RESUMO
OBJETIVO: Determinar el tiempo que requiere una curva de aprendizaje para diagnóstico ecográfico específico histopatológico en masas anexiales basándonos en cálculos estadísticos no influidos por la prevalencia según diferentes grados de experiencia. MÉTODOS: Estudio observacional, descriptivo, transversal. Se estudiaron imágenes de 108 masas anexiales. La prueba estándar de oro fue el reporte histopatológico definitivo. Se comparó el rendimiento diagnóstico de 4 examinadores con la siguiente experiencia en diagnóstico ecográfico de patología anexial: A > 20 años, B ≤ 20 hasta > 10 años, C ≤ 10 hasta > 5 años y D ≤ 5 años, analizando solo imágenes y sin datos clínicos de las pacientes, para emitir un diagnóstico específico a libre escritura. RESULTADOS: Prevalencia de masas malignas 17,2 % (15/87). Nivel de confianza en los examinadores se consideró según falta de respuesta diagnóstica: alto (<6 %) con experiencia de más de 10 años y moderado a bajo ≤ 10 años. Examinadores con más de 5 años siempre mostraron likelihood ratio positivo mayor a 10, exactitud diagnóstica mayor a 90 % y Odds ratio diagnóstica mayor a 46, no así para examinador con menor tiempo de experiencia, quién presentó resultados con mala utilidad clínica. El cambio de probabilidad de acierto específico pre-test a post-test mejoró consistentemente con los años de experiencia. CONCLUSIÓN: Se necesitarían más de 10 años de experiencia con especial dedicación a ecografía ginecológica avanzada para un rendimiento diagnóstico específico deseado junto con alta confianza en ecografía de masas anexiales.
OBJECTIVE: To determine the time required for a learning curve of histopathological specific ultrasound diagnosis in adnexal masses based on statistical calculations not influenced by prevalence according to different degrees of experience. METHODS: Observational, descriptive, cross-sectional study. Images of 108 adnexal masses were studied. The gold standard test was the definitive histopathological report. The diagnostic performance of 4 examiners with the following experience in ultrasound diagnosis of adnexal pathology: A > 20 years, B ≤ 20 to > 10 years, C ≤ 10 to > 5 years and D ≤ 5 years was compared, analyzing only images and blinded of clinical data of the patients, to issue a specific diagnosis with free writing. RESULTS: Prevalence of malignant masses 17.2% (15/87). The level of confidence in the examiners was considered according to the lack of diagnostic response: high (<6%) with experience of more than 10 years and moderate to low ≤ 10 years. The examiners with more than 5 years always showed likelihood ratio positive greater than 10, diagnostic accuracy greater than 90% and diagnostic Odds ratio greater than 46, not so for the examiner with less experience time who presented results with little clinical utility. The change in specific probability from pre-test to post-test improved consistently with years of experience. CONCLUSION: More than 10 years of experience with special dedication to advanced gynecological ultrasound are probably needed for a desired specific diagnostic performance coupled with high confidence in adnexal mass ultrasound.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ultrassom/educação , Doenças dos Anexos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Radiologia/educação , Fatores de Tempo , Estudos Transversais , Probabilidade , Doenças dos Anexos/patologia , Competência Clínica , Curva de AprendizadoRESUMO
