A. Crepaldi

OP17.06: Endometrial hyperplasia at 3D transvaginal sonography by VCI analysis

Objectives: To assess the impact of ultrasound at the time of initial assessment. Methods: Referrals to the two-week referral (TWR) clinic between 28 October 2005 and 9 June 2006 were analyzed. Referrals were made on a criteria-based form. The indication for urgent referral, procedures performed in clinic, further investigations and referrals and final diagnosis were recorded. 96% of ultrasound scans were transvaginal and 4% transabdominal. Results: 116 women were seen, mean age 56 (range 19–94) years. An ultrasound scan was indicated in 97 women (83%), 54 (56%) of which showed abnormal findings. Sixty-two women were referred with postmenopausal bleeding (PMB), 60 had ultrasound scans (two were hysterectomized). 50% (30) showed abnormal findings and all underwent endometrial sampling. Twenty-two women required hysteroscopy. The three endometrial cancers and 11 polyps/submucuous fibroids suspected on ultrasound scans were confirmed at hysteroscopy. Ten women were referred with pelvic masses and had ultrasound scans. Six ovarian cysts were detected, one of which was ovarian cancer. A further four benign ovarian cysts were noted in women referred for PMB. Seventeen (14.6%) of women required colposcopy. All six women with abnormal cervical cytology or histology were followed up in the colposcopy clinic and no cancers were found. A total of seven cancers were detected – three endometrial, three vulval and one ovarian. 71% of ultrasound scans (69/97) were normal or suggestive of benign pathology. Of these, 42/97 (43%) did not require further follow-up. 48% of referrals did not conform to criteria and there were no malignancies in this group. Conclusions: The majority of women required ultrasound scans. Two of three referrals were for PMB. Suspected cancers were immediately referred for urgent assessment, and the detection rate was 100%. The prevalence of cancer was low, at 6%. Women referred outside the criteria are at low risk of cancer. Utilizing ultrasound scans in the TWR clinic allows effective triage, appropriate immediate investigation and referral or discharge, resulting in a streamlined service.

OP19.02: Clinical history of recto‐vaginal septa deep infiltrating endometriosis during repeated ovulation induction: a case report

rectovaginal septum. When no lesion was seen, observers were asked to judge if the acquisition of the volume was defective, or if no lesion on the rectovaginal septum was evident; defective acquisition cases were discarded, a total number of 83 cases were evaluated. In order to calculate the performance of the introital 3D US, seven discordant cases were reviewed by a third observer. Interobserver agreement was assessed by calculating kappa index (κ), and Sensitivity, Specificity, PPV and NPV by the three observers were also determined. Results: Interobserver agreement was 0.816 (95% CI [0.69–0.93]) (representing a very good agreement). Sensitivity was 74.1%, Specificity 85.5%, PPV 71.4% and NPV 87%. Conclusions: Our results show that introital 3D US for diagnosis of deep endometriosis of the rectovaginal septum is reproducible with very good interobserver agreement.

OP24.05: Sonographic follow-up of solid ovarian lesion < 5 cm in post-menopausal women: preliminary results

endometrial-myometrial junction, presence of the ‘‘bright edge’’ sign at the edges of the lesions, and preservation of normal endometrial lining adjacent to the lesion. Patient clinical history and histological assessment of tumor grading were assessed. Results: 79 cases were analyzed, 26 were benign and 53 cases malignant. Antero-posterior lesion diameter was 8.89 ± 5.58, 14.8 ± 6.99, and 20 ± 10.57 millimeters for the benign, low grade and high grade malignancy lesions respectively, which was statistically significant (P < 0.05). High echogenicity, cystic formation within lesions, presence of ‘‘bright edge’’ and preservation of normal endometrium adjacent to the endometrial lesion were significantly more common in the benign group as compare to malignant lesions (P < 0.05). Complex echogenicity and loss of endometrial-myometrial junction were significantly more common in the malignant lesions group (P < 0.05). These parameters could not distinguish between low and high grade endometrial malignancy. Conclusions: Malignant endometrial lesions are associated with larger antero-posterior diameters. Sonographic parameters such as high echogenicity, cystic formation, presence of ‘‘bright edge’’ and preservation of normal endometrium might be used to distinguish between benign and malignant lesions. These parameters should be assessed, while considering a surgical intervention for endometrial lesions.

