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - C Landolfo
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A du Bois
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - L Chiva
- Department of Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - D Cibula
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - N Concin
- Department of Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - D Fischerova
- Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - W Froyman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - G Gallardo
- Department of Radiology, University Clinic of Navarra, Madrid, Spain
| | - B Lemley
- Patient Representative, President of Kraefti Underlivet (KIU), Denmark
- Chair Clinical Trial Project of the European Network of Gynaecological Cancer Advocacy Groups, ENGAGe
| | - A Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Mereu
- Department of Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - P Morice
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - D Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - A C Testa
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - I Vergote
- Department of Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Division of Translational MRI, Department of Imaging & Pathology KU Leuven, Leuven, Belgium
| | - G Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Fotopoulou
- Department of Gynecologic Oncology, Hammersmith Hospital, Imperial College, London, UK
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26
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo Madueño G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa AC, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer 2021; 31:961-982. [PMID: 34112736 PMCID: PMC8273689 DOI: 10.1136/ijgc-2021-002565] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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Affiliation(s)
- Dirk Timmerman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium .,Development and Regeneration, KU Leuven, Leuven, Belgium
| | | | - Tom Bourne
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium.,Development and Regeneration, KU Leuven, Leuven, Belgium.,Metabolism Digestion and Reproduction, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - Chiara Landolfo
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andreas du Bois
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Luis Chiva
- Gynaecology and Obstetrics, University Clinic of Navarra, Madrid, Spain
| | - David Cibula
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Nicole Concin
- Gynaecology and Gynaecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Fischerova
- Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Wouter Froyman
- Gynecology and Obstetrics, University Hospitals KU Leuven, Leuven, Belgium
| | | | - Birthe Lemley
- European Network of Gynaecological Cancers Advocacy Groups (ENGAGe) Executive Group, Prague, Czech Republic.,KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark
| | - Annika Loft
- Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Liliana Mereu
- Gynecology and Obstetrics, Gynecologic Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Philippe Morice
- Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Antonia Carla Testa
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ignace Vergote
- Obstetrics and Gynaecology and Gynaecologic Oncology, University Hospital Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Vincent Vandecaveye
- Radiology, University Hospitals Leuven, Leuven, Belgium.,Division of Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Giovanni Scambia
- Woman, Child and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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27
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Timmerman D, Planchamp F, Bourne T, Landolfo C, du Bois A, Chiva L, Cibula D, Concin N, Fischerova D, Froyman W, Gallardo G, Lemley B, Loft A, Mereu L, Morice P, Querleu D, Testa C, Vergote I, Vandecaveye V, Scambia G, Fotopoulou C. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours. Facts Views Vis Obgyn 2021; 13:107-130. [PMID: 34107646 PMCID: PMC8291986 DOI: 10.52054/fvvo.13.2.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumours, including imaging techniques, biomarkers and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the preoperative diagnosis of ovarian tumours and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the preoperative diagnosis of ovarian tumours and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
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28
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Nougaret S, McCague C, Tibermacine H, Vargas HA, Rizzo S, Sala E. Radiomics and radiogenomics in ovarian cancer: a literature review. Abdom Radiol (NY) 2021; 46:2308-2322. [PMID: 33174120 DOI: 10.1007/s00261-020-02820-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 01/25/2023]
Abstract
Ovarian cancer remains one of the most lethal gynecological cancers in the world despite extensive progress in the areas of chemotherapy and surgery. Many studies have postulated that this is because of the profound heterogeneity that underpins response to therapy and prognosis. Standard imaging evaluation using CT or MRI does not take into account this tumoral heterogeneity especially in advanced stages with peritoneal carcinomatosis. As such, newly emergent fields in the assessment of tumor heterogeneity have been proposed using radiomics to evaluate the whole tumor burden heterogeneity as opposed to single biopsy sampling. This review provides an overview of radiomics, radiogenomics, and proteomics and examines the use of these newly emergent fields in assessing tumor heterogeneity and its implications in ovarian cancer.
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Affiliation(s)
- S Nougaret
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France. .,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France.
| | - Cathal McCague
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
| | - Hichem Tibermacine
- IRCM, Montpellier Cancer Research Institute, INSERM, U1194, University of Montpellier, 208 Ave des Apothicaires, 34295, Montpellier, France.,Department of Radiology, Montpellier Cancer institute, 208 Ave des Apothicaires, 34295, Montpellier, France
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Stefania Rizzo
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, 6900, Lugano, CH, Switzerland.,Facoltà di Scienze Biomediche, Università della Svizzera Italiana, Lugano, CH, Switzerland
| | - E Sala
- Department of Radiology, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ, UK
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29
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Abstract
Importance Several predictive models and scoring systems have been developed to differentiate between benign and malignant ovarian masses, in order to guide effective management. These models use combinations of patient characteristics, ultrasound markers, and biochemical markers. Objective The aim of this study was to describe, compare, and prioritize, according to their strengths and qualities, all the adnexal prediction models. Evidence Acquisition This was a state-of-the-art review, synthesizing the findings of the current published literature on the available prediction models of adnexal masses. Results The existing models include subjective assessment by expert sonographers, the International Ovarian Tumor Analysis models (logistic regression models 1 and 2, Simple Rules, 3-step strategy, and ADNEX [Assessment of Different NEoplasias in the adneXa] model), the Risk of Malignancy Index, the Risk of Malignancy Ovarian Algorithm, the Gynecologic Imaging Reporting and Data System, and the Ovarian-Adnexal Reporting and Data System. Overall, subjective assessment appears to be superior to all prediction models. However, the International Ovarian Tumor Analysis models are probably the best available methods for nonexpert examiners. The Ovarian-Adnexal Reporting and Data System is an international approach that incorporates both the common European and North American approaches, but still needs to be validated. Conclusions Many prediction models exist for the assessment of adnexal masses. The adoption of a particular model is based on local guidelines, as well as sonographer's experience. The safety of expectant management of adnexal masses with benign ultrasound morphology is still under investigation.
