1
|
Cabrera S, Gómez-Hidalgo NR, García-Pineda V, Bebia V, Fernández-González S, Alonso P, Rodríguez-Gómez T, Fusté P, Gracia-Segovia M, Lorenzo C, Chacon E, Roldan Rivas F, Arencibia O, Martí Edo M, Fidalgo S, Sanchis J, Padilla-Iserte P, Pantoja-Garrido M, Martínez S, Peiró R, Escayola C, Oliver-Pérez MR, Aghababyan C, Tauste C, Morales S, Torrent A, Utrilla-Layna J, Fargas F, Calvo A, Aller de Pace L, Gil-Moreno A. ASO Visual Abstract: Accuracy and Survival Outcomes After National Implementation of Sentinel Lymph Node Biopsy in Early-Stage Endometrial Cancer. Ann Surg Oncol 2023; 30:7669-7670. [PMID: 37599299 DOI: 10.1245/s10434-023-14167-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Affiliation(s)
- Silvia Cabrera
- Gynecologic Oncology Unit, Gynecology Department, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Natalia R Gómez-Hidalgo
- Gynecologic Oncology Unit, Gynecology Department, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Vicente Bebia
- Gynecologic Oncology Unit, Gynecology Department, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Paula Alonso
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Tomás Rodríguez-Gómez
- Department of Obstetrics and Gynecology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Pere Fusté
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Fernando Roldan Rivas
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Hospital Universitario Gran Canarias Dr. Negrín, Las Palmas, Spain
| | - Marina Martí Edo
- Department of Obstetrics and Gynecology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Soledad Fidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Sanchis
- Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | | | - Manuel Pantoja-Garrido
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Sergio Martínez
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ricard Peiró
- Department of Obstetrics and Gynecology, Hospital General de Catalunya, Barcelona, Spain
| | - Cecilia Escayola
- Department of Obstetrics and Gynecology, El Pilar Quiron, Barcelona, Spain
| | - M Reyes Oliver-Pérez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), Complutense University of Madrid, Madrid, Spain
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Carmen Tauste
- Department of Obstetrics and Gynecology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sara Morales
- Department of Obstetrics and Gynecology, Hospital Infanta Leonor, Madrid, Spain
| | - Anna Torrent
- Department of Obstetrics and Gynecology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jesus Utrilla-Layna
- Department of Obstetrics and Gynecology, Fundación Jimenez Diaz, Madrid, Spain
| | - Francesc Fargas
- Department of Obstetrics and Gynecology, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Ana Calvo
- Department of Obstetrics and Gynecology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Laura Aller de Pace
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Gynecology Department, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
2
|
Cabrera S, Gómez-Hidalgo NR, García-Pineda V, Bebia V, Fernández-González S, Alonso P, Rodríguez-Gómez T, Fusté P, Gracia-Segovia M, Lorenzo C, Chacon E, Roldan Rivas F, Arencibia O, Martí Edo M, Fidalgo S, Sanchis J, Padilla-Iserte P, Pantoja-Garrido M, Martínez S, Peiró R, Escayola C, Oliver-Pérez MR, Aghababyan C, Tauste C, Morales S, Torrent A, Utrilla-Layna J, Fargas F, Calvo A, Aller de Pace L, Gil-Moreno A. Accuracy and Survival Outcomes after National Implementation of Sentinel Lymph Node Biopsy in Early Stage Endometrial Cancer. Ann Surg Oncol 2023; 30:7653-7662. [PMID: 37633852 PMCID: PMC10562309 DOI: 10.1245/s10434-023-14065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy has recently been accepted to evaluate nodal status in endometrial cancer at early stage, which is key to tailoring adjuvant treatments. Our aim was to evaluate the national implementation of SLN biopsy in terms of accuracy to detect nodal disease in a clinical setting and oncologic outcomes according to the volume of nodal disease. PATIENTS AND METHODS A total of 29 Spanish centers participated in this retrospective, multicenter registry including patients with endometrial adenocarcinoma at preoperative early stage who had undergone SLN biopsy between 2015 and 2021. Each center collected data regarding demographic, clinical, histologic, therapeutic, and survival characteristics. RESULTS A total of 892 patients were enrolled. After the surgery, 12.9% were suprastaged to FIGO 2009 stages III-IV and 108 patients (12.1%) had nodal involvement: 54.6% macrometastasis, 22.2% micrometastases, and 23.1% isolated tumor cells (ITC). Sensitivity of SLN biopsy was 93.7% and false negative rate was 6.2%. After a median follow up of 1.81 years, overall surivial and disease-free survival were significantly lower in patients who had macrometastases when compared with patients with negative nodes, micrometastases or ITC. CONCLUSIONS In our nationwide cohort we obtained high sensitivity of SLN biopsy to detect nodal disease. The oncologic outcomes of patients with negative nodes and low-volume disease were similar after tailoring adjuvant treatments. In total, 22% of patients with macrometastasis and 50% of patients with micrometastasis were at low risk of nodal metastasis according to their preoperative risk factors, revealing the importance of SLN biopsy in the surgical management of patients with early stage EC.