Objetivos: Evaluar el valor predictivo del sistema IOTA ADNEX®, en pacientes con diagnóstico de blastoma anexial. Objetivo secundario: Evaluar otras características sugestivas de malignidad no incluidas en el sistema IOTA ADNEX®. Materiales y métodos: Estudio observacional, retrospectivo, descriptivo. Se incluyeron 42 pacientes con diagnóstico ecográfico inicial de blastoma anexial que se atendieron y fueron operadas en nuestro servicio en el periodo 2013 - 2018, divididas en 2 grupos: Grupo A (21 pacientes con diagnóstico posterior de cáncer de ovario) y Grupo B (Pacientes con diagnóstico benigno postoperatorio). Se evaluó el valor predictivo del sistema IOTA ADNEX®, para dichas pacientes y se comparó los resultados del Grupo A vs Grupo B. Resultados: El aumento de Ca125, se encontró fuertemente asociado al cáncer de ovario. La diferencia entre Grupo A y B fue estadísticamente significativo p<0,0001. Encontramos una asociación entre el GRUPO A, con la predicción de cáncer de ovario, siendo esta diferencia estadísticamente significativa p<0,0001. Conclusión: De acuerdo a nuestros resultados el sistema ADNEX®, podría predecir tanto el riesgo de malignidad como de benignidad de un blastoma anexial de manera fidedigna. Dicho sistema presenta como ventaja el objetivar la interpretación de los estudios y su fácil implementación en todos los ámbitos. La adecuada caracterización e intervención pre quirúrgica permite la planificación del tratamiento mejorando el pronóstico de las pacientes (AU)
ABSTRACT: AIM: To assess the predictive value of the IOTA ADNEX® system, in patients diagnosed with adnexal blastoma. Secondary aim: To evaluate other characteristics suggestive of malignancy not included in the IOTA ADNEX® system. Materials and methods: Observational, retrospective, descriptive study. We included 42 patients with initial ultrasound diagnosis of adnexal blastoma, who were treated and operated in our service 2013-2018 period, divided into 2 groups: Group A (21 patients with subsequent diagnosis of ovarían cancer) and Group B (Patients with benign postoperative diagnosis). The predictive value of the IOTA ADNEX® system was evaluated for these patients and the results of Group A vs Group B were compared. Results: Ca125 was found to be strongly associated with ovarian cancer. The difference between Group A and B was statistically significant p <0.0001. We found an association between GROUP A, with the prediction of ovarian cancer, this difference being statistically significant p <0.0001. Conclusion: According to our results, the ADNEX® system could predict both the risk of malignancy and benignity of an adnexal blastoma reliably. This system has the advantage of objectifying the interpretation of the studies and their easy implementation in all areas. Proper characterization and presurgical intervention allows treatment planning to improve the prognosis of patients (AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Doenças dos Anexos/patologia , Anexos Uterinos , Previsões/métodosRESUMO
OBJETIVO: evaluar la experiencia en la utilización del método GIRADS para clasificar masas anexiales a diez años de su primera publicación. MÉTODO: Se realizó búsqueda de estudios que utilizan el sistema GIRADS: Medline (Pubmed), Google Scholar y Web of Science, desde enero de 2009 hasta diciembre de 2019. Se calculó la sensibilidad y especificidad agrupada, Likelihood ratio (LR) (+) y LR (-) y Odds ratio de diagnóstico (DOR). La calidad de los estudios se evaluó con QUADAS-2. RESULTADOS: Se identificaron 15 estudios y se incluyeron 13 de ellos con 4473 masas, 878 de ellas malignas. La prevalencia media de malignidad ovárica fue del 23 % y la agrupada de 19.6%. El riesgo de sesgo fue alto en cuatro estudios para el dominio "selección de pacientes" y fue bajo en todos en todos los estudios para los dominios "prueba índice" y "prueba de referencia". La sensibilidad, especificidad, LR (+) y LR (-) agrupadas y el DOR del sistema GIRADS para clasificar las masas anexiales fueron: 96.8% (intervalo de confianza [IC] 95% = 94% - 98%), 91.2 % (IC 95 % = 85% - 94%), 11.0 (IC 95% = 6.9 -13.4) y 0.035 (IC 95% = 0.02- 0.09), y 209 (IC 95% = 99-444), respectivamente. La heterogeneidad fue alta para la sensibilidad y especificidad. De acuerdo a la metaregresión, la heterogeneidad entre los estudios se explica por la prevalencia de malignidad, múltiples observadores y la ausencia de diagnóstico histopatológico para todos los casos incluidos en un determinado estudio. CONCLUSIÓN: el sistema GIRADS tiene un buen rendimiento diagnóstico para clasificar masas anexiales.