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30
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Guo W, Zou X, Xu H, Zhang T, Zhao Y, Gao L, Duan W, Ma X, Zhang L. The diagnostic performance of the Gynecologic Imaging Reporting and Data System (GI-RADS) in adnexal masses. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:398. [PMID: 33842619 PMCID: PMC8033324 DOI: 10.21037/atm-20-5170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Adnexal masses, mostly benign, are common in the female genital system. However, adnexal masses are the leading cause of death among women with gynecologic cancer. Ultrasound is a common imaging method for diagnosing adnexal masses. Gynecologic Imaging Reporting and Data System (GI-RADS) is a useful diagnostic tool based on objective ultrasound features to diagnose the malignancy of the female genital system. Therefore, we conducted a meta-analysis to evaluate the ability of GI-RADS to differentiate adnexal masses. Methods Published articles were searched in PubMed, Medline, and Embase from 1990 to February 2020. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio, and area under the curve (AUC) were estimated via the extracted data from the selected studies. Results Ten studies and 2,474 patients were included in this meta-analysis. The pooled sensitivity of selected studies was 0.95 [95% confidence intervals (CI): 0.94-0.97], and the pooled specificity was 0.86 (95% CI: 0.84-0.88). The pooled NLR and PLR were 0.06 (95% CI: 0.04-0.10), and 8.30 (95% CI: 4.93-13.97), respectively. Moreover, the pooled diagnostic odds ratio for GI-RADS was 174.59 (95% CI: 76.70-397.42), and the AUC was 0.9806. Conclusions This research indicates that GI-RADS might be a valuable tool to distinguish malignancies from adnexal masses.
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Affiliation(s)
- Wen Guo
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China.,West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiuhe Zou
- Department of Thyroid Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hanyue Xu
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China.,West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Zhang
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China.,West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yunuo Zhao
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China.,West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Lu Gao
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Wenyue Duan
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Cancer Center, Sichuan University, Chengdu, China
| | - Ling Zhang
- Department of Oncology, The General Hospital of Western Theater Command, Chengdu, China
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31
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Reinhold C, Rockall A, Sadowski EA, Siegelman ES, Maturen KE, Vargas HA, Forstner R, Glanc P, Andreotti RF, Thomassin-Naggara I. Ovarian-Adnexal Reporting Lexicon for MRI: A White Paper of the ACR Ovarian-Adnexal Reporting and Data Systems MRI Committee. J Am Coll Radiol 2021; 18:713-729. [PMID: 33484725 DOI: 10.1016/j.jacr.2020.12.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 01/27/2023]
Abstract
MRI is used in the evaluation of ovarian and adnexal lesions. MRI can further characterize lesions seen on ultrasound to help decrease the number of false-positive lesions and avoid unnecessary surgery in benign lesions. Currently, the reporting of ovarian and adnexal findings on MRI is inconsistent because of the lack of standardized descriptor terminology. The development of uniform reporting descriptors can lead to improved interpretation agreement and communication between radiologists and referring physicians. The Ovarian-Adnexal Reporting and Data Systems MRI Committee was formed under the direction of the ACR to create a standardized lexicon for adnexal lesions with the goal of improving the quality and consistency of imaging reports. This white paper describes the consensus process in the creation of a standardized lexicon for ovarian and adnexal lesions for MRI and the resultant lexicon.
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Affiliation(s)
- Caroline Reinhold
- Codirector, Augmented Intelligence & Precision Health Laboratory of the Research Institute of McGill University Health Center, McGill University, Montreal, Canada.