P15.06: Accuracy of a sonographic based triage with endometrial sampling during saline contrast sonohysterography in pre‐ and post‐menopausal women with abnormal uterine bleeding

and uterine and 10 mm shell myometrial 3D-PDA indices VI (vascularization index), FI (flow index) and VFI (vascularization flow index) were calculated. Signal attenuation in 3D-PDA was evaluated by categorizing the patients into two subgroups according to the distance to the center of the endometrium. The results were compared with a complete surgical staging. Results: A deep myometrial invasion was present in 23 patients. Of the color Doppler indices, the uterine artery RI and PI were statistically significantly lower in the group with deep invasion (P = 0.014 and 0.013, respectively). The uterine and myometrial 3D-PDA indices VI and VFI were statistically significantly higher in the group with deep invasion (P = 0.014 and 0.014; P = 0.013 and 0.022, respectively). No correlation was found between any of the measured indices and the presence of metastases. The subgroup analysis indicated that the uterine and myometrial VI was affected by distance, being statistically significantly higher in the group closer to the probe (P = 0.021 and 0.012, respectively). The multivariable analysis left the mean uterine artery RI as the only independent factor for the presence of deep invasion (OR 0.0003, 95%CI 0.00008–0.143, P = 0.010). Conclusions: The uterine artery RI correlates with the presence of deep invasion in endometrial carcinoma. 3D-PDA has potential in the preoperative assessment of endometrial carcinoma, but signal attenuation may bias the results.

OP29.08: Sonographic follow-up of unilocular > 5 cm and multilocular < 7 cm ovarian cysts in post-menopausal women

Objectives: To evaluate, sonographic, power-Doppler features and histological findings in cases of small unilocular-solid cyst in a normal-size ovary. Methods: All consecutive women with small ovarian unilocularsolid cyst in normal-size ovary detected by transvaginal ultrasound, were included in the study. Patients had either follow-up ultrasound examination every three months or underwent surgical removal of the cyst. CA 125 was also evaluated. Histological findings were reviewed. Results: A total of 45 cases were identified. The median age of the patients was 48 years (range 25–77). CA 125 was elevated (> 35 UI/mL) in 6/45 (13%) cases. The median size of the cyst was 18 mm (range 11–30). The vascularization was present in 20/45 (44%) cases. 15/45 (33%) women received followup ultrasound examination every three month. 30/45 (67%) undervent laparoscopic removal of the cyst. Hystological diagnosis of malignancy (three carcinoma, and six borderline tumors) was recorded in 9/45 (20%) cases and of benign lesion in 21/45 (47%). Conclusions: These data suggest that the presence of a papillary projection is more important than the size of the cyst. Small unilocular solid cysts even in a normal-size ovary have substantial risk of malignancy.

OP19.09: Clinical history of recto‐sigmoid endometriosis: a 6‐years follow‐up study

Objectives: To determine if a consistently retroverted or retroverted retroflexed uterine position is associated with pelvic pain. Methods: 969 sequential gynecological sonograms were reviewed by a radiologist on-line. Uterine position on transvaginal examination was categorized as anteverted (746–77%), retroverted (129–13%), axial (49–5%), anteverted retroflexed (40–4%), and retroverted anteflexed (5−.5%). 118 of the retroverted uteri had transabdominal and transvaginal examinatons. 41, anteverted on transabdominal exam, became retroverted on transvaginal exam (‘‘variable’’), 77 were retroverted on transabdominal and transvaginal views (‘‘fixed’’). The gynecological referral indication was compared between the ‘‘variable’’ and ‘‘fixed’’ groups. Results: Pelvic pain as an indication was commoner in the ‘‘fixed’’ group (27%) than in the ‘‘variable’’ group (14%). IUD issues (either malposition or ‘‘lost string’’) were more common in the variable group (24%) than in the fixed group (8%). Other indications such as abnormal uterine bleeding, abnormal uterine bleeding with pain, postmenopausal bleeding, retained products of conception, adnexal mass or ‘‘miscellaneous’’ were the equivalent in both groups. Conclusions: A consistently retroverted or retroverted retroflexed uterine position on both transabdominal and transvaginal ultrasound views is assocaited with pelvic pain. IUD issues occur more commonly if the uterine position changes from anteverted to retroverted between the transabdominal and endovaginal ultrasonic examinations.