Collapse
Affiliation(s)
- Silvia Cabrera
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Natalia R Gómez-Hidalgo
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Vicente Bebia
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Paula Alonso
- Department of Obstetrics and Gynecology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Tomás Rodríguez-Gómez
- Department of Obstetrics and Gynecology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Pere Fusté
- Gynecologic Oncology Unit, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Cristina Lorenzo
- Department of Obstetrics and Gynecology, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | - Enrique Chacon
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Fernando Roldan Rivas
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain
| | - Octavio Arencibia
- Department of Obstetrics and Gynecology, Hospital Universitario Gran Canarias Dr. Negrín, Las Palmas, Spain
| | - Marina Martí Edo
- Department of Obstetrics and Gynecology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Soledad Fidalgo
- Department of Obstetrics and Gynecology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Sanchis
- Gynecologic Oncology Unit, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Pablo Padilla-Iserte
- Gynecologic Oncology Unit, Hospital Politécnico Universitario La Fe, Valencia, Spain
| | - Manuel Pantoja-Garrido
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sergio Martínez
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ricard Peiró
- Department of Obstetrics and Gynecology, Hospital General de Catalunya, Barcelona, Spain
| | - Cecilia Escayola
- Department of Obstetrics and Gynecology, El Pilar Quiron, Barcelona, Spain
| | - M Reyes Oliver-Pérez
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, 12 de Octubre Research Institute (i+12), Complutense University of Madrid, Madrid, Spain
| | - Cristina Aghababyan
- Department of Obstetrics and Gynecology, Hospital General Universitario de Valencia, Valencia, Spain
| | - Carmen Tauste
- Department of Obstetrics and Gynecology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Sara Morales
- Department of Obstetrics and Gynecology, Hospital Infanta Leonor, Madrid, Spain
| | - Anna Torrent
- Department of Obstetrics and Gynecology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jesus Utrilla-Layna
- Department of Obstetrics and Gynecology, Fundación Jimenez Diaz, Madrid, Spain
| | - Francesc Fargas
- Department of Obstetrics and Gynecology, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | - Ana Calvo
- Department of Obstetrics and Gynecology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Laura Aller de Pace
- Department of Obstetrics and Gynecology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Antonio Gil-Moreno
- Gynecologic Oncology Unit, Hospital Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
3
|
Alcázar JL, Pineda L, Caparrós M, Utrilla-Layna J, Juez L, Mínguez JA, Jurado M. Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma. Ultrasound Obstet Gynecol 2016; 47:374-379. [PMID: 26033568 DOI: 10.1002/uog.14912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/23/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases among women with well-differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium. METHODS This was a single-center prospective observational cohort study comprising a consecutive series of women with a preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound examination by a single examiner. According to the examiner's subjective impression, patients were considered high risk if myometrial infiltration was ≥ 50% and/or involvement of the cervix and/or adnexa was suspected. FIGO surgical staging was performed in all cases. According to definitive histological data regarding myometrial infiltration, cervical involvement and adnexal involvement, women were classified as low risk (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high risk (myometrial infiltration ≥ 50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios, with 95% CIs, of transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated. Agreement between risk determined by transvaginal/transrectal ultrasound and postoperative definitive histology was calculated. RESULTS Of 209 eligible women, 169 were included in the study. Mean (± SD) age of the study cohort was 60.7 ± 10.3 years, with a range of 32-91 years. Sensitivity, specificity, LR+ and LR- of transvaginal/transrectal ultrasound identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI, 63.7-88.0%), 89.1% (95% CI, 81.7-93.8%), 7.14 (95% CI, 4.19-12.18) and 0.25 (95% CI, 0.15-0.42), respectively. CONCLUSIONS Preoperative transvaginal/transrectal ultrasound may play a significant role in identifying high-risk cases among those with G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy, and could be a useful test in this clinical setting. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Pineda
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Caparrós
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - L Juez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| |
Collapse
|
4
|
Alcázar JL, Orozco R, Martinez-Astorquiza Corral T, Juez L, Utrilla-Layna J, Mínguez JA, Jurado M. Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 46:405-413. [PMID: 26011665 DOI: 10.1002/uog.14905] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods. METHODS An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative assessment of myometrial infiltration by subjective evaluation and/or objective measurements. Objective measurements included, specifically, the approaches of Gordon (ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson (endometrial tumor thickness/anteroposterior uterine diameter ratio), in women with endometrial cancer, using the surgical pathological data as a reference standard. Study quality was assessed using the QUADAS-2 tool. RESULTS Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 82% (95% CI, 76-87%), 81% (95% CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I(2) range, 60.6-95.0). The main limitation was that very few studies compared different approaches in the same set of patients. CONCLUSION Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.
