Mercedes Espada

Diffusion-weighted magnetic resonance imaging evaluation of intra-abdominal sites of implants to predict likelihood of suboptimal cytoreductive surgery in patients with ovarian carcinoma

AbstractObjectivesTo analyse the diagnostic accuracy and to establish a predictive score based on diffusion-weighted magnetic resonance imaging (DWMRI) compared to exploratory laparotomy (EL) for predicting suboptimal cytoreductive surgery for different intra-abdominal sites of implants in patients with ovarian cancer.MethodsThirty-four patients with advanced ovarian carcinoma were studied. Preoperative DWMRI of the abdomen and pelvis was performed. DWMRI findings were compared with EL. Ten anatomical sites were selected for inclusion in the score. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for suboptimal cytoreduction were calculated for both DWMRI and EL. Receiver operating characteristic (ROC) curve analysis was used to assess the ability to predict suboptimal cytoreduction.ResultsUsing predictive score, ROC curves were generated with an area under the curve of 0.938 for DWMRI and 0.947 for EL (Pu2009<u20090.0001). For DWMRI, a score ≥6 had the highest overall accuracy at 91.1xa0% and identified patients with unnecessary EL with a sensitivity of 75xa0%. For EL, a score ≥4 had the highest overall accuracy at 88.2xa0% and was able to identify patients with unnecessary EL with a sensitivity of 87.5xa0%.ConclusionsDWMRI is an emerging technique that may be useful to predict suboptimal cytoreduction in ovarian cancer.Key Points• DWMRI is increasingly used in ovarian cancer.n • DWMRI is an accurate technique for depicting intra-abdominal sites of implantsn • DWMRI is useful for predicting optimal cytoreductive surgical outcome.n • We report a high predictive value similar to exploratory laparotomy.

Surgical Excision of Advanced Endometriosis: Perioperative Outcomes and Impacting Factors.

OBJECTIVEnTo determine perioperative outcomes and factors impacting operating time, length of hospital stay, and complications of patients undergoing surgery for stage 3 or 4 endometriosis.nnnDESIGNnRetrospective review of medical records (Canadian Task Force classification II-2).nnnSETTINGnMayo Clinic Hospital, Phoenix, Arizona.nnnPATIENTSnWomen (n = 493) with endometriosis stage 3 and 4 undergoing surgical excision between March 15, 2005, and December 31,xa02011.nnnINTERVENTIONSnRobotic-assisted (n = 331) or laparoscopic (n = 162) excision.nnnMEASUREMENTSnAge, body mass index, comorbidities, number and type of procedures per patient, type of surgical approach, operating time, blood loss, intraoperative and postoperative complications (within 42 days), and length of hospital stay.nnnMAIN RESULTSnThe mean patient age was 39.5 years; body mass index, 25.9; number of procedures, 3.3; operating time, 130.4 minutes; blood loss, 88.5 mL; and hospital stay, 1.0 days. Major complications occurred in 5 patients (1.5%). Fifty-nine patients (12.0%) underwent modified radical hysterectomy, 90 (18.3%) underwent ureteral and/or intestinal resection, and 3 (0.6%) underwent diaphragm resection. Factors significantly associated with operating time included age (p = .008) and blood loss, number of procedures per patient, and robotics (all p < .001). Length of stay was affected by age, operating time, and blood loss (all p < .001). Operating time was the only significant factor associated with postoperative complications (p < .001).nnnCONCLUSIONnOperating time is an independent and significant factor for postoperative complications and hospital stay.

Fetal magnetic resonance imaging and neurosonography in congenital neurological anomalies: supplementary diagnostic and postnatal prognostic value

Abstract Objective: To compare the diagnostic conclusions between fetal neurosonography and MRI in the cases of congenital neurological abnormalities, and with postnatal clinical and imaging evaluation, when available. Methods: A retrospective study of 28 patients who underwent a fetal MRI study for suspected congenital neurological anomalies. The diagnoses obtained by neurosonography and MRI were collected and compared. Both of them were compared with the final diagnosis when available by necropsy or postnatal evaluation. Postnatal imaging tests were performed only when clinically indicated. Results: The indications for the fetal MRI examination were: fetal ventriculomegaly, posterior fossa anomalies, suspected midline defects, small-for-gestational-age cephalic biometry and confirmed congenital CMV infection. There was a good degree of agreement beyond chance between both techniques (kappa testu2009=u20090.76). Conclusions: Both imaging modalities give a high-diagnostic performance with a good degree of agreement between them, when made by specialized staff. Fetal MRI is a valuable complementary tool to detailed neurosonography which allows an evaluation of the normal brain maturation from the second trimester. It also offers a higher diagnostic performance for some congenital abnormalities such as cortical development or acquired lesions.

