J. Utrilla-Layna

Interobserver agreement in describing adnexal masses using the International Ovarian Tumor Analysis simple rules in a real-time setting and using three-dimensional ultrasound volumes and digital clips

To estimate the agreement between an expert and a non‐expert examiner using the International Ovarian Tumor Analysis (IOTA) simple rules for classifying adnexal masses on real‐time ultrasound and when using three‐dimensional (3D) ultrasound volumes and digital clips.

Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis.

To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods.

Transvaginal/transrectal ultrasound for assessing myometrial invasion in endometrial cancer: a comparison of six different approaches

Objective To compare the diagnostic performance of six different approaches for assessing myometrial infiltration using ultrasound in women with carcinoma of the corpus uteri. Methods Myometrial infiltration was assessed by two-dimensional (2D) transvaginal or transrectal ultrasound in 169 consecutive women with well (G1) or moderately (G2) differentiated endometrioid type endometrial carcinoma. In 74 of these women three-dimensional (3D) ultrasound was also performed. Six different techniques for myometrial infiltration assessment were evaluated. The impression of examiner and Karlssons criteria were assessed prospectively. Endometrial thickness, tumor/uterine 3D volume ratio, tumor distance to myometrial serosa (TDS), and van Holsbekes subjective model were assessed retrospectively. All subjects underwent surgical staging within 1 week after ultrasound evaluation. Definitive histopathological data regarding myometrial infiltration was used as gold standard. Sensitivity and specificity for all approaches were calculated and compared using McNemar test. Results The impression of examiner and subjective model performed similarly (sensitivity 79.5% and 80.5%, respectively; specificity 89.6% and 90.3%, respectively). Both methods had significantly better sensitivity than Karlssons criteria (sensitivity 31.8%, p<0.05) and endometrial thickness (sensitivity 47.7%, p<0.05), and better specificity than tumor/uterine volume ratio (specificity 28.3%, p<0.05) and TDS (specificity 41.5%, p<0.05). Conclusion Subjective impression seems to be the best approach for assessing myometrial infiltration in G1 or G2 endometrioid type endometrial cancer by transvaginal or transrectal ultrasound. The use of mathematical models and other objective 2D and 3D measurement techniques do not improve diagnostic performance.

Clinical and ultrasound features of type I and type II epithelial ovarian cancer.

Objective The objective of this study was to assess whether there are differences on ultrasound features between epithelial ovarian cancer (EOC) type I and type II. Methods This was a retrospective study comprising 244 women (mean age, 55.2 years old) with histologically proven EOC treated at our institution over a 12-year period. Clinical (patient age and symptoms and tumor stage), ultrasound (tumor volume, tumor appearance on gray-scale ultrasound, and color score), and histopathologic records were reviewed. Tumors were classified as EOC type I or type II. Type I tumors comprise low-grade serous, low-grade endometrioid, clear cell, mucinous, and transitional cell carcinomas, whereas type II tumors comprise high-grade serous, high-grade endometrioid, malignant mixed mesodermal tumors, and undifferentiated carcinomas. Categorical variables were compared using &khgr;2 test. Continuous variables were compared using 1-way analysis of variance with Bonferroni post hoc test or Mann-Whitney U or Kruskal-Wallis test, depending on data distribution. Results Sixty-seven women (27.5%) had type I EOC, and 177 (72.3%) had type II EOC. We observed that women with type I EOC were younger, presented asymptomatic at diagnosis more frequently, and had lower CA-125 levels and lower tumor stage than women with type II EOC. Type II EOCs were more frequently identified as a solid mass and were smaller lesions than type I EOC. Conclusions Some differences exist between type I and type II EOC in clinical and ultrasound manifestations. Although the clinical significance of these findings is still to be determined, this information could provide some clues to clinicians faced with the diagnosis of ovarian cancer.

Transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases in well or moderately differentiated endometrioid carcinoma of the endometrium

To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases among women with well‐differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium.

