Tom Bourne

Simple ultrasound-based rules for the diagnosis of ovarian cancer

To derive simple and clinically useful ultrasound‐based rules for discriminating between benign and malignant adnexal masses.

Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome

OBJECTIVE To improve the interpretation of future studies in women who are initially diagnosed with a pregnancy of unknown location (PUL), we propose a consensus statement with definitions of population, target disease, and final outcome. DESIGN A review of literature and a series of collaborative international meetings were used to develop a consensus for definitions and final outcomes of women initially diagnosed with a PUL. RESULT(S) Global differences were noted in populations studied and in the definitions of outcomes. We propose to define initial ultrasound classification of findings into five categories: definite ectopic pregnancy (EP), probable EP, PUL, probable intrauterine pregnancy (IUP), and definite IUP. Patients with a PUL should be followed and final outcomes should be categorized as visualized EP, visualized IUP, spontaneously resolved PUL, and persisting PUL. Those with the transient condition of a persisting PUL should ultimately be classified as nonvisualized EP, treated persistent PUL, resolved persistent PUL, or histologic IUP. These specific categories can be used to characterize the natural history or location (intrauterine vs. extrauterine) of any early gestation where the initial location is unknown. CONCLUSION(S) Careful definition of populations and classification of outcomes should optimize objective interpretation of research, allow objective assessment of future reproductive prognosis, and hopefully lead to improved clinical care of women initially identified to have a PUL.

The conservative management of interstitial pregnancy

Objectives  To evaluate the effectiveness of systemic methotrexate in the treatment of interstitial pregnancy.

A randomized trial on the use of ultrasonography or office hysteroscopy for endometrial assessment in postmenopausal patients with breast cancer who were treated with tamoxifen

OBJECTIVE Our purpose was to compare the screening effectiveness and acceptability of transvaginal ultrasonography (with sonohysterography if endometrial thickness was >4 mm) with office hysteroscopy. STUDY DESIGN This randomized crossover study comprised 53 consecutive asymptomatic (without vaginal bleeding) postmenopausal patients with breast cancer who had taken tamoxifen (20 or 40 mg/day) for at least 6 months. RESULTS Two patients had endometrial cancer (1 primary, 1 breast secondary), both detected only by transvaginal ultrasonography. Twenty-six patients had at least 1 polyp (total 47, all benign). The women who had polyps were not significantly different in their age, body mass, months of tamoxifen intake, or the cumulative dose. The sensitivity and specificity of transvaginal ultrasonography were 85% and 100%, respectively. The corresponding values for office hysteroscopy were 77% and 92%. It was significant that more patients preferred transvaginal ultrasonography to hysteroscopy (P < .001). CONCLUSION Transvaginal ultrasonography (plus sonohysterography) may be more effective and acceptable than office hysteroscopy for detecting endometrial abnormalities in women taking tamoxifen.

The use of ultrasound-based 'soft markers' for the prediction of pelvic pathology in women with chronic pelvic pain--can we reduce the need for laparoscopy?

Objective  To assess the accuracy of new transvaginal ultrasound‐scan‐based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP).

Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location

Various serum human chorionic gonadotropin (hCG) discriminatory zones are currently used for evaluating the likelihood of an ectopic pregnancy in women classified as having a pregnancy of unknown location (PUL) following a transvaginal ultrasound examination. We evaluated the diagnostic accuracy of discriminatory zones for serum hCG levels of > 1000 IU/L, 1500 IU/L and 2000 IU/L for the detection of ectopic pregnancy in such women.

Should we be examining the ovaries in pregnancy? Prevalence and natural history of adnexal pathology detected at first‐trimester sonography

To assess the prevalence and natural history of ovarian pathology in pregnancy.

The conservative management of cervical ectopic pregnancies.

To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies.

Pregnancies of unknown location: consensus statement

*Early Pregnancy Unit, Nepean Centre for Perinatal Care and Research, Western Clinical School, Nepean Campus, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia, †Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, K.U. Leuven, Leuven, Belgium, ‡Department of Obstetrics and Gynecology, New York University Medical Center, New York, USA, §Department of Obstetrics and Gynecology, Malmo University Hospital, Malmo, Lund University, Sweden, ¶Early Pregnancy and Gynaecology Assessment Unit, King’s College Hospital and **Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George’s Hospital Medical School, London, UK (e-mail: gcondous@hotmail.com)

Prediction of ectopic pregnancy in women with a pregnancy of unknown location

We have previously published on the use of mathematical Model M1 to predict ectopic pregnancy in women with no signs of intra‐ or extrauterine pregnancy. The aim of this study was to improve on the performance of this model for the detection of developing ectopic pregnancies in women with pregnancies of unknown location (PULs). We therefore generated and evaluated a new logistic regression model from simple hormonal data and compared it with Model M1.