OBJECTIVE: to evaluate the experience of using GIRADS method to classify adnexal masses ten years after its publication. METHOD: A search was carried out for studies reporting on the use of the GIRADS system in the Medline (Pubmed), Google Scholar and Web of Science databases, from January 2009 to December 2019. Pooled sensitivity and specificity, Likelihood ratio (LR) (+) and LR (-) and Diagnostic Odds ratio (DOR) were calculated. The quality of the studies was assessed by QUADAS-2. RESULTS: 15 studies were identified, and 13 of them were included with 4473 masses, of which 878 were malignant. The mean prevalence of ovarian malignancy was 23% and the prevalence pooled. of 19.6%. The risk of bias was high in four studies for the domain 'patient selection' and low for all studies for the domains 'index test' and 'reference test'. The sensitivity, specificity, pooled LR (+) and LR (-) and the DOR of the GIRADS system to classify adnexal masses were 96.8% (95% confidence interval [CI] = 94% -98%), 91.2 % (95% CI = 85% -94%), 11.0 (95% CI = 6.9-13.4) and 0.035 (95% CI = 0.02-0.09), and 209 (95% CI = 99-444), respectively. Heterogeneity was high for both sensitivity and specificity. According to meta-regression, this heterogeneity was explained by the prevalence of malignancy, the use of multiple observers, and the absence of histopathological diagnosis for all cases included in a given study. CONCLUSION: the GIRADS system has a good diagnostic performance to classify adnexal masses.
Assuntos
Humanos , Feminino , Neoplasias Ovarianas/diagnóstico por imagem , Doenças dos Anexos/patologia , Doenças dos Anexos/diagnóstico por imagem , Sistemas de Informação em Radiologia , Curva ROC , Sensibilidade e Especificidade , Viés de Publicação , Medição de RiscoRESUMO
Uterine torsion is an uncommon entity that is defined as a rotation of greater than 45° around the longitudinal axis of the uterus. Although cases of uterine torsion among pregnant patients have been mentioned in the literature, torsion of a non-gravid uterus is a rare occurrence. A 73-year-old nulliparous woman with a known fibroid uterus underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section of a 17-18 cm pelvic mass seen on CT imaging. The source of the pelvic mass was unclear on imaging, and benign and malignant possibilities were discussed. During the procedure, necrosis of the uterine fundus and bilateral adnexa were seen due to the fundus being torsed with the uterine fibroid being the pivot point. Uterine torsion, though rare, can be the cause of acute pelvic pain in a postmenopausal woman.
Assuntos
Dor Abdominal/diagnóstico por imagem , Doenças dos Anexos/diagnóstico por imagem , Leiomioma/patologia , Necrose/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Dor Abdominal/cirurgia , Doenças dos Anexos/patologia , Doenças dos Anexos/cirurgia , Idoso , Feminino , Secções Congeladas , Humanos , Histerectomia , Necrose/patologia , Necrose/cirurgia , Pós-Menopausa , Salpingo-Ooforectomia , Anormalidade Torcional/patologia , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Doenças Uterinas/patologia , Doenças Uterinas/cirurgiaRESUMO
BACKGROUND: To demonstrate the use of surface-enhanced Raman spectroscopy (SERS) to determine sialic acid (SA) levels in saliva using silver nanoparticles as substrates, in adnexal mass patients scheduled for surgical intervention to remove invasive masses, with the aim to compare SA levels in benign tumor vs ovarian cancer patients. METHODS: Quantification of SA levels was accomplished by measuring their SERS and calibrating with analytical reagent SA. The mean SA concentration in saliva from 37 benign adnexal mass resulted smaller (5.1 mg/dL) than the mean concentration in 15 Ovarium cancer patients (23 mg/dL). The cancer condition was determined by biopsy of the removed adnexal mass. The CA-125 biomarker was also measured. The predictive potential of both biomarkers is discussed, together with the malignity risk index (MRI). RESULTS: Our results showed a sensitivity/specificity of 80%/100% with a cutoff to distinguish between benign/cancer cases of SA 15.5 mg/dL, as established from a ROC analysis. Our results suggest that SA may be a more useful biomarker than CA-125 to detect ovarian cancer. CONCLUSIONS: Our results suggest that the SA levels measured from saliva may be as good predictors as the MRI index for the presence of ovarian cancer in sensitivity/negative predictive value and outperforms it in specificity/positive predictive value.
