B. Graupera

IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation

To determine the diagnostic performance of International Ovarian Tumor Analysis (IOTA) ‘simple’ rules for discriminating between benign and malignant adnexal masses.

Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Müllerian duct anomalies using ESHRE–ESGE consensus on the classification of congenital anomalies of the female genital tract

To establish the accuracy of three‐dimensional ultrasound (3D‐US), compared with magnetic resonance imaging (MRI), for diagnosing uterine anomalies, using the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) consensus on the classification of congenital anomalies of the female genital tract.

Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography

OBJECTIVE To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. DESIGN Ultrasonographic results were compared with surgical and histologic findings. SETTING University Department of Obstetrics and Gynecology. PATIENT(S) This prospective study included 39 women with suspected rectovaginal endometriosis. INTERVENTION(S) All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. MAIN OUTCOME MEASURE(S) Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). RESULT(S) Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. CONCLUSION(S) Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis.

The Diagnosis of Ovarian Cancer: Is Color Doppler Imaging Reproducible and Accurate in Examiners with Different Degrees of Experience?

OBJECTIVE To evaluate the reproducibility and accuracy of color Doppler flow location in indeterminate masses after a gray-scale sonography in the diagnosis of ovarian malignancy. METHODS Digitally stored color Doppler sonographic images from a random sample of 130 women with an indeterminate adnexal mass submitted to surgery were evaluated by six different examiners with different degrees of experience. A mass was graded malignant if flow was shown within the excrescences or solid areas. Intraobserver agreement and interobserver agreement according to the level of experience were assessed by calculating the kappa index. RESULTS Intraobserver agreement was good for all examiners with different degrees of experience (kappa 0.72-0.89). Interobserver agreement was good to moderate for all operators (kappa 0.48-0.71) irrespective of degree of experience. The accuracy was comparable among different operators. CONCLUSIONS Our results indicate that color Doppler imaging for detection of adnexal malignancy seems to be a reproducible method even in moderately experienced examiners.

Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography

Objective. To assess whether there are differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler angiography (3D-PDA) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). Methods. Eighty-three women were classified into two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 45) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 38) with oligo-anovulation, clinical and/or biochemical features of hyperandrogenism, and polycystic ovary morphology at two-dimensional ultrasound. All women were evaluated by means of 3D-PDA. The parameters studied in both groups were follicle number per ovary (FNPO), ovarian volume (OV), mean gray value (MG) and three vascular indices: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Results. The PCO group showed a higher mean OV as well as FNPO. No differences in MG, VI, FI and VFI were found between the groups. Conclusions. 3D-PDA indices are not useful for discriminating between normal and polycystic ovaries.

Three-dimensional sonography for diagnosis of rectovaginal septum endometriosis: interobserver agreement.

The aim of this study was to evaluate the interobserver agreement for diagnosis of deep endometriosis of the rectovaginal septum using introital 3‐dimensional (3D) sonography.

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.

Ecografía 3D/4D en ginecología: técnica y metodología

Resumen La gran aportacion de la ecografia tridimensional respecto a la ecografia convencional (bidimensional) es el plano coronal. Hasta ahora mediante la ecografia convencional se disponia del corte longitudinal y del corte transversal. La aportacion de este tercer plano coronal es lo que permite hacer una reconstruccion volumetrica de los organos estudiados. La ecografia 3D/4D permite establecer una metodologia de adquisicion de la region que se quiere estudiar. Estos datos adquiridos se pueden almacenar y/o enviar y transferir mediante sistema DICOM ( digital imaging and communication in medicine ) lo que permite reconstruir y analizar los volumenes adquiridos tantas veces como sea necesario, por cuantos observadores se quiera y en cualquier lugar geografico. En consecuencia, la ecografia en esta modalidad deja de ser una tecnica dependiente del operador, siempre y cuando el proceso de adquisicion se haya realizado con los parametros debidamente protocolizados. El objetivo de este articulo es explicar una vision de conjunto de la metodologia en 3D y 4D, empezando con la adquisicion de imagenes en 3D, con el analisis de planos escaneados, tecnicas especiales tales como el VOCAL™ y consejos para optimizar el sistema.

Normal and abnormal images of intrauterine devices: Role of three-dimensional sonography.

The purpose of this pictorial essay is to describe the diagnostic value of two‐dimensional ultrasound (2DUS) and the additional information that three‐dimensional ultrasound (3DUS) provides in the assessment of location, type and complications of IUDs.

Malignancy risk of sonographically benign appearing purely solid adnexal masses in asymptomatic postmenopausal women.

Objective: To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. Methods: Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis. Results: Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). Conclusions: The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.