Clinical value of maternal bile Acid quantification in intrahepatic cholestasis of pregnancy as an adverse perinatal outcome predictor.

Aims: To evaluate the correlation between perinatal outcome and bile acid levels in intrahepatic cholestasis of pregnancy (ICP), and to evaluate variations in the mean bile acid level when stratifying by maternal and perinatal factors. A comparison between mild and severe ICP was made. Methods: A prospective observational study was performed in pregnant patients who underwent blood tests for bile acids due to persistent pruritus. Based on bile acid levels, maternal and neonatal data were obtained and were compared between patients presenting with ICP and gestational pruritus (normal bile acid level). Results: A total of 145 patients were included, 47 of whom were diagnosed as ICP (52 newborns) and 98 as gestational pruritus (102 newborns). The ICP group had a higher rate of NICU admission (14/42 vs. 6/98, p < 0.001) and global neonatal morbidity (13/42 vs. 9/98, p = 0.002), but these differences were no longer seen after adjusting for gestational age, singleton pregnancies and induction of labour. Patients presenting with severe ICP (maximum bile acids levels above 40 µmol/l) showed a higher rate of meconium-stained amniotic fluid (0/28 vs. 4/14, p = 0.009), NICU admission (9/34 vs. 11/17, p = 0.01) and neonatal global morbidity (5/32 vs. 8/17, p = 0.02). Conclusions: ICP patients have higher rates of adverse neonatal outcomes when compared to those with gestational pruritus. Some of this neonatal morbidity may be secondary to late spontaneous preterm deliveries, multiple gestation and a policy of elective induction of labour after 37 weeks of gestation. A comparison of outcomes among patients with mild and severe ICP shows that the severely affected group has higher rates of meconium-stained amniotic fluid and neonatal morbidity.

Sonographic Evaluation of Fetal Adrenal Gland in Gestational Diabetes: Relation to Fetal Growth and Maternal Biochemical Markers

To relate measurements and volume of the fetal adrenal gland in third trimester ultrasound in diabetic pregnancies (1) to birth weight; (2) to other sonographic markers of diabetic fetopathy (expected fetal weight, sectional area, and fractional volume in fetal limbs); and (3) to maternal biochemical markers of diabetes (HbA1c, leptin).

OP16.08: The proportion of women with a histological diagnosis of molar pregnancy who are diagnosed with ultrasound prior to uterine evacuation: Short oral presentation abstracts

Objectives: The aim of the study was to identify the preoperative ultrasound measurements of tubal ectopic pregnancies which correlate best with surgical findings. Methods: This was a prospective study of women diagnosed with a tubal ectopic pregnancy and managed in the Early Pregnancy Unit (EPU) at University College London Hospital (UCLH) between November 2015 and August 2016. Each tubal ectopic pregnancy was measured in three perpendicular planes using the following protocol:

Imaging techniques in endometriosis

Endometriosis is a common gynecological condition affecting up to 15% of the general female population. Here, we present a systematic review of imaging techniques of endometriosis. The aim of this review is to determine the most accurate site-specific preoperative diagnostic tools in order to map, locate, evaluate the extension, and stage the disease. There are important reasons to stage endometriosis: to create a common language, to enable specificity of diagnosis, standardize comparisons, and to facilitate research applications. The requirements of an ideal endometriosis classification system are that it be empirically and scientifically based, be of general consensus, have unambiguous definition of terms, be comprehensive in all cases, have a simple translation from anatomic features to verbal description, reflect disease, predict fertility, predict pain relief, be useful to guide treatment, indicate risk of recurrence, identify clinical situations in which it does not apply, be simple to calculate, and be easy to communicate to women. An extensive search of papers regarding imaging techniques in endometriosis was performed in Pubmed from January 1992 to February 2018, including original peer-reviewed papers, reviews, and international guidelines.