Assuntos
Doenças dos Anexos/diagnóstico , Biomarcadores Tumorais/química , Ácido N-Acetilneuramínico/análise , Neoplasias Ovarianas/diagnóstico , Saliva/química , Análise Espectral Raman , Doenças dos Anexos/patologia , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Biomarcadores Tumorais/normas , Antígeno Ca-125 , Diagnóstico Diferencial , Feminino , Humanos , Nanopartículas Metálicas/química , Pessoa de Meia-Idade , Ácido N-Acetilneuramínico/química , Neoplasias Ovarianas/patologia , Ovário/patologia , Saliva/metabolismo , Sensibilidade e Especificidade , Prata/químicaRESUMO
This narrative literature review addresses the problem of an adnexal mass discovered during the course of breast cancer (BC) care, which may represent a benign condition, a metastatic process, or a primary ovarian cancer (OC), clinical scenarios associated with distinct physiopathology and prognosis. Furthermore, the coexistence of BC and OC in the same patient may be owing to a hereditary disorder, deserving specific management strategies and counseling. The initial detection and evaluation of an adnexal mass in a patient with BC requires a high index of suspicion, and the initial workup should include a thorough medical history and physical examination, measurement of tumor markers, complete blood count, and imaging tests. Transvaginal ultrasonography remains the standard tool, and findings suggestive of malignancy include bilateral tumors, thick septations, predominance of a solid component, Doppler flow to the solid component, and ascites. From the pathology point of view, features that are suggestive of metastatic disease include bilaterality, mild ovarian enlargement, vascular emboli, no omental deposits, and the absence of transition from benign to malignant epithelium. Although there is a considerable overlap in OC and BC immunohistochemical profiles, BC usually stain positive for GCDFP-15 and negative for vimentine, PAX8, and WT1, and OC often stain positive for CK7, PAX8, WT1, and to mesothelin. Genetic counselling should always be indicated in this clinical scenario. In conclusion, diagnostic spectrum of an ovarian mass in a patient with BC is broad, and a systematic multi-professional strategy is necessary to conduct these challenging cases.
Assuntos
Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico , Neoplasias da Mama/complicações , Doenças dos Anexos/patologia , Doenças dos Anexos/fisiopatologia , Biomarcadores Tumorais/sangue , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Humanos , Metástase Neoplásica , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/fisiopatologia , PrognósticoRESUMO
PURPOSE: We aimed to evaluate the ADNEX MR scoring system for the prediction of adnexal mass malignancy, using a simplified magnetic resonance imaging (MRI) protocol. METHODS: In this prospective study, 200 patients with 237 adnexal masses underwent MRI between February 2014 and February 2016 and were followed until February 2017. Two radiologists calculated ADNEX MR scores using an MRI protocol with a simplified dynamic study, not a high temporal resolution study, as originally proposed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the area under the receiver operating characteristic curve were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >12 months of follow-up. RESULTS: Of 237 lesions, 79 (33.3%) were malignant. The ADNEX MR scoring system, using a simplified MRI protocol, showed 94.9% (95% confidence interval [CI], 87.5%-98.6%) sensitivity and 97.5% (95% CI, 93.6%-99.3%) specificity in malignancy prediction; it was thus highly accurate, like the original system. The level of interobserver agreement on simplified scoring was high (κ = 0.91). CONCLUSION: In a tertiary cancer center, the ADNEX MR scoring system, even based on a simplified MRI protocol, performed well in the prediction of malignant adnexal masses. This scoring system may enable the standardization of MRI reporting on adnexal masses, thereby improving communication between radiologists and gynecologists.
