U. Leone Roberti Maggiore

Computed tomographic colonography versus rectal-water contrast transvaginal ultrasonography in the diagnosis of rectosigmoid endometriosis: a pilot study.

To compare the performance of computed tomographic colonography (CTC) and rectal water‐contrast transvaginal sonography (RWC‐TVS) in the diagnosis of rectosigmoid endometriosis, and compare precision in estimating the length of the rectosigmoid nodules and the distance between the nodules and the anal verge.

Magnetic resonance enema vs rectal water‐contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis

To compare the accuracy of magnetic resonance enema (MR‐e) and rectal water‐contrast transvaginal sonography (RWC‐TVS) in the diagnosis of rectosigmoid endometriosis.

Diagnostic accuracy of midtrimester antenatal ultrasound for multicystic dysplastic kidneys

To establish the diagnostic accuracy of obstetric ultrasound at a tertiary fetal medicine center in the prenatal detection of unilateral and bilateral multicystic dysplastic kidney (MCDK) in fetuses in which this condition was suspected, and to undertake a systematic review of the relevant literature.

Microablative Fractional CO2 Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer.

Study Objective: Evaluate a new endometrial ablation device using the extirpated uterine model. This study evaluated: 1) the feasibility of using a completely hand-held endometrial ablation device, 2) the intrauterine cavity ablation profile and characteristics (predictors of efficacy) and 3) the proximity of the ablation to the uterine serosa (safety parameter). Design: Clinical feasibility study. Setting: International gynecology practice. Patients: Thirty women previously scheduled for a benign hysterectomy were consented for study. Intervention: The extirpated uteri were treated with a single endometrial ablation procedure that utilizes four sequential 33 second 150 C glycerin cycles (treatment time 132 seconds) inside an endometrial balloon deployed from a 5.4 mm outer diameter device. The resultant endomyometrial ablations were evaluated using macroscopic TTC viability staining. Measurements and Main Results: The uteri were efficiently treated with no treatment-associated myometrial perforations or serosal thermal injury. The corpus, bilateral cornua, and lower uterine segment endometrial cavity surfaces and underlying myometrium were thermally ablated (TTC-negative staining, non-viable). No TTC-negative lower endocervical or exocervical thermal injury was identified. Conclusion: The Librata is a fully hand-held device that 1) replicates the historically optimized ablation profile of hyperthermic devices; 2) has excellent cavity coverage with contoured full thickness endometrial ablation; 3) provides thermal ablation in a clinically appropriate time frame; and 4) has an acceptable safety profile for future in vivo clinical studies.

OP24.08: Combined treatment with the levonorgestrel-releasing intrauterine device and ulipristal acetate in patients with uterine adenomyosis

Objectives: To correlate the ultrasound appearance of highly vascularised uterine myomas to the histopathological diagnosis. Methods: This retrospective study included patients presenting with an ultrasound diagnosis of uterine myoma characterised by a circumferential and intralesional vascular pattern with a colour score assessment of 3 or 4, according to the Morphological Uterus Sonographic Assessment (MUSA). All the patients underwent myomectomy or hysterectomy after the ultrasound examination. The ultrasound appearance of the myomas was analysed and described using the terms and definitions of the MUSA paper. The echogenicity of each myoma, the presence of cystic areas and the total myoma volume were recorded. The ultrasound characteristics were compared with the histological diagnosis. Results: 52 patients were included in this study. Mean patient age was 42.5 years, 45 (86%) were in premenopause, 26 (50%) showed symptoms (pelvic pain, menorrhagia). At histological examination 25 (48%) myomas were compatible with a diagnosis of atypical leiomyoma (76% (19) hypercellular leiomyoma, 16% (4) myxoid leiomyoma, 8% (2) apoplectic leiomyoma). 25 (48%) were typical leiomyomas and 2 (4%) were adenomyomas. Cystic areas within the lesion were found in 32% (8/25) of atypical leiomyomas and in 16% (4/25) of typical leiomyomas. Conclusions: Ultrasound features such as circumferential and intralesional vascularity with a colour score of 3 or 4 and the presence of cystic areas may be predictive of atypical leiomyomas. Such features may be used to differentiate typical uterine myomas from the atypical variants in a pre-operative setting and to identify patients that may benefit from a conservative medical treatment rather than a radiological treatment.

