A. Gaurilcikas

Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound - A European multicenter trial

OBJECTIVE To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. PATIENTS AND METHODS Prospective multi-center trial enrolling 209 consecutive women with early-stage cervical cancer (FIGO IA2-IIA) scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology: remaining tumor, size, tumor stromal invasion<2/3 (superficial) or ≥2/3 (deep), and parametrial invasion. RESULTS Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (<2cm) and detecting parametrial invasion (kappa values 0.78 and 0.75, respectively). The agreement between MRI and histology was good for classifying tumors as <2cm, or >4cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy. CONCLUSION US and MRI are highly accurate for the preoperative assessment of women with early-stage cervical cancer, although US may be more accurate in detecting residual tumors and assessing parametrial invasion.

Early-stage cervical cancer: agreement between ultrasound and histopathological findings with regard to tumor size and extent of local disease

To determine the agreement between ultrasound and histological examination of the cervix in patients with early stage cervical cancer with regard to tumor size and local extent of the disease.

Sonographic features of primary ovarian fibrosarcoma: a report of two cases

Two cases of primary cellular fibroblastic tumor of the ovary are described, which presented a challenging clinical and histopathological differential diagnosis of primary ovarian fibrosarcoma and mitotically active cellular fibroma. On sonographic evaluation they both appeared as solid lesions with irregular margins, and on histological analysis both showed a count of 5–7 mitotic figures per 10 high‐power fields. Histopathological examination of the first case was characterized by the presence of hemorrhage, necrosis and severe nuclear atypia, with a metastatic peritoneal lesion, and the eventual diagnosis was primary ovarian fibrosarcoma. The second case, however, was diagnosed as a ‘mitotically active cellular fibroma’ owing to the lack of substantial severe cellular atypia, hemorrhage or necrosis. We speculate that ovarian fibrosarcoma at the preoperative examination might be considered in the differential diagnosis whenever a unilateral, heterogeneous, largely round solid ovarian lesion is detected. Copyright

Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization.

Objective. To assess fetal middle cerebral artery (MCA) peak systolic velocity (PSV) in cases of rhesus alloimmunization and to establish whether MCA-PSV is valid for the prediction of fetal anemia. Methods. The study population included 157 pregnant women diagnosed with rhesus alloimmunization. MCA-PSV measurements were obtained within 3 days of blood sampling for estimation of hemoglobin concentration either at delivery or cordocentesis by the same operator and by means of the same ultrasound machine using techniques described previously. To evaluate the measurements of the MCA-PSV as the multiples of median (MoM) for gestation we used original nomograms for various gestational ages derived from a group of 273 normal fetuses between 22 and 40 weeks of gestation, not at risk for anemia. Receiver–operator characteristic (ROC) curves were employed to evaluate the relation of the sensitivity (the true positive rate) and the false positive rate (100% specificity) of different threshold values of the MCA-PSV. Results. The sensitivity of the MCA-PSV was 94.4% in the case of the subgroup of fetuses with severe anemia. The sensitivity of the MCA-PSV test decreased in less anemic fetuses and was 77.3% in the subgroup with moderate anemia and 32% in the subgroup with mild anemia. According to ROC curves, we selected the optimal MCA-PSV threshold values of 1.15, 1.44, and 1.53 MoM for the prediction of mild, moderate, and severe anemia, respectively. Conclusions. MCA-PSV is a significant Doppler index valid for the prediction of moderate and severe fetal anemia.

Sonographic imaging of urinoma

infantile myofibromatosis. Am J Med Genet 2004; 126: 261–266. 8. Stenman G, Nadal N, Persson S, Gunterberg B, Angervall L. Del(6)(q12q15) as the sole cytogenetic anomaly in a case of solitary infantile myofibromatosis. Oncol Rep 1999; 6: 1101–1104. 9. Rumack C, Wilson S, Charboneau J. Diagnostic Ultrasound. Mosby Year Book: St. Louis, 1991. 10. Shelling AN, Ferguson LR. Genetic variation in human disease and a new role for copy number variants. Mutat Res 2007; 622: 33–41.