| | - Andrea Rockall
- Division of Surgery and Cancer, Imperial College London and Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth A Sadowski
- Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Evan S Siegelman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine E Maturen
- Departments of Radiology and Obstetrics and Gynecology, University of Michigan Hospitals, Ann Arbor, Michigan
| | | | - Rosemarie Forstner
- Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria
| | - Phyllis Glanc
- University of Toronto, Sunnybrook Health Science Center, Toronto, Ontario, Canada
| | - Rochelle F Andreotti
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isabelle Thomassin-Naggara
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Imagerie, Paris, France
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Diagnostic Efficiency of Gynecologic Imaging Reporting and Data System Combined With 3-dimensional Contrast-enhanced Ultrasound Scoring System in Evaluating Ovarian Tumor. Ultrasound Q 2020; 36:375-381. [DOI: 10.1097/ruq.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Abd elsalam SM, Hamed ST, Sayed MAE. Diagnostic performance of GI-RADS reporting system in evaluation of adnexal masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Transvaginal and pelvic ultrasound are considered the primary imaging modality in evaluating adnexal masses. Gynaecologic Imaging Reporting and Data System (GI-RADS) depends on different ultrasound patterns and criteria adopted by the International Ovarian Tumour Analysis (IOTA) group. The current study aimed to detect the diagnostic accuracy of the GI-RADS classification in evaluating adnexal masses. In this prospective cross-sectional study, a total of 112 adnexal masses belonging to 100 women, age ranged 12 to 66 years old, were included. The study population was recruited throughout the period between January and November 2017. Ultrasound examination was performed to all patients; different US and Doppler criteria were assessed.
Results
Out of the 112 lesions, 36 (32.1%) were GI-RADS 2, 32 (28.6%) GI-RADS 3, 13 (11.6%) GI-RADS 4, and 31 (27.7%) GI-RADS 5. The GI-RADS classification showed sensitivity 97%, specificity 84.8%, positive predictive value (PPV) 72.7%, negative predictive value (NPV) 98.5%, and accuracy 88.4%.
Conclusion
The GI-RADS reporting system carried a high sensitivity in identifying adnexal masses at high risk of malignancy. The increased number of benign lesions misclassified as GI-RADS 4 required additional markers to improve the specificity in GI-RADS classification.
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Basha MAA, Metwally MI, Gamil SA, Khater HM, Aly SA, El Sammak AA, Zaitoun MMA, Khattab EM, Azmy TM, Alayouty NA, Mohey N, Almassry HN, Yousef HY, Ibrahim SA, Mohamed EA, Mohamed AEM, Afifi AHM, Harb OA, Algazzar HY. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol 2020; 31:674-684. [PMID: 32809166 DOI: 10.1007/s00330-020-07143-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The American College of Radiology (ACR) recently published the ovarian-adnexal reporting and data system (O-RADS) to provide guidelines to physicians who interpret ultrasound (US) examinations of adnexal masses (AM). This study aimed to compare the O-RADS with two other well-established US classification systems for diagnosis of AM. METHODS This retrospective multicenter study between May 2016 and December 2019 assessed consecutive women with AM detected by the US. Five experienced consultant radiologists independently categorized each AM according to O-RADS, gynecologic imaging reporting and data system (GI-RADS), and international ovarian tumor analysis (IOTA) simple rules. Pathology and adequate follow-up were used as reference standards for calculating the validity of three US classification systems for diagnosis of AM. Kappa statistics were used to assess the inter-reviewer agreement (IRA). RESULTS A total of 609 women (mean age, 48 ± 13.7 years; range, 18-72 years) with 647 AM were included. Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA (p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (p > 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA (κ = 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA. CONCLUSIONS O-RADS compares favorably with GI-RADS and IOTA. O-RADS had higher sensitivity than GI-RADS and IOTA simple rules with relatively similar specificity and reliability. KEY POINTS • The malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. • The O-RADS had significantly higher sensitivity for malignancy than GI-RADS and IOTA (96.8% vs 92.7% and 92.1%; p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (92.8% vs 93.6% and 93.2%, respectively; p > 0.05). • The O-RADS, GI-RADS, and IOTA showed similar overall inter-reviewer agreement (IRA) (κ = 0.77, 0.69, and 0.63, respectively), with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.
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Affiliation(s)
| | | | - Shrif A Gamil
- Department of Radio-diagnosis, Al-Ahrar Teaching Hospital, Zagazig, Egypt
| | - Hamada M Khater
- Department of Radio-diagnosis, Benha University, Benha, Egypt
| | | | | | | | - Enass M Khattab
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | - Taghreed M Azmy
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | | | - Nesreen Mohey
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | | | - Hala Y Yousef
- Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | - Ekramy A Mohamed
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | | | | | - Ola A Harb
- Department of Pathology, Zagazig University, Zagazig, Egypt
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Khalaf LMR, Desoky HHM, Seifeldein GS, El-Sharkawy M, Sayed MM, Ahmed S, Rezk K, Hussien MT. The diagnostic efficacy of Gynecology Imaging Reporting and Data System (GI-RADS): single-center prospective cross-sectional study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0071-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To assess the validity and accuracy of GI-RADS classification in the prediction of malignancy and in triaging the management protocol in ovarian lesions.