P11.05: Subjective ultrasound assessment and the ADNEX model to differentiate between benign and malignant ovarian tumours

Methods: All the patients found in our Clinic database affected by ovarian/tubaric carcinoma, who carried a mutation on BRCA1 or BRCA2 genes, and whom the ultrasonographic images were available of, have been included in our study. Results: 26 patients have been recruited in our study. In 100% of the cases histological report revealed that the patients had a high grade (G3) istotype of carcinoma. Nineteen out of twenty-six lesions (73%) were solid and six out of twenty-six lesions (23%) were multilocular-solid. In one patient out of twenty-six (4%) we found a unilocular-solid lesion. The echotexture of the lesions was heterogeneous in twenty-three out of twenty-six patients (88%) and lesions appeared to have irregular margins in twenty-two out of twenty-six of the cases (85%); lesions appeared to be hypoechoic in twenty-five out of twenty-six cases (96%). Vascularisation of the lesions was discrete to high (colour-score 3-4) in twenty-five out of twenty-six patients (96%). Twenty-three out of twenty-six patients (88%) did not have ascites; only three out of twenty-six patients (12%) presented a huge ascites at the ultrasonographic study. Conclusions: In conclusion, in our study ovarian cancer appeared to be a solid or multilocular-solid lesion and, moreover, we found ascites in only three patients (12%), data which has been confirmed by the surgery, even though in 73% of the cases cancer was found at FIGO stage IIIC or IV.

Real-Time Transvaginal Elastography of Recto-Sigmoid Endometriotic Nodules: Correlation With Symptoms and Histology

Study Objective: Our group previously described a technique of temporary suspension of the ovary to the abdominal wall using nylon suture (Abuzeid et al 2002). The aim of this study is to describe a modified simple technique of temporary suspension of the ovary to the fascia of the anterior abdominal wall after operative laparoscopy for advanced stage endometriosis to reduce postoperative adhesion formation. Design: Retrospective cohort study. Setting: Academic affiliated community medical center. Patients: Patients who underwent temporary suspension of one or both ovaries, using 3-0 plain catgut suture, after operative laparoscopy for advanced stage endometriosis (Stage III/IVASRM classification) between 2006 and 2015. Intervention: Temporary suspension of one or both ovaries to the fascia of the abdominal wall at the conclusion of operative laparoscopy using dissolvable suture (3-0 plain catgut suture). Measurements and Main Results: Forty one infertile patients were studied. A 3-0 plain catgut suture was used to elevate the ovary away from the ovarian fossa towards the abdominal wall . The ends of the sutures were brought out of the peritoneal cavity through a 3 mm skin incision using Endo Close device. The suture was tied over the fascia while allowing CO2 gas out of the peritoneal cavity to ensure that the suture remained under tension and the ovary is well suspended without touching the abdominal wall. Any complications were documented. There was no reported incidence of increased postoperative pain, while in the hospital or after discharge. All patients were discharged home on oral pain medication on the same day of surgery. No postoperative complications were reported as a result of the suspension procedure. All patients had uneventful recovery. Conclusion: This modified approach of temporary ovarian suspension to the fascia of the anterior abdominal wall appears to be simple and safe and easy to learn.

OP20.06: Changes in sonographic findings of adenomyosis after treatment with aromatase inhibitor

This prospective study included symptomatic women with adenomyosis. The diagnosis of adenomyosis was suspected on the basis of transvaginal ultrasonography (TVS) and confirmed by magnetic resonance imaging. Patients received oral letrozole (2.5 mg/day, Femara; Novartis Farma) for 6 months. Patients underwent TVS before starting the treatment, after 3 and 6 months of treatment. During TVS, ultrasonographic parameters were examined by using a standardized protocol (Table 1).