Ultrasound-Based Endometriosis Staging System: Validation Study to Predict Complexity of Laparoscopic Surgery

STUDY OBJECTIVEnTo validate the preoperative ultrasound-based endometriosis staging system (UBESS) for predicting the correct Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and Australasian Gynaecological Endoscopy and Surgery (AGES) Societys level of laparoscopic skill required for endometriosis surgery.nnnDESIGNnMulti-center retrospective cohort study (Canadian Task Force classification II-2).nnnSETTINGnTertiary teaching hospital and a private gynecologic clinic.nnnPATIENTSn155 women presenting with chronic pelvic pain and/or a history of endometriosis.nnnINTERVENTIONSnWomen underwent detailed specialized transvaginal ultrasound (TVS) in a tertiary referral unit to diagnose and stage endometriosis using the 3 stages of the UBESS. The UBESS was correlated to RANZCOG/AGES laparoscopic skill levels. The UBESS classifications were correlated as follows: UBESS I to predict RANZCOG/AGES surgical skill level 1/2, UBESS II to predict RANZCOG/AGES skill level ¾, and UBESS III to predict RANZCOG/AGES skill level 6.nnnMAIN RESULTSnThe accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the UBESS I to predict the RANZCOG/AGES surgical skill levels 1/2 were 99.4%, 98.9%, 100%, 100%, 98.5%, not applicable, and .011; those of UBESS II to predict surgical skill levels 3/4 were: 98.1%, 96.8%, 98.4%, 93.8%, 99.2%, 60 and .033, respectively, and those for UBESS III to predict surgical skill level 6 were: 98.7%, 97.2%, 99.2%, 97.2%, 99.2%, 115.7, and 0.028, respectively. The rate of correctly predicting the exact level of skills needed was 98.1%, and Cohens kappa statistic for the agreement between UBESS prediction and levels of training required at surgery was 0.97, indicating almost perfect agreement.nnnCONCLUSIONSnThe UBESS can be used to predict the level of complexity of laparoscopic surgery for endometriosis based on the RANZCOG/AGES skills levels for laparoscopy. It now awaits external validation in multiple centers with various surgical skill level classification systems to assess its general applicability.

To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: Ultrasound “sliding sign,” transvaginal ultrasound direct visualization or both?

The study aim was to evaluate the transvaginal sonography (TVS) “sliding sign” alone, direct visualization of the bowel with TVS, and the combination of both methods (ie “sliding sign” and direct visualization of the bowel), to determine the optimal TVS method for the prediction of rectal/rectosigmoid deep endometriosis (DE).

P18.02: Prevalence of negative 'sliding sign' in low-risk population: a feasibility study

Objectives: To investigate whether or not an ovarian endometrioma detected by ultrasound was associated with other appearances of pelvic endometriosis such as adhesions and/or deep infiltrating endometriosis (DIE) in order to improve the management of patients with pelvic pain or infertility. Methods: This is an observational retrospective study including a group of women (n=255) with at least an ovarian endometrioma (at least diameter of ≥ 20 mm) detected by transvaginal ultrasound (TVS). Patients with previous pelvic surgery and without symptoms were excluded. Other associated sonographic signs of pelvic endometriosis such as adhesions, tubal pathology, adenomyosis and DIE were recorded according to a detailed TVS mapping of pelvic endometriosis. Subsequently a group of women (n=50) underwent laparoscopic treatment and during surgery a complete endometriosis mapping was assessed. Results: Mean age was 34.2 ± 6.6 years, mean endometriomas diameter was 40.0 ± 18.1mm, bilateral endometriomas were observed in 65patients (25.5%). Of the 255 patients 50 underwent laparoscopic surgery due to severe symptoms whereas 205 had indications to medical therapy or ART. At TVS 55 (21.5%) showed posterior rectal DIE and 93 (36.4%) a thickening of at least one uterosacral ligament. 186 patients (73%) showed adhesions and 134 (53%) showed ultrasonographic features of adenomyosis. Only 57 (22%) had a single isolated ovarian lesion with a mobile ovary and without any other ultrasound signs of pelvic endometrioma. No statistically significant differences were observed in the TVS mapping and histological confirmation. Conclusions: Ovarian endometrioma is a marker for pelvic endometriosis and is rarely isolated 44% patients with an endometrioma showed DIE. Adhesions and adenomyosis are associated to endometrioma in more than 50%. In a clinical context when there is an ovarian endometrioma an accurate TVS should investigate the extension of the disease to check for other endometriotic lesions in order to choose the most appropriate treatment to manage pain and infertility.