Results
One hundred fifty-six ovarian lesions were detected in the examined 116 women. The prevalence of malignant tumors was 44%. Overall GI-RADS classification rates were as follows: 41 cases (26.3%) were classified as GI-RADS 1, 26 cases (16 .7%) as GI-RADS 2, 34 cases (21.8%) as GI-RADS 3, 14 cases (8.9%) as GI-RADS 4, and 41 cases (26.3%) as GI-RADS 5. No follow-up was done in GI-RADS 1 patients. A final diagnosis of all GI-RADS 2 ovarian masses such as functional cyst (n = 10), hemorrhagic cysts (n = 8), corpus luteal cysts (n = 6), and some GI-RADS 3 as simple cysts (n = 10) was made by spontaneous resolution of these masses at follow-up after 6 weeks. Fifteen cases of GI-RADS 3 as mature teratoma, serous and mucinous cystadenoma, endometrioma, and ovarian torsion and all GI-RADS 4 and 5 underwent laparoscopic or surgical removal of the ovarian mass with histopathological examination. The diagnostic performance of the GI-RADS in predicting the risk of malignancy in ovarian masses was as follows: 98.11% sensitivity, 95.15% specificity, 91.2% positive predictive value (PPV), 99.2% negative predictive value (NPV), and 20.2 positive likelihood ratio, and the overall accuracy was 96.2% (area under receiver operating curve (AUC) = 0.96, P < 0.001).
Conclusion
GI-RADS classification performs well as a reporting system of the ovarian masses with high diagnostic performance in the prediction of malignancy, and it seems to be a helpful tool in triaging management in patients with ovarian masses.
Trial registration
The trial was registered in the US National Library of Medicine, under clinical trial number NCT03175991. Also, the ethical committee approval number of the Faculty of Medicine, Assiut University, was 17100016 on February 28, 2017.
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Abstract
Ovarian lesions are common and require a consistent approach to diagnosis and management for best patient outcomes. In the past 20 years, there has been an evolution in the approach to abnormal ovarian lesions, with increasing emphasis on reducing surgery for benign disease, standardizing terminology, assessing risk of malignancy through use of evidence-based scoring systems, and triaging suspicious abnormalities to dedicated oncology centers. This article provides an evidence-based review of how these changes in diagnosis and management of ultrasound-detected abnormal ovarian lesions have occurred. Current recommended practices are summarized. The current literature on transvaginal screening for ovarian cancer also is reviewed and summarized.
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Wang X, Yang S, Lv G, Liao J, Wu S, Zhang W. Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses. ACTA ACUST UNITED AC 2019; 65:959-964. [PMID: 31389505 DOI: 10.1590/1806-9282.65.7.959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.
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Affiliation(s)
- Xiali Wang
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Guorong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Jianmei Liao
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shufen Wu
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Weina Zhang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
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Behnamfar F, Adibi A, Khadra H, Moradi M. Diagnostic accuracy of gynecology imaging reporting and data system in evaluation of adnexal lesions. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:57. [PMID: 31523243 PMCID: PMC6669995 DOI: 10.4103/jrms.jrms_608_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/03/2019] [Accepted: 01/16/2019] [Indexed: 11/24/2022]
Abstract
Background: Considering the increasing incidence rate of ovarian cancer in worldwide and the utility of Gynecologic Imaging Reporting and Data System (GI-RADS) in diagnosing malignant adnexal lesions such as ovarian cancer, we aimed to evaluate the diagnostic performance of this reporting system in differentiating between malignant and benign adnexal lesions. Materials and Methods: In this cross-sectional study, women with suspected adnexal lesions were enrolled. For differentiating of malignant adnexal lesions, Grade II and III of GI-RADS system were classified as low risk for malignancy and Grades IV and V as high risk. Results of histopathologic diagnosis were compared with the results of the mentioned GI-RADS system classification, and the diagnosed accuracy of the system was determined. Patients who did not have histopathologic diagnosis were followed up. Results: In this study, 197 women with suspected adnexal lesions were evaluated. Frequency of GI-RADS II, III, IV, and V were 34.5% (69 cases), 38.0% (76 cases), 19.5% (39 cases), and 6.5% (13 cases), respectively. According to the low- and high-risk classification of GI-RADS, 72.5% were classified as GI-RADS II and III and 26% as GI-RADS IV and V, respectively. Definitive histopathologic diagnosis was reported for 158 cases. Histopathologic evaluation indicated that 12 (7.6%) of the masses were malignant and 146 (92.6%) were benign. Comparing with the histopathologic diagnosis, the GI-RADS system sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (LR), and negative LR were 91.6%, 80.82%, 28.2%, 99.1%, 4.77, and 0.10, respectively. The accuracy of the scoring system was 81.64%. Conclusion: Our findings indicated that using GI-RADS, we could quantify the risk of malignancy by such a structured as well as simple reporting system so that the system could be useful for clinicians for performing an appropriate clinical management.
