M. Pascual

Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements : A consensus opinion from the International Deep Endometriosis Analysis (IDEA) group

The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright

IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation

To determine the diagnostic performance of International Ovarian Tumor Analysis (IOTA) ‘simple’ rules for discriminating between benign and malignant adnexal masses.

Accuracy of three-dimensional ultrasound compared with magnetic resonance imaging in diagnosis of Müllerian duct anomalies using ESHRE–ESGE consensus on the classification of congenital anomalies of the female genital tract

To establish the accuracy of three‐dimensional ultrasound (3D‐US), compared with magnetic resonance imaging (MRI), for diagnosing uterine anomalies, using the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) consensus on the classification of congenital anomalies of the female genital tract.

Diagnosis of the Most Frequent Benign Ovarian Cysts: Is Ultrasonography Accurate and Reproducible?

OBJECTIVE To evaluate the reproducibility and the accuracy of B-mode ultrasonographic features of three different kinds of benign ovarian cysts: ovarian endometrioma, mature teratoma, and serous cyst. METHODS Digitally stored B-mode sonographic images of 98 women submitted to surgery for the presence of an adnexal mass were evaluated by five different examiners with different degrees of experience. The histological type of each mass was predicted on the basis of the B-mode typical benign findings, as in the case of endometrioma (groundglass endocystic pattern), cystic teratoma (echogenic pattern with or without acoustic shadow), and serous cyst (anechoic cyst without endocystic vegetations). To assess the reproducibility of the B-mode findings, intraobserver and interobserver agreements were calculated using the kappa index. RESULTS The intraobserver agreement was good or very good for all examiners and for all patterns (kappa = 0.71-1) except for the dermoid cyst, which showed moderate agreement (kappa = 0.42) for the highly experienced operator. The interobserver agreement was good for all experts for endometrioma (kappa = 0.66-0.78) and for serous cyst (kappa = 0.82-1), whereas it was moderate or good for cystic teratoma (kappa = 0.51-0.72). Interobserver agreement between experts and highly experienced operators was fair (kappa = 0.33-0.36) for teratoma and good or very good for endometrioma (kappa = 0.70-0.83) and serous cyst (kappa = 0.76-0.82). For different kinds of cysts, the accuracy was comparable among different operators. CONCLUSIONS Typical features of benign masses using grayscale transvaginal ultrasonography are reproducible even in moderately experienced examiners, although more experience was associated with better interobserver agreement. The diagnostic performance of different operators with different degrees of experience is similar.

Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography

OBJECTIVE To evaluate the diagnostic accuracy of introital three-dimensional (3D) transvaginal sonography for preoperative detection of rectovaginal septal endometriosis. DESIGN Ultrasonographic results were compared with surgical and histologic findings. SETTING University Department of Obstetrics and Gynecology. PATIENT(S) This prospective study included 39 women with suspected rectovaginal endometriosis. INTERVENTION(S) All patients underwent 3D transvaginal sonography for the evaluation of the rectovaginal septum, before undergoing laparoscopic radical resection of endometriosis. Rectovaginal endometriosis was defined as hypoechoic areas, nodules, or anatomic distortion of this specific location. MAIN OUTCOME MEASURE(S) Sensitivity, specificity, and likelihood ratios (positive or negative) were calculated with 95% confidence intervals (CIs). RESULT(S) Surgery associated with histopathologic evaluation revealed deep endometriosis in the rectovaginal septum in 19 patients. The specificity, sensitivity, positive likelihood ratio, and negative likelihood ratio were 94.7% (95% CI, 78.6%-99.7%), 89.5% (95% CI, 73.3%-94.5%), 17.2 (95% CI, 2.51-115), and 0.11 (95% CI, 0.03-0.41), respectively. CONCLUSION(S) Introital 3D ultrasonography seems to be an effective method for the diagnosis of endometriosis of the rectovaginal septum and should be included in the preoperative evaluation of patients with clinical suspicion of deep endometriosis.

