E De Jonge

Ultrasound methods to distinguish between malignant and benign adnexal masses in the hands of examiners with different levels of experience

To determine the effect of an ultrasound training course on the performance of pattern recognition when used by less experienced examiners and to compare the performance of pattern recognition, a logistic regression model and a scoring system to estimate the risk of malignancy between examiners with different levels of experience.

Audit on nuchal translucency thickness measurements in Flanders, Belgium: a plea for methodological standardization.

To audit nuchal translucency thickness (NT) measurements for fetal aneuploidy screening in Flanders, and to estimate the impact of small variations in NT measurement on the screening result of two first‐trimester screening algorithms: maternal age + NT (Algorithm A), and maternal age + NT + pregnancy associated plasma protein‐A + free β‐human chorionic gonadotropin (Algorithm B).

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.

Development and external validation of new ultrasound‐based mathematical models for preoperative prediction of high‐risk endometrial cancer

To develop and validate strategies, using new ultrasound‐based mathematical models, for the prediction of high‐risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only.

OC17.02: New ultrasound based mathematical models for the preoperative prediction of high risk endometrial cancer

Objectives: To describe the sonographic and clinical findings in a cohort of fetuses with commissural anomalies. To compare between US, MRI and autopsy findings. Methods: Retrospective review of all the cases with commissural anomalies diagnosed between January 1989–May 2010. Results: 176 cases of commissural anomalies were identified. The number of cases diagnosed rose from a mean of 1.25/year during 1989–2000 to 15.8/year during 2001–2010. The mean gestational age was 26.5 ± 4.7 weeks (range 15–38). Agenesis of the corpus callosum (ACC) was diagnosed in 47%, dysgenesis of the corpus callosum (DCC) in 46%, cavum septi pellucidi (CSP) anomalies in 5% and pericallosal lipoma in 2%. Associated anomalies were present in 122 (69%) and included anomalies of: central nervous system (104), musculoskeletal (29), genitourinary (17), cardiac (14), dysmorphic features (24), gastrointestinal (5), and miscellaneous (12). Colpocephaly was evident in 71 (40%) cases. MRI was performed in 79 (45%) cases; added new information but did not modify management in 10; and was not conclusive in 7 cases. Autopsy were performed in 65 cases out of 119 (78%) terminated pregnancies. There was a case of IUFD, 53 (30%) children were delivered but 5 died. Out of the 48 livebirths there were 13 with ACC, 22 with DCC, 4 with lipoma and 9 with CSP anomalies. Overall 27 of them are developing normally, 10 suffer from mild to moderate developmental delay, 5 form severe developmental delay and 6 have not yet been evaluated. Conclusions: Fetal commissural anomalies can be diagnosed reliably by the sonographic examination. The correlation between US, MRI and autopsy findings is high. MRI has only a marginal role in diagnosis but contributes to reassure the patients. Prognosis is highly dependent on the presence of associated anomalies.

OC148: The value of the “ovarian crescent sign” to exclude an invasive malignancy

Objectives: To prospectively evaluate the results of the CA-125 analyses performed on the IOTA (International Ovarian Tumor Analysis group) phase 1 data. Methods: Using the IOTA phase 1 data, logistic regression models with and without CA-125 as a predictor were developed to predict malignancy of ovarian tumors in preand postmenopausal women. These models were applied to the prospectively collected data from phase 2 (n = 1940). Their performance was evaluated using receiver operating characteristic (ROC) curves, area under the curve (AUC), and the sensitivity at 75% specificity (Sens75). Next, the performance of the expert operator’s subjective impression (pattern recognition) was compared to CA-125 alone, and the median CA125 level was computed for each histological endpoint. To this end, the data from IOTA phases 1, 1b, and 2 were used (n = 3513). Results: In premenopausal women, the logistic regression models with and without CA-125 had AUCs of 0.940 and 0.939, respectively. Sens75 levels were 94.2 and 95.9%. For postmenopausal women, the models with and without CA-125 had AUC values of 0.937 and 0.920, respectively, with Sens75 levels of 91.3 and 92.0%. The ROC curves for models with and without CA-125 were nearly identical in their top left part where sensitivity and specificity are high. Pattern recognition (sensitivity 92%, specificity 90%) clearly performed better than CA-125 alone. CA-125 levels were high in endometriomas (median = 20 U/ml) and abscesses (40 U/ml). Borderline stage I tumors had a median CA-125 level of 29 U/ml, rare primary invasive tumors of 52 U/ml. The highest CA-125 levels were obtained for primary invasive tumors of stage II–IV. Conclusions: The results confirmed our previous conclusions regarding the role of CA-125 in ovarian tumor diagnosis. This marker need not be used in mathematical models for preor postmenopausal patients. Characterizing ovarian pathology using CA-125 alone is inferior to pattern recognition by an experienced operator.