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Affiliation(s)
- Fariba Behnamfar
- Department of Obstetrics and Gynecology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atoosa Adibi
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hiba Khadra
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Moradi
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Marko J, Marko KI, Pachigolla SL, Crothers BA, Mattu R, Wolfman DJ. Mucinous Neoplasms of the Ovary: Radiologic-Pathologic Correlation. Radiographics 2019; 39:982-997. [PMID: 31283462 PMCID: PMC6677283 DOI: 10.1148/rg.2019180221] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/03/2019] [Accepted: 03/15/2019] [Indexed: 12/31/2022]
Abstract
Mucinous neoplasms of the ovary account for 10%-15% of ovarian neoplasms. They may be benign, borderline, or malignant. The large majority are benign or borderline, accounting for 80% and 16%-17%, respectively. Mucinous neoplasms of the ovary most commonly affect women in their 20s to 40s. The clinical manifestation is nonspecific, but most mucinous ovarian neoplasms manifest as large unilateral pelvic masses. At gross pathologic analysis, mucinous ovarian neoplasms appear as large multiloculated cystic masses. The contents of the cyst loculi vary on the basis of differences in internal mucin content. At histologic analysis, mucinous ovarian neoplasms are composed of multiple cysts lined by mucinous epithelium, often resembling gastrointestinal-type epithelium. Imaging evaluation most commonly includes US and/or MRI. The imaging findings parallel the gross pathologic features and include a large, unilateral, multiloculated cystic mass. The cyst loculi vary in echogenicity, attenuation, and signal intensity depending on the mucin content. Mucinous neoplasms of the ovary are staged surgically using the FIGO (International Federation of Gynecology and Obstetrics) staging system. Primary treatment is surgical, with adjuvant chemotherapy considered in the uncommon case of mucinous carcinoma with extraovarian disease. Since most mucinous ovarian neoplasms are benign or borderline, the overall prognosis is excellent.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Kathryn I. Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Suvidya L. Pachigolla
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Barbara A. Crothers
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Rubina Mattu
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
| | - Darcy J. Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (J.M.); Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC (K.I.M.); University of Illinois College of Medicine, Peoria, Ill (S.L.P.); Department of Pathology, the Joint Pathology Center, Washington, DC (B.A.C., R.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Department of Radiology, Johns Hopkins Hospital and Health System, Washington, DC (D.J.W.)
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Abstract
Ovarian cancer is the seventh most common cancer affecting women. Despite advances in cancer control and healthcare in general, mortality from ovarian cancer remains unacceptably high due to diagnosis at an advanced stage of the disease. The 5-year survival rate is 47.4% because a majority of ovarian cancers are diagnosed when advanced. Only 14.9% of ovarian cancers are diagnosed when localized where the survival rate is 92.3%. Mortality rate reduction by screening has not been proven in women at an average risk for ovarian cancer. Ultrasound remains the primary modality for assessment of ovarian tumors. The need for standardizing terminology is critical for optimal assessment of the risk of malignancy in an ovarian tumor. The international ovarian tumor analysis group and more recently the American College of Radiology Ovarian - Adnexal Reporting and Data System Committee have published standardized lexicon for ovarian lesions and encourage ultrasound imagers to adopt this standardized terminology. The aim is to apply the lexicon for risk stratification to allow for consistent follow-up and management. Various methodologies have been tested for characterization of adnexal tumors and to assess risk of malignancy preoperatively. Risk assessment models have been studied against the gold standard of a pattern recognition approach and subjective assessment by an experienced imager. The morphologic patterns of ovarian tumors are detailed and features that are more discriminatory than others in suggesting an ovarian malignancy are described. The imaging pathologic correlation for different tumor types is presented. A brief summary of the ovarian cancer pathologic types and staging of cancer is presented. Finally, the current role of transvaginal sonography as a screening modality for ovarian cancer is discussed. Recently published data show encouraging results, that a multimodal approach of screening for ovarian cancer using transvaginal sonography in women with an elevated CA-125 may prove beneficial and cost effective.
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Affiliation(s)
- Mahesh Shetty
- Department of Radiology, Baylor College of Medicine, Houston, TX.
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41
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Basha MAA, Refaat R, Ibrahim SA, Madkour NM, Awad AM, Mohamed EM, El Sammak AA, Zaitoun MMA, Dawoud HA, Khamis MEM, Mohamed HAE, El-Maghraby AM, Abdalla AAEHM, Assy MM, Nada MG, Obaya AA, Abdelbary EH. Gynecology Imaging Reporting and Data System (GI-RADS): diagnostic performance and inter-reviewer agreement. Eur Radiol 2019; 29:5981-5990. [PMID: 30993433 DOI: 10.1007/s00330-019-06181-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/12/2019] [Accepted: 03/19/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate diagnostic performance and inter-reviewer agreement (IRA) of the Gynecologic Imaging Reporting and Data System (GI-RADS) for diagnosis of adnexal masses (AMs) by pelvic ultrasound (US). PATIENTS AND METHODS A prospective multicenter study included 308 women (mean age, 41 ± 12.5 years; range, 15-73 years) with 325 AMs detected by US. All US examinations were analyzed, and AMs were categorized into five categories according to the GI-RADS classification. We used histopathology and US follow-up as the reference standards for calculating diagnostic performance of GI-RADS for detecting malignant AMs. The Fleiss kappa (κ) tests were applied to evaluate the IRA of GI-RADS scoring results for predicting malignant AMs. RESULTS A total of 325 AMs were evaluated: 127 (39.1%) were malignant and 198 (60.9%) were benign. Of 95 AMs categorized as GI-RADS 2 (GR2), none was malignant; of 94 AMs categorized as GR3, three were malignant; of 13 AMs categorized as GR4, six were malignant; and of 123 AMs categorized as GR5, 118 were malignant. On a lesion-based analysis, the GI-RADS had a sensitivity, a specificity, and an accuracy of 92.9%, 97.5%, and 95.7%, respectively, when regarding only those AMs classified as GR5 for predicting malignancy. Considering combined GR4 and GR5 as a predictor for malignancy, the sensitivity, specificity, and accuracy of GI-RADS were 97.6%, 93.9%, and 95.4%, respectively. The IRA of the GI-RADS category was very good (κ = 0.896). The best cutoff value for predicting malignant AMs was >GR3. CONCLUSIONS The GI-RADS is very valuable for improving US structural reports. KEY POINTS • There is still a lack of a standard in the assessment of AMs. • GI-RADS is very valuable for improving US structural reports of AMs. • GI-RADS criteria are easy and work at least as well as IOTA.
