Begoña Olartecoechea

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.

Expectant management of adnexal masses in selected premenopausal women: a prospective observational study

To evaluate the results of expectant management of ovarian cysts with benign ultrasound morphology in selected asymptomatic premenopausal women.

Endometriosis in a postmenopausal woman without previous hormonal therapy: a case report

IntroductionThe prevalence of pelvic endometriosis is high, affecting approximately 6% to 10% of women of reproductive age. Although endometriosis has been associated with the occurrence of menstrual cycles, it can affect between 2% to 5% of postmenopausal women.Case presentationWe present a case of ovarian endometriosis in a 62-year-old Spanish Caucasian woman with no previous use of hormonal therapy and no history of endometriosis or infertility.ConclusionAlthough the reported situation is rare, it is important to be aware of endometriosis after the menopause: post-menopausal endometriosis confers a risk of recurrence and malignant transformation.

Clinical and sonographic features of uncommon primary ovarian malignancies

To describe the gray‐scale and color Doppler ultrasound features of uncommon (<5% prevalence) primary malignant ovarian tumors.

The value of minilaparotomy for total hysterectomy for benign uterine disease: A comparative study with conventional Pfannenstiel and laparoscopic approaches

Background The aim of this paper is to review and compare the results obtained using the Pfannenstiel, laparoscopy and minilaparotomy approaches for total hysterectomy procedure in relation to benign uterine diseases. Methods A retrospective data analysis was performed on 165 patients who underwent hysterectomy for benign uterine diseases at our centre during the period 2004 to 2006. Findings The minilaparotomy procedure was the fastest procedure with a mean time of 73.4 minutes (range: 67.85 to 78.94 minutes, p < 0.001). Hospital stay was shortest for laparosopic procedure (mean time: 3.24 days, range: 2.86 to 3.61 days) (p < 0.001). The rate of intraoperative and postoperative complications were not statistical different among three procedures. Conclusion The minilaparotomy procedure offers a minimally invasive option for total hysterectomy due to benign uterine disease.

Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor

To describe the gray‐scale and color Doppler ultrasound features as well as some clinical and biochemical features of metastatic ovarian tumors according to the origin of the primary tumor in a large study population,

Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: a case report

IntroductionAn imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation.Case presentationA 33-year-old woman (G3, P3) presented referring intense dysmenorrhea and intermenstrual spotting since her third cesarean delivery, 1 year before. A cesarean section dehiscence with utero-peritoneal fistula was diagnosed by transvaginal ultrasound.ConclusionWe can conclude that transvaginal two-dimensional power Doppler and three-dimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.

Different injection sites of radionuclide for sentinel lymph node detection in breast cancer: single institution experience.

OBJECTIVE The sentinel node is defined as the first lymph node in a regional basin that receives lymph flow from the primary tumor. There is still a controversy over deep versus superficial injection administration in the breast. STUDY DESIGN From June 2006 to June 2008, 133 patients with biopsy proven breast carcinoma and clinically negative axilla have been treated with conservative surgery and a study of their axillary sentinel lymph nodes (SLN) has been conducted. RESULTS The median number of SLN detected was significantly higher in the periareolarly injected (PA) group (2.43) than in the intratumorally injected (IT) group (1.92) (p=0.008). The incidence of positive SLN in the PA group was not significantly different from the incidence observed in the IT group (p=0.22). CONCLUSION Both techniques seem to reliably identify the true SLN in the axilla. Although intradermal as compared with intratumoral injection has numerous advantages, including ease of injection, shorter time between injection and sentinel node identification, and increased radiotracer nodal uptake, nevertheless, intradermal injection allows almost exclusive identification of axillary nodes, and only on rare occasions, of non-axillary nodes. We therefore think that intratumoral injection must be preferred to intradermal when possible to identify the node that is the first draining step of the tumoral tissue.

Assessing the reproducibility of the IOTA simple ultrasound rules for classifying adnexal masses as benign or malignant using stored 3D volumes

OBJECTIVE To analyze the reproducibility of the IOTA simple ultrasound rules for classifying adnexal masses as benign or malignant among examiners with different level of expertise using stored 3D volumes of adnexal masses. STUDY DESIGN Five examiners, with different levels of experience and blinded to each other, evaluated 100 stored 3D volumes from adnexal masses and looked for the presence or absence of malignant or benign features according to the IOTA definitions. Multiplanar view and virtual navigation were used. All examiners had to assess the 3D volume of each adnexal mass and classify it as benign or malignant. To analyze intra-observer agreement each examiner performed the assessment twice with a two-week interval between the first and second assessments. To analyze the inter-observer agreement, the second assessment from each examiner was used. Reproducibility was assessed calculating the weighted Kappa index. RESULTS Intra-observer reproducibility was moderate or good for all observers (Kappa index ranging from 0.59 to 0.74). Inter-observer reproducibility was moderate to good (Kappa index range: 0.46-0.67). CONCLUSIONS The simple rules are reasonably reproducible among observers with different level of expertise when assessed in stored 3D volumes.

Diagnostic performance of IOTA simple rules for adnexal masses classification: a comparison between two centers with different ovarian cancer prevalence

OBJECTIVE The aim of this study was to compare the diagnostic performance of the IOTA simple rules for classifying adnexal masses when used in two centers with different ovarian cancer prevalence. STUDY DESIGN A prospective study was performed between June 2012 and December 2013 at two different centers with different ovarian cancer prevalence. Center A had high ovarian malignancy prevalence and Center B had low malignancy rates. Eligible patients were all women diagnosed as having a persistent adnexal mass. Examiners had to analyze the masses according to IOTA simple rules (SR) providing a diagnosis of malignant, benign or inconclusive. Those cases classified as inconclusive were then examined by an expert examiner (the same examiner in center A, a different examiner in center B), who had to classify the mass as malignant, benign or uncertain according to his subjective impression (SI). Definitive histologic diagnosis from tumors removed surgically was used as gold standard. The diagnostic performance was assessed by calculating the sensitivity and specificity, positive and negative likelihood ratios, for SR and SR+SI assessments. McNemar test was used for comparing sensitivity and specificity. RESULTS During this period, 247 women were eligible for this study. The rate of inconclusive masses was 18.4% and 18.0% for centers A and B, respectively (p>0.05). Ovarian malignancy rate was significantly higher in center A as compared with center B (27.2% versus 11.3%), (p=0.001). When analyzing only cases classifiable by SR, sensitivity in center A was significantly higher (100% versus 84.6% p=0.001), but specificity was similar in both centers (93.9% and 95.8% respectively). When analyzing SR plus SI, sensitivity in center A was significantly higher (100% versus 86.7% p=0.001), but specificity was similar in both centers (89.9% and 88.8%, respectively). CONCLUSIONS The diagnostic performance in terms of sensitivity of IOTA rules is higher in a center with higher prevalence of ovarian malignancy.