OP20.01: 3D-transvaginal sonography by VCI analysis to differentiate endometrial polyp and hyperplasia in pre-menopausal women: Short Oral Presentation (OP) Abstracts

Objectives: To determine if a consistently retroverted or retroverted retroflexed uterine position is associated with pelvic pain. Methods: 969 sequential gynecological sonograms were reviewed by a radiologist on-line. Uterine position on transvaginal examination was categorized as anteverted (746–77%), retroverted (129–13%), axial (49–5%), anteverted retroflexed (40–4%), and retroverted anteflexed (5−.5%). 118 of the retroverted uteri had transabdominal and transvaginal examinatons. 41, anteverted on transabdominal exam, became retroverted on transvaginal exam (‘‘variable’’), 77 were retroverted on transabdominal and transvaginal views (‘‘fixed’’). The gynecological referral indication was compared between the ‘‘variable’’ and ‘‘fixed’’ groups. Results: Pelvic pain as an indication was commoner in the ‘‘fixed’’ group (27%) than in the ‘‘variable’’ group (14%). IUD issues (either malposition or ‘‘lost string’’) were more common in the variable group (24%) than in the fixed group (8%). Other indications such as abnormal uterine bleeding, abnormal uterine bleeding with pain, postmenopausal bleeding, retained products of conception, adnexal mass or ‘‘miscellaneous’’ were the equivalent in both groups. Conclusions: A consistently retroverted or retroverted retroflexed uterine position on both transabdominal and transvaginal ultrasound views is assocaited with pelvic pain. IUD issues occur more commonly if the uterine position changes from anteverted to retroverted between the transabdominal and endovaginal ultrasonic examinations.

OP29.08: 3D-transvaginal sonography by VCI analysis to differentiate endometrial polyp and hyperplasia in pre-menopausal women: Oral poster abstracts

W. P. Martins1,2, N. Raine-Fenning3, J. C. Lima1,2, C. O. Nastri1,2 1Departamento de Ginecologia e Obstetrı́cia (DGO), Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, Brazil; 2Escola de Ultra-sonografia e Reciclagem Médica de Ribeirão Preto (EURP), Ribeirão Preto, Brazil; 3School of Clinical Sciences, Division of Human Development, University of Nottingham, Nottingham, United Kingdom

OP07.03: 3D‐transvaginal sonography by VCI analysis to differentiate endometrial polyp and hyperplasia in pre‐menopausal women

Results: Mean age (±SD) was 49 years ±14. Sensibility (%), specificity (%), positive and negative LR were 96, 97, 30.9 and 0.04 for endometrial polyp, respectively; 85, 97, 24.9 and 0.16 for endometrial hyperplasia, respectively; 90, 99, 280.4 and 0.09 for endometrial cancer, respectively. Conclusions: Saline contrast sonohysterography with endometrial sampling performed by using the 14Fr bioptic intrauterine catheter showed to be accurate and efficacious in the triage of patients with AUB, showing to be a diagnostic test. Failed cases and inadequate samples should undergo hysteroscopy.

OC21.05: Sonographic follow‐up of unilocular > 5 cm and multilocular ovarian cysts < 7 cm in post‐menopausal women: preliminary results

Objectives: To investigate the contribute of sonographic followup in the clinical management of incidental unilocular > 5 cm and multilocular ovarian cysts < 7 cm in post-menopausal women. Methods: 62 women presenting with incidental sonographic diagnosis of unilocular > 5 cm and multilocular ovarian cysts (< 10 locules) were prospectively recruited. All patients were assessed by transvaginal sonography (TVS) with color power-Doppler (CD) evaluation according to the IOTA protocol. A proper counselling on ovarian cancer risk was given and an adequate informed consent was obtained. Sonographic follow-up was proposed at 3 and 9 months, than yearly. Surgery was proposed in case of changes of ovarian cyst volume (> 50%) and/or sonographic parameters. Demographic, sonographic and pathologic data were recorded. Results: Median age (IR) was 70 years (61–75). Median years after menopause (IR) were 23 (12–27). Mean BMI (±SD) was 27 kg/m2 ±5. Mean parity (±SD) was 2 ± 1. 5 women reported bilateral cysts. 39 cysts were unilocular, 28 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 55 mm (50–62) and 42 mm (30–57), respectively. The median follow-up period was 24 months (11–46). Surgery was performed in 9 cases: 2 dropout and 7 volume changes. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular > 5 cm and multilocular ovarian cysts < 7 cm in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management.