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Affiliation(s)
| | - Rania Refaat
- Department of Radiodiagnosis, Ain Shams University, Cairo, Egypt
| | - Safaa A Ibrahim
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | - Nadia M Madkour
- Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt
| | - Awad Mahmoud Awad
- Department of Obstetrics & Gynecology, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Hitham A Dawoud
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Mai E M Khamis
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | - Heba A E Mohamed
- Department of Radiodiagnosis, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Ahmed Ali Obaya
- Department of Clinical Oncology, Zagazig University, Zagazig, Egypt
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Zheng H, Tie Y, Wang X, Yang Y, Wei X, Zhao X. Assessment of the diagnostic value of using serum CA125 and GI-RADS system in the evaluation of adnexal masses. Medicine (Baltimore) 2019; 98:e14577. [PMID: 30762809 PMCID: PMC6408110 DOI: 10.1097/md.0000000000014577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cancer antigen 125 (CA125) is a valuable tumor marker for ovarian cancer. Gynecology Imaging Reporting and Data System (GI-RADS) is proved to be effective at identifying the adnexal masses. We investigated whether the combination of these two methods can improve the diagnostic accuracy of ovarian cancer.We retrospectively analyzed preoperative data of 325 patients diagnosed with suspected adnexal mass, 196 patients with benign ovarian masses and 129 with malignant ovarian cancer (stage I: 34, II: 16, III: 61, IV: 18). CA125 was analyzed using the ARCHITECT system, GI-RADS was evaluated according to the International Ovarian Tumor Analysis consensus nomenclature and definitions. Sensitivities and specificities were also calculated for GI-RADS, CA125 and the combinations.The sensitivity, specificity and accuracy of CA125, GI-RADS were 75.97%, 79.59%, 78.15%, and 90.70%, 90.82%,90.77%, the combination data were 94.79%, 96.00%,95.53%. The AUC of combined diagnostic methods was the largest and significantly better compared with each method alone, P < .001). For stage I-II malignancy, GI-RADS as a single method was superior to CA125.Combined use of serum CA 125 and GI-RADS system improved the identification of adnexal masses at high risk of malignancy and could be used for clinical decision-making.
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Affiliation(s)
- Heng Zheng
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu
| | - Yan Tie
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xi Wang
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu
| | - Yang Yang
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu
| | - Xiawei Wei
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu
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Migda M, Bartosz M, Migda MS, Kierszk M, Katarzyna G, Maleńczyk M. Diagnostic value of the gynecology imaging reporting and data system (GI-RADS) with the ovarian malignancy marker CA-125 in preoperative adnexal tumor assessment. J Ovarian Res 2018; 11:92. [PMID: 30390688 PMCID: PMC6215357 DOI: 10.1186/s13048-018-0465-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/24/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives The purpose of this study is to assess the preoperative evaluation of an adnexal mass using the GI-RADS classification and to verify whether CA-125 measurement can offer any additional benefits to the GI-RADS-based prediction of ovarian tumor malignancy. Material and methods In this study, we assessed a total of 215 women with an adnexal tumor using the GI-RADS classification combined with CA-125 measurement. All adnexal masses underwent histological verification. Results Of a total of 215 lesions, we classified 2 lesions as GI-RADS 2 (0.9%), 118 lesions as GI-RADS 3 (54.9%), 86 lesions as GI-RADS 4 (40.0%) and 9 lesions as GI-RADS 5 (4.2%). For GI-RADS 4–5 lesions, the sensitivity, specificity, PPV, NPV, ACC and OR were as follows: 94.3, 72.2, 52.6, 97.5, 77.7%, and 43.3 (CI 12.0–146), respectively. The corresponding parameters resulting from combining the GI-RADS classification with the CA-125 marker were as follows: 66.0, 93.8, 77.8, 89.4, 87.0%, and 29.6 (CI 12.6–69.6), respectively, with p < 0.001. For Ca-125 > 30 IU/mL alone, the results were as follows: 70.0, 80.3, 53.8, 89.1, 77.7%, and 9.5 (4.6–19.6), respectively, with p < 0.0001. Additionally, 47.8% of the patients had no symptoms, 36.5% had back pain, 5.2% had an increased abdominal size, 4.3% had menstrual irregularities and 2.6% had constipation. There were 152 benign and 18 malignant cases in the low risk group (GIRADS 1–3 and GIRADS 4 + CA-125 < 30 IU/mL) and 10 benign and 35 malignant tumors in the high-risk group (GIRADS 4 + CA125 > 30 IU/mL and GIRADS 5). Conclusions GI-RADS classification had good performance in discriminating ovarian tumors. The additional measurement of CA-125 improves the system specificity, PPV and ACC for preoperative adnexal tumor assessment.
