Álvaro Ruiz-Zambrana

Diagnostic performance of transvaginal gray-scale ultrasound for specific diagnosis of benign ovarian cysts in relation to menopausal status

In this study we aimed to assess the diagnostic accuracy of transvaginal ultrasound for assigning a specific diagnosis to benign adnexal masses in pre- and postmenopausal women. The study comprised 2146 adnexal masses in 1980 women. 1420 women were premenopausal and 560 were postmenopausal. Specific diagnosis of presumed histology of the lesion using gray-scale ultrasound findings was provided based on examiners impression. Definitive diagnosis was obtained in all cases. Sensitivity and specificity for each diagnosis were calculated in both pre and postmenopausal women. Specificity for malignant tumors was significantly higher in premenopausal women (p<0.001). Sensitivity for endometrioma (p<0.05) and hemorrhagic cyst (p<0.01) was significantly higher in premenopausal women. There was a trend for a higher sensitivity for serous cyst in postmenopausal women (p=0.09). We conclude that the diagnostic performance of transvaginal gray-scale ultrasound for specific diagnosis of adnexal masses based on examiners impression is different in premenopausal and postmenopausal women.

Perinatal outcome and long-term follow-up of extremely low birth weight infants depending on the mode of delivery

Objective. To assess the effect of the mode of delivery (vaginal or cesarean section) on survival, morbidity, and long-term psychomotor development of extremely low birth weight (ELBW) infants. Methods. A longitudinal observational study including 138 ELBW infants (73 born by c-section and 65 vaginally) was conducted. We analyzed the survival and short-term morbidity. We also studied the long-term neurocognitive and motor development using the McCarthy Scales of Childrens Abilities (MSCA). Results. Mortality was significantly higher in newborns delivered vaginally (49.3%) than those delivered by c-section (23.1%). Newborns delivered vaginally had a higher incidence of retinopathy and peri-intraventricular hemorrhage (P-IVH). Children who died had lower gestational age at birth and lower birth weight. After multivariate analysis only birth weight, gestational age at birth and P-IVH were independently associated to mortality. Regarding the long-term evaluation (MSCA), we observed that children born by c-section had lower incidence of abnormal results. Conclusions. The mode of delivery does not affect survival. Cesarean section provides lower morbidity and better prognosis for neurodevelopment long-term outcome in ELBW infants

Adding Cancer Antigen 125 Screening to Gray Scale Sonography for Predicting Specific Diagnosis of Benign Adnexal Masses in Premenopausal Women Is It Worthwhile

The purpose of this study was to assess whether a single determination of the serum cancer antigen 125 (CA‐125) level provides additional information to sonography for specific diagnosis of benign adnexal masses in premenopausal women.

External validation of IOTA simple descriptors and simple rules for classifying adnexal masses

To assess the diagnostic performance of a three‐step strategy proposed by the International Ovarian Tumor Analysis (IOTA) Group for discriminating between benign and malignant adnexal masses.

Prospective external validation of IOTA three-step strategy to characterize and classify adnexal masses and retrospective assessment of an alternative two-step strategy using simple rules risk: IOTA three-step validation

To perform an external validation of the diagnostic performance of the three‐step strategy proposed by the International Ovarian Tumor Analysis (IOTA) group for classifying adnexal masses as benign or malignant, when ultrasound is performed by non‐expert sonographers in the first two steps. The second objective was to assess the diagnostic performance of an alternative strategy using simple‐rules risk (SRR), instead of simple rules (SR), in the second step.

P14.06: Interobserver reproducibility of hysterosalpingo-sonography with foam (HyFoSy) for assessing tubal patency: Poster discussion hub abstracts

0.001). The fallopian tubal patency of 219 pregnant patients were as follows:99 patients (45.21%) in bilateral tubal patency group, 88 patients (40.18%) in unilateral tubal patency group and 32 patients (14.61%) in bilateral tubal lesion group. The proportion for the patients who didn’t get pregnant were 71 (33.33%), 87 (40.85%) and 99 (25.82%), separately. The pain perception in pregnant patients were as follows: 178 patients (81.27%) reported absent or mild pain (VAS 0 and VAS 1-4), 25 patients (11.42%) reported moderate pain (VAS 5-7) and only 16 patients (7.31%) reported severe pain (VAS 8-10). Conclusions: Transvaginal 4D HyCoSy, a method for assessing tubal patency with better patient tolerance, can not only provide diagnosis, but also play some therapeutic roles to facilitate pregnancy.

Evaluation of the Four-dimensional “Spatiotemporal Image Correlation” Technology with High-definition Color Doppler as Third Step for Preoperative Differential Diagnosis of Ovarian Tumors: A Prospective Study.

