Guillermo López-García

Endometrial Volume and Vascularity Measurements by Transvaginal 3-Dimensional Ultrasonography and Power Doppler Angiography in Stimulated and Tumoral Endometria An Interobserver Reproducibility Study

The purpose of this study was to evaluate interobserver reproducibility of endometrial volume and vascular indices of the endometrium and subendometrial area estimated by 3‐dimensional power Doppler angiography (3D‐PDA) using the Virtual Organ Computer‐Aided Analysis program, determining the influence of the endometrial growth etiology on measurements.

Diagnostic accuracy of FDG PET in the follow-up of platinum-sensitive epithelial ovarian carcinoma

PurposeThis study was designed to retrospectively evaluate the diagnostic yield of FDG PET for the diagnosis of recurrent ovarian cancer.MethodsEighty FDG PET scans were performed on 55 patients owing to suspicion of relapse, and 45 FDG PET scans were performed on 31 patients who were clinically disease free. PET results were compared with the results of conventional radiological imaging (CIM) and serum CA 125 levels, and related to pathological findings in 54 cases or clinical follow-up in 71 cases.ResultsCIM correctly identified 49 cases with recurrence [sensitivity (SE) 53.3%] ,and there were 27 true negatives [specificity (SP) 81.8%] However, 43 cases were false negative and six were false positive. The positive predictive value (PPV), negative predictive value (NPV) and accuracy (ACC) of CIM were 89%, 38.6% and 60.8%, respectively. FDG PET correctly detected recurrent disease in 80/92 cases (SE 86.9%, p < 0.05) and ruled out relapse in 26/33 cases (SP = 78.8%). The PPV, NPV and ACC of PET were 91.9%, 68.4% and 84.8%, respectively. Standardised uptake values did not provide additional diagnostic accuracy compared with visual analysis. The CA 125 results showed an SE of 57.6%, an SP of 93.9% and an ACC of 67.2%. In 23 patients with positive serum CA 125 levels, but negative CIM, FDG PET was positive and relapse was confirmed. Furthermore, FDG PET was positive and relapse was confirmed in 11 patients with negative serum CA 125 levels and CIM.ConclusionFDG PET may detect recurrent ovarian cancer earlier than CIM, with higher sensitivity and even higher diagnostic accuracy.

Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with three-dimensional US.

PURPOSE To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer. MATERIALS AND METHODS Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more. RESULTS Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r = 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for US-measured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%. CONCLUSION Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.

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.

Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics

To assess the correlation between intratumoral vascularization using three‐dimensional power Doppler angiography (3D‐PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma.

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.

Tumor vascularization in cervical cancer by 3-dimensional power Doppler angiography: correlation with tumor characteristics.

Objective: To evaluate whether tumor vascularity as assessed by 3-dimensional power Doppler angiography (3D-PDA) correlates with some tumor features in cervical cancer. Methods: Clinical, sonographic, and histologic data on 56 women (mean age, 47.8 years; range, 27-81 years) with a diagnosis of carcinoma in the uterine cervix were analyzed. Tumor volume and 3D-PDA indexes (vascularization index, flow index, and vascularization flow index) were calculated in all cases. These data were correlated with some tumoral features such as histologic type, histologic grade, lymphovascular space involvement, lymph node metastases, and tumor stage. Results: Intratumoral blood flow was found in all cases. No correlation was found between tumor volume and 3D-PDA indexes with histologic type, lymphovascular space involvement, and lymph node metastases. Moderately and poorly differentiated tumors and advanced-stage tumors had larger volume and 3D-PDA indexes (P < 0.05). Conclusions: Our data indicate that tumor vascularization as assessed by 3D-PDA correlates with some tumor features in cervical cancer.

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.

OC05.02: Transvaginal color Doppler in the detection of ovarian cancer in a large study population of postmenopausal women

Objectives: To evaluate number of preand postnatally detected cases of trisomy 18 and trisomy 13 in relation to the introduction of a new national screening strategy for trisomy 21 issued in 2004. Methods: All cases of trisomy 18 and trisomy 13 detected preand postnatally from 1997 to 2007 were retrieved from the National Danish Cytogenetic Registry including information on gestational age at diagnosis for prenatal cases. Results: The number of cases of trisomy 13 and trisomy 18 detected after 22 weeks or at birth has decreased from 15–20 cases per year in 1997–2004 to less than 5 cases in 2007 (figure 1). The proportion of prenatal cases detected before 18 weeks has increased after 2004. Conclusion: Introduction of new national guidelines, offering a combined first trimester risk assessment for trisomy 21 to all pregnant women, have also had an impact on the detection of other chromosomal aneuploidies. The vast majority of fetuses with trisomy 13 and trisomy 18 are diagnosed early in pregnancy, even though the number of invasive procedures performed in Denmark after the introduction of the new national guidelines has decreased steeply.