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Affiliation(s)
- Michal Migda
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, sw. Jozefa 53/59, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland. .,Civis Vita Medical Center, Torun, Poland.
| | - Migda Bartosz
- Department of Diagnostic Imaging, Second Faculty of Medicine with the English Division and the Physiotherapy Division, Medical University of Warsaw, Warsaw, Poland
| | | | - Marcin Kierszk
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, sw. Jozefa 53/59, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland
| | - Gieryn Katarzyna
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, sw. Jozefa 53/59, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland
| | - Marek Maleńczyk
- Clinical Unit of Obstetrics, Women's Disease and Gynecological Oncology, sw. Jozefa 53/59, United District Hospital, Collegium Medicum University of Nicolaus Copernicus in Toruń, Torun, Poland
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Andreotti RF, Timmerman D, Benacerraf BR, Bennett GL, Bourne T, Brown DL, Coleman BG, Frates MC, Froyman W, Goldstein SR, Hamper UM, Horrow MM, Hernanz-Schulman M, Reinhold C, Strachowski LM, Glanc P. Ovarian-Adnexal Reporting Lexicon for Ultrasound: A White Paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol 2018; 15:1415-1429. [DOI: 10.1016/j.jacr.2018.07.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 12/12/2022]
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45
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Hidalgo Mora J, Rams Llop N, Ros Bernal F, Alcázar Zambrano J. Sistemas de clasificación y predicción de riesgo de malignidad de las lesiones anexiales. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Zhang T, Li F, Liu J, Zhang S. Diagnostic performance of the Gynecology Imaging Reporting and Data System for malignant adnexal masses. Int J Gynaecol Obstet 2017; 137:325-331. [PMID: 28295272 DOI: 10.1002/ijgo.12153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/11/2017] [Accepted: 03/09/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the Gynecology Imaging Reporting and Data System (GI-RADS) for diagnosis of malignant adnexal masses in a Chinese population. METHODS A retrospective study was conducted of patients who underwent evaluation of suspected adnexal masses at a hospital in Tianjin, China, between January 1, 2015, and January 31, 2016. Ultrasonographic diagnosis was based on the GI-RADS classification-a standardized summary of imaging data that estimates the risk of malignancy-and compared with the final pathological diagnosis. RESULTS Among 242 patients, thick wall, solid papillary projection, solid area, central blood flow, ascites, and GI-RADS classification were associated with malignancy (P<0.05 for all variables). The 263 masses evaluated were classified as GI-RADS 2 (functional cyst; n=65), GI-RADS 3 (benign neoplasm; n=68), GI-RADS 4 (one or two morphological findings suggestive of malignancy; n=101), and GI-RADS 5 (≥3 morphological findings suggestive of malignancy; n=28). Four malignant cases with false-negative findings were misclassified as GI-RADS 3, whereas 24 benign cases with false-positive findings were misclassified as GI-RADS 4. The sensitivity, specificity, false-positive rate, false-negative rate, accuracy, and Youden index of the GI-RADS classification were 96.4%, 84.3%, 18.5%, 3.0%, 89.3%, and 80.7%, respectively. CONCLUSION The GI-RADS classification performed well in the diagnosis of malignant adnexal masses.
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Affiliation(s)
- Tan Zhang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Fangxuan Li
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Juntian Liu
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Sheng Zhang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy: A Pilot Study. AJR Am J Roentgenol 2016; 206:1286-91. [DOI: 10.2214/ajr.15.15381] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Dias DS, Bueloni-Dias FN, Delmanto A, Tonon ÂFS, Tayfour NM, Traiman P, Dias R. Clinical management of incidental findings on pelvic adnexal masses. Rev Assoc Med Bras (1992) 2016; 61:469-73. [PMID: 26603011 DOI: 10.1590/1806-9282.61.05.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 11/21/2022] Open
Abstract
Due to widespread use of pelvic and transvaginal ultrasound in routine gynecological evaluation, the incidental finding of adnexal masses has led to discussions about management in asymptomatic patients regarding the risk of ovarian cancer. Transvaginal ultrasonography remains the modality of choice in the evaluation of suspicious characteristics. The combined analysis of ultrasound morphological parameters with Doppler study, serum carcinoma antigen 125 and investigation of a symptom index may improve diagnosis. Surgical approach should be considered whenever there are suspicious images, rapid growth of cysts, changes in the appearance compared to the initial evaluation or when the patient has symptoms. Future studies on genetic and molecular mechanisms may help explain the pathophysiology of ovarian cancer, improving early diagnosis and treatment.
