C. Laparte

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.

Assessment of a new logistic model in the preoperative evaluation of adnexal masses.

To assess a new logistic regression model developed to predict malignancy in adnexal masses.

Transvaginal color Doppler imaging in the detection of ovarian cancer in a large study population.

Introduction: The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group. Methods: The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral. Results: Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P = 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status. Conclusions: The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.

Comparative Study of Transvaginal Ultrasonography and Hysteroscopy in Postmenopausal Bleeding

Twenty-eight women with postmenopausal bleeding were retrospectively studied to assess the accuracy of transvaginal sonography (TVS) and hysteroscopy for diagnosing endometrial pathology. TVS was performed in all patients. Considering a cutoff value of < or = 5 mm as normal, TVS showed normal findings in 14 patients (50%) and suggested endometrial abnormalities in other 14 (50%). Hysteroscopy could be performed in 24 patients (85.7%). In 17 (70.2%) cases no abnormality was found; an endometrial polyp was suspected in 6 (25%) and endometrial hyperplasia in 1 (4.8%) patient. All patients underwent endometrial biopsy or dilatation and curettage for histopathologic study. Sensitivity, specificity, and positive and negative predictive values for TVS and hysteroscopy were 100, 60.8, 35.7, and 100% and 100, 89.4, 71.4, and 100%, respectively. In our experience, both methods were highly sensitive, but hysteroscopy was more specific than TVS.

Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound‐based scoring system

To prospectively evaluate an ultrasound‐based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.

In vivo validation of the time domain velocity measurement technique of blood flow in human fetuses

Time domain ultrasonography is an alternative to Doppler analysis of blood flow direction and velocity. The time domain technique uses timing information between successive echo pulses to measure flow velocities directly through a color display map. This study was undertaken to validate this technique for measuring peak systolic velocity compared to the pulsed-wave Doppler method in human fetuses. Twenty normally developing fetuses were included in the study. The fetal abdominal aorta and the umbilical artery were studied in 12 and eight cases, respectively. We first estimated flow velocity using time domain ultrasonography and immediately after pulsed Doppler was used. The intraclass correlation coefficient was used to assess the agreement between measurements. A close correlation was found (intraclass correlation coefficient = 0.96). Our results show that time domain ultrasonography seems to be a valid technique for imaging fetal vessels and for measuring blood flow velocity.

Performance of three-dimensional power Doppler angiography as third-step assessment in differential diagnosis of adnexal masses

To evaluate the contribution of three‐dimensional (3D) power Doppler angiography (3D‐PDA) to the differential diagnosis of adnexal masses.

OP21.07: Tumor angiogenesis as assessed by three-dimensional power Doppler ultrasound in early versus advanced and metastatic ovarian cancer

and 20% (n = 13) an indifferent/mixed growth pattern. None of the malignant tumors displayed the compression pattern. 35% of the 106 benign tumors (n = 37) showed the compression pattern and 59% (n = 63) an indifferent/mixed growth pattern. 5.6% of the benign tumors (n = 6) displayed a retraction pattern. Conclusions: The 3D multiplanar ultrasound analysis of breast lesions, particularly their growth pattern visible in the coronal plane, helps to distinguish between malignant and benign tumors. However, in cases with an indifferent/mixed growth pattern further investigations are necessary.

OC19.01: Additional value of CA‐125 to ultrasound for predicting specific diagnosis of benign adnexal cysts in premenopausal women

Uterine artery (UA) PI and RI were also measured. Customised birth weight centiles were calculated using the ‘Grow’ package, and SGA was defined as ≤ 10th centile. A mixed model statistical analysis was used which takes into account the longitudinal nature of the data (SAS). Results: 65 women were recruited. Nine women had SGA babies; only one had abnormal UA Dopplers at 23 weeks. Mixed model analysis demonstrated that the PI of the jets was significantly higher in ‘SGA’ pregnancies (P = 0.05) although the RI was not (P = 0.08). There was no significant difference in either the PI (P = 0.71) or RI (P = 0.84) of the UA between ‘SGA’ and ‘> 10th centile’ pregnancies. Conclusions: The PI of SA blood flow into the IVS is significantly higher when the pregnancy resulted in a SGA baby. Increased pulsatility may reflect the histologically observed persistence of vessel muscularity in the SA of pregnancies with APO. That no significant difference was seen in the UA indices may indicate that they are influenced by more than just physical change in the SAs. The technique used may have detected the pathology underlying impaired placentation resulting in SGA babies.

OP21.06: Diagnostic performance of transvaginal power Doppler ultrasound for predicting malignancy of adnexal masses in symptomatic and asymptomatic women

Objectives: To investigate the contribute of sonographic followup in the clinical management of incidental unilocular >5 cm and multilocular ovarian cysts 5 cm and multilocular ovarian cysts ( 50%) and/or sonographic parameters. Demographic, sonographic and pathologic data were recorded. Results: Median age (IR) was 70 years (61–75). Median years after menopause (IR) were 23 (12–27). Mean BMI (±SD) was 27 kg/m2 ±5. Mean parity (±SD) was 2 ± 1. 5 women reported bilateral cysts. 39 cysts were unilocular, 28 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 55 mm (50–62) and 42 mm (30–57), respectively. The median follow-up period was 24 months (11–46). Surgery was performed in 9 cases: 2 dropout and 7 volume changes. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular >5 cm and multilocular ovarian cysts <7 cm in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management.