P11.02: Performance of IOTA ADNEX model in differentiating histological subtypes of borderline ovarian tumours

Objectives The aim of this research was to systematically examine the placenta in congenital anomalies. Methods: The placental pathological section was examined in 217 cases with congenital fetal anomalies including 87 cases with congenital heart diseases, 41 cases facial abnormalities, genitourinary abnormalities, 62 cases with neurologic abnormalities. Results: Placental infarction or villus degeneration was observed in 4 cases and chorangiosis was found in 12 cases with congenital heart diseases corresponding to the overall placental disease rate being 16.1%; chorangiosis was observed in 5 cases with facial abnormalities corresponding to the placental disease rate being 12.1%; chorangiosis was found in 2 cases with genitourinary abnormalities corresponding to the placental disease rate being 7.4%. In addition, chorangiosis was observed in 10 cases with neurologic abnormalities corresponding to the placental disease rate being 14.5%. Conclusions: Relative to other system abnormalities the placental disease rate was more higher in cases with congenital fetal heart anomalies.

OC24.01: Early stage cervical cancer: tumor delineation by magnetic resonance imaging and ultrasound in a preoperative staging, verified by pathological results: the results of an European multicentre trial

E. Epstein1, A. Testa2, A. Gaurilcikas3, A. Di Legge2, L. Ameye4, V. Atstupenaite5, A. Valentini6, B. Gui6, N. Wallengren7, S. Pudaric7, A. Cizauskas8, A. Masback9, G. Zannoni10, P. Kannisto11, M. Zikan12, I. Pinkavova12, A. Burgetova13, P. Dundr14, K. Nemejcova14, D. Cibula12, D. Fischerova12 1Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden; 2Oncology, Catholic University of Sacred Heart, Rome, Italy; 3Obstetrics and Gynecology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 4Department of Electrical Engineering, ESAT-SCD, Katholieke Universiteit, Leuven, Belgium; 5Radiology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 6Radiology, Catholic University of Sacred Heart, Rome, Italy; 7Radiology, Skane University Hospital, Lund, Sweden; 8Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania; 9Pathology, Skane University Hospital, Lund, Sweden; 10Pathology, Catholic University of Sacred Heart, Rome, Italy; 11Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden; 12Gynecological Oncology Centre, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic; 13Radiology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic; 14Pathology, First Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic

OC24.01: †Agreement between ultrasound and histopathological findings with regard to tumor size and extent of local disease in cases of early stage cervical cancer

A. Gaurilcikas1, D. Vaitkiene1, A. Cizauskas2, E. Svedas1, A. Bartusevicius1, S. Augustis3, A. Testa4 1Obstetrics and Gynecology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; 2Department of Pathology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania; 3Lithuanian University of Health Sciences, Kaunas, Lithuania; 4Gynecologic Oncology Unit, Catholic University of Rome, Rome, Italy

OC23.05: Transvaginal ultrasonography for the evaluation of the response to concomitant chemoradiotherapy in cases of invasive cervical carcinoma

Methods: Patients with persistent adnexal mass with a risk of major malignancy of 3%, based on ultrasound examination were included in this prospective study. Predefined ultrasound morfological and Doppler characteristics were used by an expert sonologist to determine the nature (benign o malignant) of the mass. Border-line masses were considered as malignant. All patients underwent combined PET/CT with F-fluorodeoxyglucose (FDG). The ultrasound and PET/CT findings were correlated with final hystological diagnosis. Results: Sixty one patients were included in this series. Hystologically there were 25 benign, 27 malignant and 9 border-line masses. All malignant masses were correctly classified at transvaginal sonography, while at PET/CT 25 of those demonstrated metabolic activity and 2 lesions resulted false negative. Among hystologically benign lesions transvaginal ultrasound was accurate in 21 (4 false positive), the same as PET/CT. The borderline tumours were correctly identified at sonography as suspected malignant, though PET/TC was predictive in only 1 of 9. Moreover, 2 malignant and 7 border-line masses revealed silent at PET/CT were mucinous tumours. Conclusions: These data show that PET/CT does not provide additional information compared with expert transvaginal ultrasound. It is likely that some malignant mucinous lesions and especially border-line tumours do not show FDG uptake.

OC132: Correlation of sonographic characteristics and pathomorphological findings in cases of early‐stage cervical cancer: preliminary results

prospective study. All women were subsequently assessed by 3DPDA. Endometrial volume, vascularity index (VI), flow index (FI) and vascularity–flow index (VFI) were calculated using the VOCAL method (Voluson 730, GE Systems, USA). Histological diagnoses were obtained in all cases. No patient taking tamoxifen or hormone replacement therapy was included. Cases with intrauterine fluid collection were also excluded. Results: Histological diagnoses were as follows: endometrial cancer 44 (50%), endometrial polyp 19 (22%), endometrial hyperplasia 12 (14%), endometrial cystic atrophy seven (8%) and submucous myoma five (6%). Endometrial volume, VI, FI and VFI were significantly higher in malignant than benign conditions (Table). All parameters showed similar area under the curve in ROC analysis.