Role of Color Doppler Ultrasonography in the Diagnosis of Endometriotic Cyst

We studied the role of color Doppler ultrasonography in the distinction between endometriomas and other adnexal masses. Three hundred and fifty‐two ovarian lesions were studied, comparing sonographic diagnosis with pathologic findings. On color Doppler sonography, an endometriotic cyst usually appeared as a cystic lesion with diffuse internal echoes and low vascularization. The sensitivity and specificity of color Doppler transvaginal sonography in detecting endometriotic cysts were 91.8% and 95.3%, respectively. The positive and negative predictive values were 95.5% and 91.5%, respectively. In our experience, transvaginal sonography with color Doppler interrogation is a useful technique in the diagnosis of pathologic ovarian conditions, including cystic endometriosis.

INTRAOBSERVER AND INTEROBSERVER AGREEMENT OF GRAYSCALE TYPICAL ULTRASONOGRAPHIC PATTERNS FOR THE DIAGNOSIS OF OVARIAN CANCER

The purpose of this study was to evaluate the intraobserver and interobserver agreement for identifying ovarian malignancy using typical grayscale ultrasonographic patterns. Digitally stored grayscale sonographic images from a random sample of 98 women with an adnexal mass submitted to surgery after a grayscale transvaginal sonography were evaluated by five different examiners with different degrees of experience in three European university departments of obstetrics and gynecology. Masses in which the echo features were highly characteristic of a benign pathology were categorized as benign. Any cystic mass containing excrescences, thick septations, multiple irregular septations or solid component in which the echo architecture was not highly suggestive of benign histology was categorized as malignant. Intraobserver and interobserver agreement according to the level of experience were assessed by calculating the kappa index. Of the 98 cases randomly selected, 28 (29%) were malignant masses and 70 (71%) were benign. Intraobserver agreement was good or very good for all examiners with different degrees of experience (kappa = 0.72 to 1). Interobserver agreement was good for all expert operators (kappa = 0.69 to 0.75). Interobserver agreement between experts and highly experienced operators was moderate or good (kappa = 0.51 to 0.63). Interobserver agreement between the moderately experienced operator and experts was fair to moderate (kappa = 0.29 to 0.46). Interobserver agreement between moderately and highly experienced operators was fair (kappa = 0.33). Our results indicate that ultrasonographic malignant patterns are reproducible, even in moderately experienced examiners, although more experience is associated with better interobserver agreement.

Clinical and sonographic features of uncommon primary ovarian malignancies

To describe the gray‐scale and color Doppler ultrasound features of uncommon (<5% prevalence) primary malignant ovarian tumors.

The Diagnosis of Ovarian Cancer: Is Color Doppler Imaging Reproducible and Accurate in Examiners with Different Degrees of Experience?

OBJECTIVE To evaluate the reproducibility and accuracy of color Doppler flow location in indeterminate masses after a gray-scale sonography in the diagnosis of ovarian malignancy. METHODS Digitally stored color Doppler sonographic images from a random sample of 130 women with an indeterminate adnexal mass submitted to surgery were evaluated by six different examiners with different degrees of experience. A mass was graded malignant if flow was shown within the excrescences or solid areas. Intraobserver agreement and interobserver agreement according to the level of experience were assessed by calculating the kappa index. RESULTS Intraobserver agreement was good for all examiners with different degrees of experience (kappa 0.72-0.89). Interobserver agreement was good to moderate for all operators (kappa 0.48-0.71) irrespective of degree of experience. The accuracy was comparable among different operators. CONCLUSIONS Our results indicate that color Doppler imaging for detection of adnexal malignancy seems to be a reproducible method even in moderately experienced examiners.

Preoperative diagnosis of metastatic ovarian cancer is related to origin of primary tumor

To describe the gray‐scale and color Doppler ultrasound features as well as some clinical and biochemical features of metastatic ovarian tumors according to the origin of the primary tumor in a large study population,