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Affiliation(s)
- Daniel Spadoto Dias
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Flávia Neves Bueloni-Dias
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Armando Delmanto
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Ângela Favorito Santarém Tonon
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Najla Mohamad Tayfour
- Gynecology Service, Division of Pelvic Oncogynecology, Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | - Paulo Traiman
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Rogério Dias
- Department of Gynecology and Obstetrics, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, Wynants L, Van Holsbeke C, Epstein E, Franchi D, Kaijser J, Czekierdowski A, Guerriero S, Fruscio R, Leone FPG, Rossi A, Landolfo C, Vergote I, Bourne T, Valentin L. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol 2016; 214:424-437. [PMID: 26800772 DOI: 10.1016/j.ajog.2016.01.007] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Accurate methods to preoperatively characterize adnexal tumors are pivotal for optimal patient management. A recent metaanalysis concluded that the International Ovarian Tumor Analysis algorithms such as the Simple Rules are the best approaches to preoperatively classify adnexal masses as benign or malignant. OBJECTIVE We sought to develop and validate a model to predict the risk of malignancy in adnexal masses using the ultrasound features in the Simple Rules. STUDY DESIGN This was an international cross-sectional cohort study involving 22 oncology centers, referral centers for ultrasonography, and general hospitals. We included consecutive patients with an adnexal tumor who underwent a standardized transvaginal ultrasound examination and were selected for surgery. Data on 5020 patients were recorded in 3 phases from 2002 through 2012. The 5 Simple Rules features indicative of a benign tumor (B-features) and the 5 features indicative of malignancy (M-features) are based on the presence of ascites, tumor morphology, and degree of vascularity at ultrasonography. Gold standard was the histopathologic diagnosis of the adnexal mass (pathologist blinded to ultrasound findings). Logistic regression analysis was used to estimate the risk of malignancy based on the 10 ultrasound features and type of center. The diagnostic performance was evaluated by area under the receiver operating characteristic curve, sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), negative predictive value (NPV), and calibration curves. RESULTS Data on 4848 patients were analyzed. The malignancy rate was 43% (1402/3263) in oncology centers and 17% (263/1585) in other centers. The area under the receiver operating characteristic curve on validation data was very similar in oncology centers (0.917; 95% confidence interval, 0.901-0.931) and other centers (0.916; 95% confidence interval, 0.873-0.945). Risk estimates showed good calibration. In all, 23% of patients in the validation data set had a very low estimated risk (<1%) and 48% had a high estimated risk (≥30%). For the 1% risk cutoff, sensitivity was 99.7%, specificity 33.7%, LR+ 1.5, LR- 0.010, PPV 44.8%, and NPV 98.9%. For the 30% risk cutoff, sensitivity was 89.0%, specificity 84.7%, LR+ 5.8, LR- 0.13, PPV 75.4%, and NPV 93.9%. CONCLUSION Quantification of the risk of malignancy based on the Simple Rules has good diagnostic performance both in oncology centers and other centers. A simple classification based on these risk estimates may form the basis of a clinical management system. Patients with a high risk may benefit from surgery by a gynecological oncologist, while patients with a lower risk may be managed locally.
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Affiliation(s)
- Dirk Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Antonia Testa
- Department of Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Daniela Fischerova
- Gynecological Oncology Center, Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic
| | - Wouter Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Laure Wynants
- Department of Electrical Engineering-ESAT, Stadius Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; iMinds Medical IT Department, KU Leuven, Leuven, Belgium
| | - Caroline Van Holsbeke
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Elisabeth Epstein
- Departments of Obstetrics and Gynecology at Karolinska University Hospital, Stockholm, Sweden
| | - Dorella Franchi
- Preventive Gynecology Unit, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - Jeroen Kaijser
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Gynecology and Obstetrics, Ikazia Hospital, Rotterdam, The Netherlands
| | - Artur Czekierdowski
- First Department of Gynecological Oncology and Gynecology, Medical University of Lublin, Lublin, Poland
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Francesco P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, University of Milan, Milan, Italy
| | - Alberto Rossi
- Department of Obstetrics and Gynecology, University of Udine, Udine, Italy
| | - Chiara Landolfo
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Ignace Vergote
- Department of Oncology, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Queen Charlotte's and Chelsea Hospital, Imperial College, London, United Kingdom
| | - Lil Valentin
- Skåne University Hospital Malmö, Lund University, Malmö, Sweden
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Pilot study of ultrasound parotid imaging reporting and data system (PIRADS): Inter-observer agreement. Eur J Radiol 2015; 84:2533-8. [DOI: 10.1016/j.ejrad.2015.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 08/10/2015] [Accepted: 09/02/2015] [Indexed: 11/20/2022]
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