Are we ready for conservative treatment in ovarian cancer

To the editor: Ovarian cancer is a rare malignancy, which is the 4th in frequency of all gynecologic malignancies; however, it represents the most lethal gynecological cancer. Ovarian cancer in young patients is also rare; it is considered that 3% to 17% of all epithelial ovarian cancers occur in women less than 40 years. The presentation of majority epithelial ovarian cancers is in advanced stages (The International Federation of Gynecology and Obstetrics [FIGO] III to IV) when 5-year overall survival is less than 30%. When presented in early stages the 5-year overall survival reaches 90% for FIGO stage I. Pregnancy rate in women after fertility-sparing surgery in cases of early ovarian cancer is 63% to 100%, with a 20% abortion rate [1]. The proportion of patients with early ovarian cancer demanding fertility-preserving techniques is increasing. This represents a challenge to the gynecologic oncologist when setting the limits in order to not affect the prognosis and survival of these patients. Management of FIGO stages I to II includes bilateral salpingoophorectomy and hysterectomy, so it is mandatory to identify women desiring preserve fertility. Most studies published to date conclude that preserving the uterus and contralateral ovary in very early stages (FIGO IA and IB), with a histological grade differentiated or moderately differentiated (G1 to G2), could be a reasonable option [2]. After reading the last paper from Ditto et al. [3] we are quite concerned about their conclusions, since in their series the authors included 5 FIGO stage IC cases, and 5 grade 3 tumors with a recurrence rate of 22% in the fertility-preserving group. Authors concluded that considering their results, fertility sparing surgery in early epithelial ovarian cancer seems to be safe, which on the basis of the current evidence it is very controversial and it seems to be unsafe for tumors FIGO IC/G3 and higher [1]. Moreover, although we partially agree with Kajiyama [4] on the low impact of preserving surgery in survival, we do not have enough evidence to assume FIGO stage IC and grade 3 tumors, and we completely agree on the idea that further investigation in this line is needed, mandatorily by multicentric cooperation. Very limited authors have tried conservative treatment in FIGO stage IC and/or poorly differentiated tumors (G3), but with a moderate high rate of recurrence [5]. Some others consider removal of uterus and ovaries after birth, but in our opinion, preservation of endocrine function in selected young women is as important as fertility sparing approach, so we suggest the maintenance of the uterus and contralateral ovary delaying its removal until 45 years old with a close follow-up. It is also important to consider the probability of the patient to get pregnant and to reach term, since after 40 years old the fertility rate drops dramatically, and maybe the low risk of recurrence could not be justify. This can also make the patient require assisted reproductive technology (ART), which is also unclear how it can affect the cancer process. The influence of ART nowadays is unclear and the results are controversial. ART could increase the rate of recurrent ovarian cancer or even the incidence of further estrogen-dependent cancers such as breast or endometrial. In the literature just borderline ovarian tumors are clearly related to ART. Moreover, the risk of recurrence in low-risk patients (ovarian cancer FIGO IA/IB-G1/G2) is very low, with just one case reported in literature after fertility sparing surgery and ART. There is a need of close collaboration between cancer centers and reproductive clinics in these cases, which may be advantageous to safeguard reproductive health among women [6]. In conclusion, we think we are ready for fertility-sparing surgery in early epithelial ovarian cancer as an effective alternative to conventional radical surgery in younger women but just for selected cases where recurrence rate is very low such as FIGO stage IA/IB-G1/G2, and we need to be very careful with stages IC and G3 individualizing every case.

Transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well- or moderately differentiated endometrioid carcinoma.

To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high‐risk cases among women with well‐differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium.

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.

Malignant Ovarian Tumors (Serous/Mucinous/Endometrioid/Clear Cell Carcinoma): Clinical Setting and Ultrasound Appearance

Epithelial ovarian cancer remains as the most deadly gynecological malignancy and it is the seventh leading cause of cancer in women in developed countries. Worldwide more than 200,000 new cases are diagnosed annually, resulting in more than 140,000 deaths. Histologically, ovarian malignancies are classified in two broad groups: epithelial and non-epithelial ovarian cancer. Epithelial ovarian cancers are subclassified based on hystotype, with serous, endometrioid, clear cell, and mucinous carcinomas accounting for 96 % of all cases. In this chapter we shall review the origin, clinical setting, and ultrasound appearance of serous, endometrioid, and mucinous carcinomas.