Aim: The purpose of this study is to analyze whether the addition of volumetric pulsatility indices (vPI) derived from spatiotemporal image correlation (STIC) assessment could improve the diagnostic performance of conventional two-dimensional (2D) ultrasound for discriminating benign from malignant adnexal tumors used as a third sequential step. Study design: Ours was an observational prospective cohort study between September 2014 to September 2016. Women diagnosed as having a persistent ovarian tumor evaluated at our center were included in this study. All women underwent transvaginal ultrasonography before surgery to assess the ultrasonographic characteristics of the lesion by gray-scale morphological analysis classifying the lesion as benign or suspicious based on “pattern recognition”. In benign lesions, no further test was conducted. For those tumors regarded as suspicious, assessment of the vascularization was performed by using conventional 2D high-definition flow color Doppler (2D-HDF), classifying the lesion as suspicious if vascularization within solid component was detected. In those lesions with intratumoral vascularization, four-dimensional (4D)-STIC technology with HDF was applied for calculating vPI. We used two reference standards: Definitive histology when the mass was surgically removed and in case the mass was not removed, those with spontaneous resolution or persistent without change and follow-up longer than 12 months were considered as benign. We compared diagnostic performance of conventional approach (pattern recognition followed by 2D-HDF) vs pattern recognition followed by 2D-HDF followed by 4D-STIC. Results: A total of 214 patients were included; 175 had a benign tumor and 39 a malignant tumor. We observed that vPI was significantly lower in malignant masses as compared with benign masses when 4D-STIC was used. Sensitivity and specificity of B-mode + 2D-HDF were 0.95 [95% confidence interval (CI): 0.83–0.98] and 0.92 (95% CI: 0.87–0.95) respectively. Sensitivity and specificity of B-mode + 2D-HDF + 4D-STIC were 0.95 (95% CI: 0.83–0.98) and 0.94 (95% CI: 0.90–0.96) OriGinal article 1,7,8Professor, 2-6Attending Physician 1-6,8Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, School of Medicine, Pamplona, Spain 7Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Monserrato, Italy Corresponding Author: Juan L Alcázar, Professor, Department of Obstetrics and Gynecology, Clinica Universidad de Navarra School of Medicine, Pamplona, Spain, Phone: +34 948245400 e-mail: jlacazar@unav.es 10.5005/jp-journals-10009-1560 respectively. No significant differences by adding the STIC were observed (McNemar test p > 0.05). Conclusion: The 4D-STIC does not improve the diagnostic performance of conventional ultrasound in the differential diagnosis of ovarian tumors as compared with conventional assessment using 2D ultrasound. However, a low vPI increases significantly the probability of malignancy in questionable masses.

OC14.03: Preoperative assessment of the extent of disease in ovarian cancer: comparative study of ultrasound and CT scan

women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Gray-scale and colour Doppler features changed with increasing grade and stage. High-risk tumours (stage 1A, grade 3 or non-endometrioid or > stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9mm, 95% CI +8 to +11mm), more frequently had non-uniform echogenicity (difference of -10%, 95% CI -15 to -5%), the multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high colour score (difference of +22%, 95% CI +18 to +27%), than low-risk tumours. Conclusions: Gray-scale and colour Doppler ultrasound features of endometrial tumours vary by grade and stage. This knowledge may improve preoperative ultrasound discrimination between low and high-risk cancer.

OC166: Which parameters could be useful to predict malignancy in sonographically solid adnexal masses?

A. C. Testa1, D. Timmerman2, E. Fruscella1, C. Van Holsbeke2, L. Savelli3, E. Ferrazzi4, F.P.G. Leone4, H. Marret5, C. Exacoustos6, G. De Placido7, D. Bokor8, G. Ferrandina1, V. Van Belle9, L. Valentin10 1Universita Cattolica del Sacro Cuore, Rome, Italy, 2University Hospitals, Leuven, Belgium, 3Reproductive Medicine Unit, Bologna, Italy, 4DSC L. Sacco Universita di Milano, Milano, Italy, 5Unite INSERM CHU Bretonneau, Tours, France, 6University of Tor Vergata, Rome, Italy, 7University of Naples, Naples, Italy, 8Bracco S.p.A., Milano, Italy, 9Dept Electrical Engineering (ESAT-SCD), Katholieke Universiteit Leuven, Leuven, Belgium, 10University Hospital, Malmo, Sweden

OC200: Ultrasound‐based triage for surgical management of adnexal masses in asymptomatic women

diagnosis of an ovarian mass and select masses for power Doppler evaluation. Methods: Between 1996 and 2006, 905 masses in 831 patients were referred to the Department of Obstetrics and Gynecology, University of Cagliari, Italy, and underwent ultrasound evaluation before surgery. Sixty-hundred and eighty masses were in premenopausal women and 225 in postmenopausal patients. The histological type of each mass was predicted on the basis of the B-mode typical benign findings as in case of endometrioma (‘ground glass’ endocystic pattern with a clear demarcation from the ovarian parenchyma), cystic teratoma (echogenic pattern with or without acoustic shadow) and serous cyst (anechoic unilocular or bilocular cyst with a thin regular wall without endocystic vegetations). Any cystic mass containing excrescences, thick septations, multiple irregular septations or a solid mass in which the echo architecture was not suggestive of benign histology was categorized as malignant. All masses suspected to be malignant were submitted to power Doppler evaluation to identify the location of flow. A mass was suspected to be malignant at power Doppler examination when central location of flow was found. Results: The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of B-mode and power Doppler for each evaluated histological type (divided into two groups, premenopausal and postmenopausal, for the diagnosis of ovarian cancer) are reported in the table. Conclusions: The use of simple ultrasonographic findings has high specificity for the prediction of several types of benign cyst with a good sensitivity. Besides the different prevalence of ovarian cancer in premenopausal and postmenopausal patients, the use of power Doppler seems to improve the specificity of B-mode in the diagnosis of ovarian cancer in both groups of patients.