L. Juez

Three-Dimensional Hysterosalpingo-Contrast-Sonography for the Assessment of Tubal Patency in Women with Infertility: A Systematic Review with Meta-Analysis

Background/Aims: We aimed at performing a systematic review to determine the diagnostic accuracy of three-dimensional (3D) hysterosalpingo-contrast-sonography (HyCoSy) for detecting tubal occlusion. Methods: A systematic review in Medline database search from January 1989 to October 2015 to identify relevant studies evaluating 3D-HyCoSy. Eligibility criteria were studies assessing the role of 3D-HyCoSy for diagnosing tubal occlusion in infertile women. Index test was 3D-HyCoSy. Reference standard was laparoscopy with dye test or X-ray hysterosalpingography. Quality was assessed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity for the method were estimated. Results: A total number of 88 papers were identified. After exclusions, nine studies were ultimately included. Pooled estimated sensitivity was 98% (95% CI 91-100) with a moderate heterogeneity (I2: 64.8%, 95% CI 39.6-89.9; and Cochran Q 22.7, p < 0.001). Pooled estimated specificity was 90% (95% CI 83-95) with significant heterogeneity (I2: 80.3%, 95% CI 68.1-92.5; and Cochran Q 40.6, p < 0.001). Positive likelihood ratio was 10.3 (95% CI 5.6-18.7) and negative likelihood ratio was 0.02 (95% CI 0.00-0.21). Conclusion: 3D-HyCoSy is an accurate test for diagnosing tubal occlusion in women with infertility.

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.

Intraoperative Gross Examination and Intraoperative Frozen Section in Patients With Endometrial Cancer for Detecting Deep Myometrial Invasion: A Systematic Review and Meta-analysis.

Objective The aim of this study was to perform a meta-analysis comparing diagnostic performance of intraoperative gross evaluation (IGE) and intraoperative frozen section (IFS) for the assessment of myometrial invasion in patients with endometrial cancer. Methods An extensive search was performed in several databases from January 1989 to May 2015. Eligibility criteria were studies using intraoperative gross evaluation or intraoperative frozen section to determine deep myometrial invasion in patients with endometrial cancer using the final histopathology report with reference standard. Quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results Forty-seven articles were identified. Of these, 35 studies were selected and included in the meta-analysis. A total of 6387 women were evaluated intraoperatively with any of the 2 methods mentioned. Pooled sensitivity and specificity for IGE were 71% (95% confidence interval [CI], 63%–77%) and 91% (95% CI, 89%–93%), respectively. Heterogeneity was found high for sensitivity (I2: 83.6%; Cochran Q: 79.4; P < 0.001) and moderate for specificity (I 2, 51.4%; Cochran Q, 29.8; P =0.01). Pooled sensitivity and specificity for IFS were 85% (95% CI, 81%–88%) and 97% (95% CI, 96%–98%), respectively. Heterogeneity was found moderate for sensitivity (I 2, 56.4%; Cochran Q, 45.9; P < 0.001) and high for specificity (I 2, 83.2%; Cochran Q, 118.9; P < 0.001). Both sensitivity (P = 0.0008) and specificity (P = 0.0021) were significantly higher for IFS compared to IGE. Conclusion Intraoperative frozen section has better diagnostic performance than intraoperative gross evaluation for the intraoperative diagnosis of deep myometrial invasion in patients with endometrial cancer.

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.

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.

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.

Malignancy risk of sonographically benign appearing purely solid adnexal masses in asymptomatic postmenopausal women.

Objective: To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. Methods: Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis. Results: Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). Conclusions: The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.

Reproducibility of the International Endometrial Analysis Group Color Score for Assigning the Amount of Flow Within the Endometrium Using Stored 3-Dimensional Volumes

To estimate intraobserver and interobserver reproducibility for assigning an International Endometrial Tumor Analysis (IETA) group color score for endometrial vascularization on color Doppler imaging.