Assuntos
Anexos Uterinos/diagnóstico por imagem , Doenças dos Anexos/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias Ovarianas/diagnóstico por imagem , Anexos Uterinos/anatomia & histologia , Anexos Uterinos/patologia , Doenças dos Anexos/patologia , Doenças dos Anexos/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Variações Dependentes do Observador , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To evaluate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX model in the preoperative discrimination between benign ovarian (including tubal and para-ovarian) tumors, borderline ovarian tumors (BOT), Stage I ovarian cancer (OC), Stage II-IV OC and ovarian metastasis in a gynecological oncology center in Brazil. METHODS: This was a diagnostic accuracy study including 131 women with an adnexal mass invited to participate between February 2014 and November 2015. Before surgery, pelvic ultrasound examination was performed and serum levels of tumor marker CA 125 were measured in all women. Adnexal masses were classified according to the IOTA ADNEX model. Histopathological diagnosis was the gold standard. Receiver-operating characteristics (ROC) curve analysis was used to determine the diagnostic accuracy of the model to classify tumors into different histological types. RESULTS: Of 131 women, 63 (48.1%) had a benign ovarian tumor, 16 (12.2%) had a BOT, 17 (13.0%) had Stage I OC, 24 (18.3%) had Stage II-IV OC and 11 (8.4%) had ovarian metastasis. The area under the ROC curve (AUC) was 0.92 (95% CI, 0.88-0.97) for the basic discrimination between benign vs malignant tumors using the IOTA ADNEX model. Performance was high for the discrimination between benign vs Stage II-IV OC, BOT vs Stage II-IV OC and Stage I OC vs Stage II-IV OC, with AUCs of 0.99, 0.97 and 0.94, respectively. Performance was poor for the differentiation between BOT vs Stage I OC and between Stage I OC vs ovarian metastasis with AUCs of 0.64. CONCLUSION: The majority of adnexal masses in our study were classified correctly using the IOTA ADNEX model. On the basis of our findings, we would expect the model to aid in the management of women with an adnexal mass presenting to a gynecological oncology center. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Doenças dos Anexos/diagnóstico por imagem , Estadiamento de Neoplasias , Doenças dos Anexos/patologia , Doenças dos Anexos/cirurgia , Adulto , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , UltrassonografiaAssuntos
Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico , Carcinoma/diagnóstico , Carcinoma/patologia , Neoplasias Vulvares/complicações , Neoplasias Vulvares/diagnóstico , Doenças dos Anexos/patologia , Biomarcadores Tumorais/análise , Antígeno Carcinoembrionário , Feminino , Histocitoquímica , Humanos , Imuno-Histoquímica , Proteínas de Membrana , Microscopia , Pessoa de Meia-Idade , Neoplasias Vulvares/patologiaRESUMO
BACKGROUND: This study describes the accuracy of three-dimensional power Doppler (3D-PD) angiography as secondary method for differential diagnosis of ovarian tumors. METHOD: Seventy-five women scheduled for surgical removal of adnexal masses were assessed by transvaginal ultrasound. Ovarian tumors were classified by IOTA simple rules and two three-dimensional blocks were recorded. In a second step analyses, a 4 cm(3) spherical sample was obtained from the highest vascularized solid area of each stored block. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were calculated. The repeatability was assessed by concordance correlation coefficient (CCC) and limits of agreement (LoA), and diagnostic accuracy by area under ROC curve. RESULTS: IOTA simple rules classified 26 cases as benign, nine as inconclusive and 40 as malignant. There were eight false positive and no false negative. Among the masses classified as inconclusive or malignant by IOTA simple rules, the CCCs were 0.91 for VI, 0.70 for FI, and 0.86 for VFI. The areas under ROC curve were 0.82 for VI, 0.67 for FI and 0.81 for VFI. CONCLUSIONS: 3D-PD angiography presented considerable intraobserver variability and low accuracy for identifying false positive results of IOTA simple rules.