D. Paladini

Simple ultrasound-based rules for the diagnosis of ovarian cancer

To derive simple and clinically useful ultrasound‐based rules for discriminating between benign and malignant adnexal masses.

Endometriomas: their ultrasound characteristics

To describe the ultrasound characteristics of endometriomas in pre‐ and postmenopausal patients and to develop rules that characterize endometriomas.

Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary

To describe the clinical and ultrasound features of fibroma and fibrothecoma of the ovary.

Imaging of gynecological disease (4): clinical and ultrasound characteristics of struma ovarii

To describe the clinical history and ultrasound findings in women with struma ovarii.

Clinically oriented three-step strategy for assessment of adnexal pathology

To determine the diagnostic performance of ultrasound‐based simple rules, risk of malignancy index (RMI), two logistic regression models (LR1 and LR2) and real‐time subjective assessment by experienced ultrasound examiners following the exclusion of masses likely to be judged as easy and ‘instant’ to diagnose by an ultrasound examiner, and to develop a new strategy for the assessment of adnexal pathology based on this.

Acoustic streaming cannot discriminate reliably between endometriomas and other types of adnexal lesion: a multicenter study of 633 adnexal masses

To determine the ability of acoustic streaming to discriminate between endometriomas and other adnexal masses.

Prospective external validation of the 'ovarian crescent sign' as a single ultrasound parameter to distinguish between benign and malignant adnexal pathology

To determine the sensitivity and specificity of the ‘ovarian crescent sign’ (OCS)—a rim of normal ovarian tissue seen adjacent to an ipsilateral adnexal mass—as a sonographic feature to discriminate between benign and malignant adnexal masses.

Effect of cancer prevalence on the use of risk-assessment cut-off levels and the performance of mathematical models to distinguish malignant from benign adnexal masses.

Two logistic regression models have been developed for the characterization of adnexal masses. The goal of this prospective analysis was to see whether these models perform differently according to the prevalence of malignancy and whether the cut‐off levels of risk assessment for malignancy by the models require modification in different centers.

OC153: Prospective evaluation of a model to diagnose adnexal masses as benign, primary invasive, borderline, or metastatic

a prevalence of less than 15%, between 15 and 30% and above 30%. To ascertain statistically significant differences in performance between the types of centers, the AUCs were compared using bootstrapping. The optimal cut-off level per center and type was chosen corresponding to a sensitivity level as high as possible (preferable above 90%) while still keeping a good specificity (80%) as this was considered to be very important in correctly identifying malignant cases. Results: Both LR1 and LR2 performed better, although not statistically significant, in centers with a lower prevalence of malignant cases. The AUC of centers with less than 15% of malignancy was 0.956 and 0.941, for LR1 and LR2 respectively; centers with prevalence between 15 and 30% had an AUC of 0.948 and 0.925, respectively and centers with more than 30% malignancies had an AUC of 0.933 and 0.914, respectively. The optimal cut-off per center varied between 0.05 and 0.20, but the performance in the centers with a higher percentage of malignant cases did not improve by choosing a different cut-off level. Conclusions: The performance of the logistic regression models increases with decreasing prevalence of malignancy. Because new cut-off levels per center would be based on 8 to 253 patients and the cut-off of 0.10 is optimal for all three types of center, it seems reasonable to use this cut-off in all centres.

OC025: Ultrasound characteristics of typical and atypical endometriomas

Objectives: Previously we showed that sonovaginography is an accurate ultrasonographic tool in the assessment of recto-vaginal endometriosis. The aim of this study was to compare the diagnostic accuracy of sonovaginography in the diagnosis of recto-vaginal endometriosis. Methods: A longitudinal prospective study in which 62 women with recto-vaginal endometriosis suspected with medical history and/or pelvic examination were enrolled. The study group underwent transvaginal ultrasonography and in the same session a sonovaginography was performed as follows: an assistant inserted a Foley into the vagina and an ultrasound probe covered with a specific ballon to shell the vagina. The ballon was filled with water with a mean of 40 ml, soon after an amount of 60–180 cc of saline solution was inserted trough the Foley catheter to fill the vagina with saline solution in order to create an acoustic window through the vagina to detect recto-vaginal lesions. The Bladder of women was not empty to obtain another acoustic window from the uterus and bladder. After the examination all the study group underwent laparoscopic surgery to enucleate the endometriosic lesion which was measured and sent for pathologic examination. Results: Fifty-four (87%) patients showed recto-vaginal endometriosic lesions. The sensitivity of sonovaginography was 92.1%, specificity 75.2%, PPV 96% and NPV 61.1%, The procedure was well tolerated with a median visual analogue scale of 2 (range 0–8). Conclusion: Sonovaginography is a well tolerated procedure, costless and with a high accuracy in the detection of recto-vaginal endometriosis.