Collapse
Affiliation(s)
- J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - R Orozco
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - L Juez
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - J A Mínguez
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
| |
Collapse
|
5
|
Affiliation(s)
- Jesus Utrilla-Layna
- Department of Gynecological Oncology, Clinica Universitaria de Navarra School of Medicine, Pamplona, Spain
| | - Ignacio Zapardiel
- Department of Gynecological Oncology, La Paz University Hospital, Madrid, Spain.
| |
Collapse
|
6
|
Utrilla-Layna J, Alcázar JL, Aubá M, Laparte C, Olartecoechea B, Errasti T, Juez L, Mínguez JÁ, Guerriero S, Jurado M. Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses. Ultrasound Obstet Gynecol 2015; 45:613-617. [PMID: 25270368 DOI: 10.1002/uog.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/12/2014] [Accepted: 09/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the contribution of three-dimensional (3D) power Doppler angiography (3D-PDA) to the differential diagnosis of adnexal masses. METHODS This was a prospective study in women diagnosed with a persistent adnexal mass and subsequently scheduled for surgery in a tertiary university hospital. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol, with transabdominal ultrasound being performed in some cases. First, morphological evaluation of the mass was performed using gray-scale 'pattern recognition' (first step). Lesions diagnosed as having a benign pattern were considered as being at low risk of malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as being at high risk of malignancy. In both cases no further test was performed and a decision regarding clinical management, either for follow-up or surgery, was taken. Tumors with solid components but without signs of ascites or carcinomatosis were considered as being at intermediate risk of malignancy. These lesions were assessed by two-dimensional (2D) PDA to evaluate tumor vascularity (color score) (second step). Solid tumors with a color score of 1 or 2 were considered as benign and no further test was performed, while tumors with a color score of 2, 3 or 4 within solid components or a color score of 3 or 4 in the case of a solid tumor were considered as malignant. The latter group underwent 3D-PDA assessment (third step). Vascularization index (VI) was calculated in a 1-mL sphere of the most vascularized area of the tumor. When a VI ≥ 24.015% was found, the tumor was considered as malignant. All masses were removed surgically and definitive histological diagnosis was used as the gold standard. Sensitivity and specificity for each strategy were calculated and compared. In the case of bilateral tumors, only the more suspicious one was used for analysis. RESULTS A total of 367 adnexal masses diagnosed in 367 women (mean age, 46.5 (range, 18-80) years) were evaluated during the study period. Of these, 86 masses were malignant and 281 were benign. The sensitivity and specificity for each assessment strategy were as follows: one-step, 97.7% and 78.6%; two-step, 94.2% and 97.9% (P < 0.001 for specificity when compared with that of one-step); three-step, 90.7% and 98.9% (not statistically significant when compared with that of two-step). CONCLUSIONS The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.
Collapse
Affiliation(s)
- J Utrilla-Layna
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Ruiz de Gauna B, Sanchez P, Pineda L, Utrilla-Layna J, Juez L, Alcázar JL. Reply: To PMID 24265132. Ultrasound Obstet Gynecol 2015; 45:238-239. [PMID: 25627098 DOI: 10.1002/uog.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- B Ruiz de Gauna
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu and Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
8
|
Ruiz de Gauna B, Sanchez P, Pineda L, Utrilla-Layna J, Juez L, Alcázar JL. Interobserver agreement in describing adnexal masses using the International Ovarian Tumor Analysis simple rules in a real-time setting and using three-dimensional ultrasound volumes and digital clips. Ultrasound Obstet Gynecol 2014; 44:95-99. [PMID: 24265132 DOI: 10.1002/uog.13254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/30/2013] [Accepted: 11/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To estimate the agreement between an expert and a non-expert examiner using the International Ovarian Tumor Analysis (IOTA) simple rules for classifying adnexal masses on real-time ultrasound and when using three-dimensional (3D) ultrasound volumes and digital clips. METHODS Forty-two non-consecutive women diagnosed as having an adnexal mass were evaluated by transvaginal power Doppler ultrasound as part of their diagnostic work-up. In each woman, examination was first performed by a non-expert examiner (a trainee) and immediately afterwards by an expert examiner. Both used the IOTA simple rules to describe the mass, blinded to each other's results. After finishing the examination, each examiner classified the mass as benign, malignant or inconclusive, according to the IOTA simple rules. Additionally, the expert recorded a short videoclip and acquired a static 3D volume of each mass, which were subsequently assessed by four trainees in obstetrics and gynecology with different levels of training, who also classified the mass as benign, malignant or inconclusive according to the IOTA simple rules. Agreement was assessed by calculating weighted and standard kappa index values with 95% CI and the percentage of agreement between observers. RESULTS Agreement between the observers who performed real-time ultrasound examination was good (weighted kappa = 0.76; 95% CI, 0.61-0.90; agreement = 78.6%). Agreement between trainees using videoclips plus 3D volumes was moderate (kappa values ranged from 0.45 to 0.58, depending on pair comparison). CONCLUSION Interobserver agreement of the IOTA simple rules for classifying adnexal masses as benign, malignant or inconclusive using real-time ultrasound, between an expert and a non-expert examiner, might be considered good. Agreement using a videoclip plus a 3D volume was moderate for trainees with different degrees of training.
Collapse
Affiliation(s)
- B Ruiz de Gauna
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu and Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | |
Collapse
|