C. Carusotti

Hysterosalpingo-contrast sonography compared with hysterosalpingography and laparoscopic dye pertubation to evaluate tubal patency.

STUDY OBJECTIVE To evaluate the advantages and accuracy of hysterosalpingo-contrast sonography (HyCoSy) in assessing tubal patency compared with hysterosalpingogram (HSG) and laparoscopic dye pertubation. DESIGN Prospective study (Canadian Task Force classification II-2). SETTING Obstetrics and Gynecology Department, University of Rome Tor Vergata. PATIENTS Twenty-three women with at least 1 year of infertility, and 15 women with a history of chronic pelvic pain, suspected endometriosis, or pelvic inflammatory disease (PID), or with sonographic markers of adhesions. INTERVENTIONS HyCoSy, HSG, and laparoscopic dye pertubation. MEASUREMENTS AND MAIN RESULTS All patients underwent HyCoSy during the proliferative phase using air with saline as contrast medium, and HSG within 1 month of HyCoSy. Laparoscopy and dye pertubation were performed only in women with chronic pelvic pain, suspected endometriosis, PID, and sonographic markers of adhesions. In women undergoing all three procedures, HSG and HyCoSy had the same high concordance as laparoscopy, 86.7% and 86.7%, respectively. Three women in the infertility group became pregnant immediately after HyCoSy and dropped out of the study. In one woman, HyCoSy could not be performed because of cervical stenosis. Considering the total number of tubes (67), concordance between HyCoSy and HSG was 89.6%. CONCLUSION Transvaginal HyCoSy using a combination of air and saline appears to be an inexpensive, fast, and well-tolerated method of determining tubal patency. One of the most important advantages of this technique is, in our opinion, the possibility of obtaining information on tubal status and the uterine cavity at the same time as conventional ultrasound scan is performed.

Staging of Pelvic Endometriosis: Role of Sonographic Appearance in Determining Extension of Disease and Modulating Surgical Approach

Abstract Study Objective To estimate whether laparoscopic staging of endometriosis can be predicted by ultrasound findings. Design Prospective study (Canadian Task Force classification II-2). Setting Obstetrics and Gynecology Department, University of Rome Tor Vergata. Patients One hundred twenty-one women with histologically confirmed sonographic diagnosis of endometriomas. Intervention Ultrasonographic staging and laparoscopic assessment. Measurements and Main Results All patients underwent transvaginal and/or transrectal sonographic evaluation of ovarian endometriomas and other sonographic markers (anatomic sites and their relation to abdominovaginal palpation, adhesions, deep or infiltrating nodules) to stage the disease before surgery. These results were compared with laparoscopic staging. Concordance between methods was 83.5%. Specificity and sensitivity of ultrasonographic staging of stages 3 and 4 disease were 86% and 82% and 76% and 91%, respectively. Conclusion Ultrasonographic findings can predict pelvic extension and stage of endometriosis.

Laparoscopic approach to dermoid cysts: Combined surgical technique and ultrasonographic evaluation of residual functioning ovarian tissue

STUDY OBJECTIVE To estimate how and if laparoscopic removal of ovarian dermoid cysts is a tissue-sparing procedure. DESIGN Prospective study (Canadian Task Force classification II-2). SETTING University-associated hospital. PATIENTS Fifty-five women. INTERVENTION Laparoscopic removal of ovarian dermoid cysts by a combination of hydrodissection and blunt dissection, and transvaginal sonographic (TVS) evaluation of residual ovarian tissue. MEASUREMENTS AND MAIN RESULTS Within 1 week before surgery all recruited patients underwent TVS evaluation of ovarian volume, size, and morphology of dermoid cysts and measurement of surrounding ovarian cortex. Mean cyst diameter was 5.5 +/- 2.2 cm (range 2.1-15.0 cm). Within 6 to 12 months after laparoscopic excision, TVS measurements of residual ovarian tissues were obtained. Ovarian residual cortex surrounding the cyst was not visible at TVS in 24 ovaries, whereas in 56 ovaries residual tissue volume was greater than 3 cm3 after laparoscopic excision. CONCLUSION We propose laparoscopic removal of dermoid cysts by combining hydrodissection and blunt dissection with maximum tissue sparing, even when the cyst seems to fill the ovary and no surrounding ovarian cortex can be seen on ultrasound.

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

removed – there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention – there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks’ gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy.

WS09-05Sonographic appearance of borderline ovarian tumors

Background

OC234: Suspicious ultrasonographic and power flow Doppler imaging for leiomyosarcoma of the uterus

would have been detected. An alternative cut-off value of 35 U/ml would have resulted in a detection rate of 33%. Conclusions: Transvaginal ultrasonography can effectively detect intra-ovarian cancer and tumours of borderline malignancy in women with a family history of the disease. The level of serum CA125 can be used to select women for ultrasonography, but the detection rate for early cancers would be reduced.

F03Transvaginal sonographic detection of endometrial pathology in postmenopausal women on HRT

Background

F02Sonographic preoperative assessment of myometrial invasion in endometrial cancer

Background