Rosendo Galván

Three-dimensional power Doppler ultrasound scanning for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium.

OBJECTIVE The purpose of this study was to evaluate the role of 3-dimensional power Doppler angiography (3D-PDA) to discriminate between benign and malignant endometrial disease in women with postmenopausal bleeding and thickened endometrium. STUDY DESIGN Ninety-nine postmenopausal women (median age, 63.1 years; range, 48-84 years) with uterine bleeding and a thickened endometrium (>or= 5 mm) at baseline transvaginal sonography were assessed by 3D-PDA before endometrial biopsy. Endometrial volume, vascularity index (VI), flow index, and vascularity-flow index were calculated with the virtual organ computer-aided analysis method. RESULTS Histologic diagnoses were endometrial cancer (44 cases), hyperplasia (13 cases), polyp (23 cases), cystic atrophy (14 cases), and submucous myoma (5 cases). Endometrial volume, VI, and vascularity-flow index were significantly higher in malignant vs benign conditions. Receiver operating characteristic analysis revealed that VI was the best parameter for the prediction of endometrial cancer. CONCLUSION The findings show that 3D-PDA may be useful for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium at baseline sonography.

Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with three-dimensional US.

PURPOSE To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer. MATERIALS AND METHODS Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more. RESULTS Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r = 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for US-measured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%. CONCLUSION Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.

Intraobserver and Interobserver Reproducibility of 3-Dimensional Power Doppler Vascular Indices in Assessment of Solid and Cystic-Solid Adnexal Masses

The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3‐dimensional (3D) power Doppler angiography–derived vascular indices in evaluation of vascularized solid and cystic‐solid adnexal masses.

Transvaginal color Doppler imaging in the detection of ovarian cancer in a large study population.

Introduction: The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group. Methods: The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral. Results: Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P = 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status. Conclusions: The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.

Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics

To assess the correlation between intratumoral vascularization using three‐dimensional power Doppler angiography (3D‐PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma.

Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound‐based scoring system

To prospectively evaluate an ultrasound‐based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.

Three-Dimensional Sonographic Morphologic Assessment of Adnexal Masses A Reproducibility Study

The purpose of this study was to assess the reproducibility of 3‐dimensional (3D) sonography for classifying adnexal masses.

Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women.

To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women.

Three-Dimensional Power Doppler Vascular Network Assessment of Adnexal Masses Intraobserver and Interobserver Agreement Analysis

Objective. The purpose of this study was to assess intraobserver and interobserver agreement for tumor vascular network evaluation as assessed by 3‐dimensional (3D) power Doppler sonography for discriminating benign from malignant adnexal masses. Methods. Stored 3D power Doppler angiographic volume data from 39 women with a diagnosis of a vascularized adnexal mass who were evaluated and treated at our institution were retrieved from our database for analysis. Two different examiners (observer A, with 6 years of experience in 3D sonography; and observer B, with 1 year of experience) reviewed 3D sonograms blinded to each other. Three‐dimensional vascular network reconstruction was done with surface rendering in the color mode. Malignancy was considered in the presence of at least 2 of the following: irregular branching, vessel caliber changes, microaneurysms, and vascular lakes. A definitive histologic diagnosis was obtained in all cases. Intraobserver and interobserver agreement rates were estimated by calculating the κ index. Results. Twenty (51%) tumors were malignant, and 19 (49%) were benign. Intraobserver agreement was good for observer A (κ = 0.69) and moderate for observer B (κ = 0.54). Interobserver agreement was moderate (κ = 0.49). Conclusions. We found intraobserver and interobserver agreement to be moderate for 3D power Doppler assessment of the vascular network in adnexal masses.

Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases

Extrauterine pelvic diseases include several kinds of adnexal masses. In addition, pelvic adhesions and deep endometriosis can be considered extrauterine pelvic diseases. In this article we will review a practical approach to adnexal pathologies using simple transvaginal ultrasonographic findings of several benign masses. Moreover, we will investigate the additional role of color Doppler and explain a simplified presurgical triage of adnexal masses that uses color Doppler as a secondary test for the detection of ovarian cancer, already confirmed by several studies. We will also evaluate the new insight of transvaginal ultrasonography in the detection of pelvic adhesions and deep endometriosis. A possible improvement in the field of the preoperative diagnosis of ovarian cancer in the next years comes from the constitution of the International Ovarian Tumor Analysis Group and from the introduction into clinical practice of 3D color Doppler sonography.