1
|
Sayasneh A, Ferrara L, De Cock B, Saso S, Al-Memar M, Johnson S, Kaijser J, Carvalho J, Husicka R, Smith A, Stalder C, Blanco MC, Ettore G, Van Calster B, Timmerman D, Bourne T. Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study. Br J Cancer 2016; 115:542-8. [PMID: 27482647 PMCID: PMC4997550 DOI: 10.1038/bjc.2016.227] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/04/2016] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II-IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience. METHODS This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated. RESULTS Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915-0.954) when CA125 was included, and 0.925 (95% CI: 0.902-0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes. CONCLUSIONS The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.
Collapse
Affiliation(s)
- A Sayasneh
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
- Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - L Ferrara
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
- Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy
| | - B De Cock
- KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium
| | - S Saso
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - M Al-Memar
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - S Johnson
- Southampton University Hospitals, Princess Anne Hospital, Southampton SO16 5YA, UK
| | - J Kaijser
- Department of Obstetrics and Gynecology, Ikazia Ziekenhuis Rotterdam, Montessoriweg 1, Rotterdam 3083 AN, The Netherlands
| | - J Carvalho
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - R Husicka
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - A Smith
- Ultrasound Scan Department, Queen Charlottes and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - C Stalder
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - M C Blanco
- Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy
| | - G Ettore
- Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy
| | - B Van Calster
- KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
| | - T Bourne
- Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, Du Cane Road, London W12 0HS, UK
- Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK
- KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium
| |
Collapse
|
2
|
Sayasneh A, Kaijser J, Preisler J, Smith AA, Raslan F, Johnson S, Husicka R, Ferrara L, Stalder C, Ghaem-Maghami S, Timmerman D, Bourne T. Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses. Ultrasound Obstet Gynecol 2015; 45:605-612. [PMID: 25270506 DOI: 10.1002/uog.14675] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 05/10/2014] [Revised: 09/14/2014] [Accepted: 09/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess the diagnostic performance of subjective assessment by Level II ultrasound examiners in predicting the specific histology of adnexal masses. METHODS The women included in this prospective multicenter cross-sectional study were older than 16 years of age and had at least one adnexal mass. They underwent transvaginal sonography (TVS) performed by Level II examiners, all of whom were familiar with the International Ovarian Tumor Analysis (IOTA) group definitions of ultrasound features of ovarian masses. The final outcome was histology. Specific diagnoses were categorized into 16 groups. Agreement between subjective assessment and final histology was measured using unweighted kappa coefficients. Sensitivities and specificities were obtained for subjective assessment. RESULTS Of the 1279 women who underwent TVS, 313 were included in the final analysis. Overall agreement (16 × 16 table) between subjective assessment and histology was moderate, with a Cohen's kappa coefficient of 0.59 (95% CI, 0.53-0.65). The specificity of subjective assessment ranged between 91% and 100% for all histological subgroups. Highest sensitivities were achieved in the diagnosis of simple cysts (100% (95% CI, 61-100%)), hydrosalpinges (100% (95% CI, 34-100%)), mature teratomas (88% (95% CI, 74-96%)), endometriomas (75% (95% CI, 61-85%)), ovarian fibromas (88% (95% CI, 47-100%)), tubo-ovarian abscesses (88% (95% CI, 47-100%)) and serous cystadenocarcinomas (82% (95% CI, 66-93%)). Serous cystadenomas were misdiagnosed most commonly (40.5%). The sensitivity of subjective assessment in diagnosing adnexal torsion was 54% (95% CI, 25-81%); the 17 confirmed and/or suspected cases of adnexal torsion were not included in the 313 cases examined and analyzed for diagnostic performance. CONCLUSION Overall, subjective assessment by Level II examiners was good for the detection of simple cysts, endometriomas, mature teratomas, hydrosalpinges, fibroma, tubo-ovarian abscess and serous cystadenocarcinomas.
Collapse
Affiliation(s)
- A Sayasneh
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, London, UK; Early Pregnancy and Acute Gynaecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Sayasneh A, Kaijser J, Preisler J, Johnson S, Stalder C, Husicka R, Guha S, Naji O, Abdallah Y, Raslan F, Drought A, Smith AA, Fotopoulou C, Ghaem-Maghami S, Van Calster B, Timmerman D, Bourne T. A multicenter prospective external validation of the diagnostic performance of IOTA simple descriptors and rules to characterize ovarian masses. Gynecol Oncol 2013; 130:140-6. [PMID: 23578539 DOI: 10.1016/j.ygyno.2013.04.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/26/2013] [Accepted: 04/02/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the IOTA (International Ovarian Tumor Analysis group) (clinically oriented three-step strategy for preoperative characterization of ovarian masses when ultrasonography is performed by examiners with different background training and experience. METHODS A 27-month prospective multicenter cross-sectional study was performed. 36 level II ultrasound examiners contributed in three UK hospitals. Transvaginal ultrasonography was performed using a standardized approach. Step one uses simple descriptors (SD), step two ultrasound simple rules (SR) and step three subjective assessment of ultrasound images (SA) by examiners. The final outcome was findings at surgery and the histological diagnosis of surgically removed masses. RESULTS 1165 women with adnexal masses underwent transvaginal ultrasonography, 301 had surgery. Prevalence of malignancy was 31% (n=92). SD were able to classify 46% of the masses into benign or malignant (step one), with a sensitivity of 93% and specificity of 97%. Applying SD followed by SR to residual unclassified masses by SD enabled 89% of all masses (n=268) to be classified with a sensitivity 95% of and specificity of 95%. SA was then used to evaluate the rest of the masses. Compared to the risk of malignancy index (RMI), the sensitivity and specificity for the three-step (SD+SR+SA) strategy were 93% (95% CI: 86-97%) and 92% (95% CI: 87-95%) vs. 72% (95% CI: 62-80%) and 95% (95% CI: 91-97%) for RMI, respectively. CONCLUSION The IOTA three-step strategy shows good test performance on external validation in the hands of ultrasonography examiners with different background training and experience. This performance is considerably better than the RMI.
