M. Perniciano

Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis.

To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of rectosigmoid endometriosis in patients with clinical suspicion of deep infiltrating endometriosis (DIE), comparing enhanced (E‐TVS) and non‐enhanced approaches.

OC15.07: Ultrasonographic “soft” markers for the detection of rectosigmoid endometriosis

Objectives: To assess the value of nodule’s volume and location for predicting type of resection during surgery in women with DIE involving the rectosigmoid. Methods: Retrospective analysis of prospectively collected data from 76 consecutive women (mean age: 33.8-year old) who underwent enhanced transvaginal ultrasound for assessing DIE involving the rectosigmoid prior to surgery. DIE nodule’s volume and distance to the anal verge were estimated. All women underwent laparoscopy and bowel surgery. The type of surgery (complete resection with termino-terminal anastomosis (T-T), discoid resection or shaving) was correlated with ultrasound measurements. Results: Sixty women underwent shaving surgery, four women underwent discoid resection and twelve women underwent complete resection with T-T. Median nodule’s volume was significantly higher in women with complete resection and T-T as compared with women discoid resection or shaving surgery (4.8 cm3 versus 1.6 cm3, p < 0.001). There were no differences for nodule distance to the anal verge. A volume > 2.3 cm3 had a sensitivity of 100%, specificity of 75%, PPV of 43% and NPV of 100% for identifying women with complete resection ad T-T. Conclusions: Nodule volume estimation by enhanced transvaginal ultrasound in women with DIE involving the rectosigmoid might be useful for predicting the type of resection during surgery.

OC04.04: Is the introduction of magnetic resonance in the diagnostic workout of adnexal masses just an increase of costs when IOTA Simple Rules are applied?

Methods: This is a retrospective study in a tertiary referral centre. Patients who presented at the Department of O&G at Singapore General Hospital in a 3-year period between 2014 and 2017 with suspected ovarian pathology were evaluated using IOTA LR2 model and designated as benign (likelihood ratio of malignancy less than 10%) or malignant (likelihood ratio of malignancy greater than 10%). LR2 scores were correlated with histopathological findings. Collected data was statistically analysed using chi-square test. Results: Of the 1110 patients who were assigned an IOTA LR2 score, 745 (67.7%) were managed conservatively or declined surgery. Of the 355 (32.3%) patients who underwent surgery, 150 (42%) had ovarian masses classified as malignant (LR2 greater than 10%). Of these 150 patients, 21 received a benign diagnosis with histopathological confirmation. All of the remaining 205 patients with masses assigned a likelihood score of LR2 less than 10% were confirmed to benign. The sensitivity for the detection of malignancy using the IOTA LR2 model was 100% and the specificity was 90.7%, with a positive predictive value of 86% and accuracy of 94%. Conclusions: IOTA ultrasound-based logistic regression models were highly sensitive and specific in predicting ovarian malignancy preoperatively yet being reproducible, easy to train and use.

Deep Infiltrating Endometriosis: Comparison Between 2-Dimensional Ultrasonography (US), 3-Dimensional US, and Magnetic Resonance Imaging: Deep Infiltrating Endometriosis: Comparison Between 2DUS, 3DUS, and MRI

To evaluate the diagnostic accuracy of 2‐dimensional (2D) and 3‐dimensional (3D) transvaginal ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for identification of deep infiltrating endometriosis.

The Ovarian Endometrioma: Clinical Setting and Ultrasound Findings

Ovarian endometrioma is defined as a pseudocyst arising from growth of ectopic endometrial tissue. The typical features of endometriomas are diffuse low-level internal echoes (“ground glass”) in the absence of particular neoplastic features and with a clear demarcation from ovarian parenchyma. Several studies report very high values of specificity with values of sensitivity usually ranging from 87 to 77 %.

OC21.05: Low rate of inconclusive findings in less expert operators using ultrasound simple rules for the diagnosis of ovarian cancer

and LR2, the simple rules and the RMI were applied to each of the three groups. Sensitivity, specificity, positive and negative likelihood ratio (LR+, LR−), Diagnostic Odds Ratio (DOR), and area under the receiver operating characteristic curve (AUC) were used to describe diagnostic performance. The gold standard was the histological diagnosis of the surgically removed adnexal mass. Results: The rate of invasive malignancy was 10% in the small tumors, 19% in the medium sized tumors and 40% in the large tumors; 11% of the large tumors were borderline tumors versus 3% and 4% of the small and medium sized tumors. The type of benign histology also differed between the three subgroups. For all methods, the sensitivity with regard to malignancy was lowest in the small tumors, while the specificity was lowest in the large tumors; the DOR and the AUC were highest in the medium sized tumors. The AUC was largest in tumors with a largest diameter 7–11 cm. Conclusions: Tumor size affects the ability of subjective assessment, LR1 and LR2, the IOTA simple rules and the RMI to correctly discriminate between benign and malignant adnexal masses.

OP29.09: Accuracy and reproducibility of ultrasonography for the diagnosis of ovarian cancer in operators with different degrees of experience

according to the IOTA protocol. A proper counselling on a low ovarian cancer risk was given and an adequate informed consent was obtained. Sonographic follow-up was proposed at 3 and 9 months, than yearly. Surgery was proposed in case of changes of ovarian cyst volume (>50%) and/or sonographic parameters at TVS-CD. Demographic, medical, sonographic and pathologic data were recorded. Results: 98 post-menopausal patients with 106 ovarian cysts were enrolled. Median age (IR) was 69 years (59–74). Median years after menopause (IR) were 18 (8–24). Median BMI (IR) was 26 kg/m2 (24–29). Mean parity (±sd) was 2 ± 1.8 women reported bilateral cysts. 53 cysts were unilocular, 53 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 50 mm (34–56). At a median follow-up period of 36 months, surgery was performed in 28 cases: 14 patients required immediate removal, 5 drop-out, 9 volume changes. One successfully managed cardiac arrest occurred during laparoscopic procedure. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular >5 cm and multilocular <7 cm ovarian cysts in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management.

OP29.06: Perception error and levels of certainty in diagnosing ovarian cancer in operators with different degree of experience

Objectives: To evaluate, sonographic, power-Doppler features and histological findings in cases of small unilocular-solid cyst in a normal-size ovary. Methods: All consecutive women with small ovarian unilocularsolid cyst in normal-size ovary detected by transvaginal ultrasound, were included in the study. Patients had either follow-up ultrasound examination every three months or underwent surgical removal of the cyst. CA 125 was also evaluated. Histological findings were reviewed. Results: A total of 45 cases were identified. The median age of the patients was 48 years (range 25–77). CA 125 was elevated (>35 UI/mL) in 6/45 (13%) cases. The median size of the cyst was 18 mm (range 11–30). The vascularization was present in 20/45 (44%) cases. 15/45 (33%) women received followup ultrasound examination every three month. 30/45 (67%) undervent laparoscopic removal of the cyst. Hystological diagnosis of malignancy (three carcinoma, and six borderline tumors) was recorded in 9/45 (20%) cases and of benign lesion in 21/45 (47%). Conclusions: These data suggest that the presence of a papillary projection is more important than the size of the cyst. Small unilocular solid cysts even in a normal-size ovary have substantial risk of malignancy.