Collapse
Affiliation(s)
- Ahmad Sayasneh
- Department of Cancer and Surgery, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Barnhart K, van Mello NM, Bourne T, Kirk E, Van Calster B, Bottomley C, Chung K, Condous G, Goldstein S, Hajenius PJ, Mol BW, Molinaro T, O'Flynn O'Brien KL, Husicka R, Sammel M, Timmerman D. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril 2010; 95:857-66. [PMID: 20947073 DOI: 10.1016/j.fertnstert.2010.09.006] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/30/2010] [Accepted: 09/03/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To improve the interpretation of future studies in women who are initially diagnosed with a pregnancy of unknown location (PUL), we propose a consensus statement with definitions of population, target disease, and final outcome. DESIGN A review of literature and a series of collaborative international meetings were used to develop a consensus for definitions and final outcomes of women initially diagnosed with a PUL. RESULT(S) Global differences were noted in populations studied and in the definitions of outcomes. We propose to define initial ultrasound classification of findings into five categories: definite ectopic pregnancy (EP), probable EP, PUL, probable intrauterine pregnancy (IUP), and definite IUP. Patients with a PUL should be followed and final outcomes should be categorized as visualized EP, visualized IUP, spontaneously resolved PUL, and persisting PUL. Those with the transient condition of a persisting PUL should ultimately be classified as nonvisualized EP, treated persistent PUL, resolved persistent PUL, or histologic IUP. These specific categories can be used to characterize the natural history or location (intrauterine vs. extrauterine) of any early gestation where the initial location is unknown. CONCLUSION(S) Careful definition of populations and classification of outcomes should optimize objective interpretation of research, allow objective assessment of future reproductive prognosis, and hopefully lead to improved clinical care of women initially identified to have a PUL.
Collapse
Affiliation(s)
- Kurt Barnhart
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Crha I, Kralikova M, Melounova J, Ventruba P, Zakova J, Beharka R, Husicka R, Pohanka M, Huser M. Seminal plasma homocysteine, folate and cobalamin in men with obstructive and non-obstructive azoospermia. J Assist Reprod Genet 2010; 27:533-8. [PMID: 20676751 DOI: 10.1007/s10815-010-9458-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 07/16/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this study was to analyze homocysteine, folate and cobalamin in men with normozoospermia, obstructive and non-obstructive azoospermia. METHODS Analysis of plasma and seminal plasma homocysteine, folate and cobalamin in 72 azoospermic and 62 normozoospermic men. Evaluation of the azoospermic patient included testicular biopsy, endocrine, urological and ultrasound examination. RESULTS Homocysteine (1.2 μmol/l) and cobalamin (322.05 pmol/l) concentrations (median values) in seminal plasma were significantly lower (p < 0.001) in men with azoospermia than in men with normozoospermia (2.5 μmol/l and 579.0 pmol/l). Folate and cobalamin concentrations were significantly higher in obstructive than in non-obstructive azoospermia. Significant correlations were determined between testis volume and seminal plasma homocysteine in azoospermic men. CONCLUSION Lower concentrations of homocysteine and cobalamin (but not folate) were found in azoospermic seminal plasma than normozoospermic. Folate and cobalamin were higher in seminal plasma from obstructive azoospermia than in non-obstructive azoospermia patients.
Collapse
Affiliation(s)
- Igor Crha
- Department of Gynecology and Obstetrics, Masaryk University, Faculty Hospital, Brno, Czech Republic.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Roztocil A, Koudelka M, Husicka R, Jelínek J, Pilka L. [Programmed labor--beneficial for the mother and fetus or an obstetrical hazard?]. Ceska Gynekol 1996; 61:226-30. [PMID: 8963491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
During the period between Jan. 1, 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics 482 full-term pregnancies were terminated by elective induction of labour. Labour was induced by extraamnial administration of PGE2 (Prostin UPJOHN 3.0 mg tablets vag). Depending on the maturity of the portio uteri a maximum of two doses after two hours were administered: 0.5 mg PGE2 when the cervical score was > 8 and 1.0 mg PGE2 when the score was 5-8 points. The results were compared with 278 non-risk pregnant women who were delivered of babies between Jan. 1 and June 30, 1995. The first stage of labour was longer in patients with spontaneous labour. The second stage of labour was longer in patients with induced labour. From the results ensues that an elective induction of labour does not increase the perinatal risk for mother and foetus, and conversely if all conditions are respected it is better for the mother, her family and the staff of the labour ward.
Collapse
|