| 1. |
- Epstein, Elisabeth, et al.
(författare)
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Early-stage cervical cancer: Tumor delineation by magnetic resonance imaging and ultrasound - A European multicenter trial
- 2013
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258. ; 128:3, s. 449-453
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the preoperative assessment of early-stage cervical cancer using pathologic findings as the reference standard. Patients and methods. Prospective multi-center trial enrolling 209 consecutive women with early-stage cervical cancer (FIGO IA2-IIA) scheduled for surgery. The following parameters were assessed on US and MRI and compared to pathology: remaining tumor, size, tumor stromal invasion <2/3 (superficial) or >= 2/3 (deep), and parametrial invasion. Results. Complete data were available for 182 patients. The agreement between US and pathology was excellent for detecting tumors, correctly classifying bulky tumors (>4 cm), and detecting deep stromal invasion (kappa values 0.84, 0.82, and 0.81 respectively); and good for classifying small tumors (<2 cm) and detecting parametrial invasion (kappa values 0.78 and 0.75, respectively). The agreement between MRI and histology was good for classifying tumors as <2 cm, or >4 cm, and detecting deep stromal invasion (kappa values 0.71, 0.76, and 0.77, respectively). It was Moderately accurate in tumor detection, and in assessing parametrial invasion (kappa values 0.52 and 0.45, respectively). The agreement between histology and US was significantly better in assessing residual tumor (p<0.001) and parametrial invasion (p<0.001) than the results obtained by MRI. Imaging methods were not significantly influenced by previous cone biopsy. Conclusion. US and MRI are highly accurate for the preoperative assessment of women with early-stage cervical cancer, although US may be more accurate in detecting residual tumors and assessing parametrial invasion. (C) 2012 Elsevier Inc. All rights reserved.
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| 2. |
- Epstein, Elisabeth, et al.
(författare)
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Sonographic characteristics of squamous cell cancer and adenocarcinoma of the uterine cervix.
- 2010
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Ingår i: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. - : Wiley. - 1469-0705. ; Apr 8, s. 512-516
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the sonographic characteristic of squamous cell cancer (SCC) and adenocarcinoma (AC) of the cervix using transvaginal ultrasound. METHODS: Women with early stage cervical cancer undergoing transvaginal ultrasound examination prior to surgery were prospectively included. The sonographic characteristics were assessed with regard to tumor morphology, vascularization, size, extension and location. Histological assessment of tumor subtype, size, growth pattern, extension, location was performed. Both sonographic and histological assessments were done according to a standardized protocol. RESULTS: Fifty-five women were recruited. Ten were excluded since no tumor was seen on ultrasound and 5 because radical surgery was aborted due to positive lymph nodes, detected by the sentinel node technique. Among the remaining 40 women 20 had AC and 20 SCC. At pathological examination 34 women had tumors confined to the cervix, 3 had parametrial and 3 vaginal invasion. Hypoechoic echogenicity was associated with SCC in 73% (11/15), while isoechoic echogenicity indicated AC in 68% (13/19) of the women (p=0.03). Mixed echogenicity (n=4) showed a non-significant relation to larger tumor volume (p=0.23). Hyperechoic echogenicity was found in 2 women, both with the less malignant villoglandular AC. Color Doppler signals were found in all AC and 90% (18/20) of the SCC, as compared to most normal cervical tissue with virtually no detectable vascularization. CONCLUSIONS: We found that the sonographic appearance of SCC and AC differs, a knowledge that can be of use in the clinical evaluation of cervical tumors. Copyright (c) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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| 3. |
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| 4. |
- Froyman, Wouter, et al.
(författare)
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Risk of complications in patients with conservatively managed ovarian tumours (IOTA5) : a 2-year interim analysis of a multicentre, prospective, cohort study
- 2019
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Ingår i: The Lancet Oncology. - 1470-2045 .- 1474-5488. ; 20:3, s. 448-458
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography. Methods: In the international, prospective, cohort International Ovarian Tumor Analysis Phase 5 (IOTA5) study, patients aged 18 years or older with at least one adnexal mass who had been selected for surgery or conservative management after ultrasound assessment were recruited consecutively from 36 cancer and non-cancer centres in 14 countries. Follow-up of patients managed conservatively is ongoing at present. In this 2-year interim analysis, we analysed patients who were selected for conservative management of an adnexal mass judged to be benign on ultrasound on the basis of subjective assessment of ultrasound images. Conservative management included ultrasound and clinical follow-up at intervals of 3 months and 6 months, and then every 12 months thereafter. The main outcomes of this 2-year interim analysis were cumulative incidence of spontaneous resolution of the mass, torsion or cyst rupture, or borderline or invasive malignancy confirmed surgically in patients with a newly diagnosed adnexal mass. IOTA5 is registered with ClinicalTrials.gov, number NCT01698632, and the central Ethics Committee and the Belgian Federal Agency for Medicines and Health Products, number S51375/B32220095331, and is ongoing. Findings: Between Jan 1, 2012, and March 1, 2015, 8519 patients were recruited to IOTA5. 3144 (37%) patients selected for conservative management were eligible for inclusion in our analysis, of whom 221 (7%) had no follow-up data and 336 (11%) were operated on before a planned follow-up scan was done. Of 2587 (82%) patients with follow-up data, 668 (26%) had a mass that was already in follow-up at recruitment, and 1919 (74%) presented with a new mass at recruitment (ie, not already in follow-up in the centre before recruitment). Median follow-up of patients with new masses was 27 months (IQR 14–38). The cumulative incidence of spontaneous resolution within 2 years of follow-up among those with a new mass at recruitment (n=1919) was 20·2% (95% CI 18·4–22·1), and of finding invasive malignancy at surgery was 0·4% (95% CI 0·1–0·6), 0·3% (<0·1–0·5) for a borderline tumour, 0·4% (0·1–0·7) for torsion, and 0·2% (<0·1–0·4) for cyst rupture. Interpretation: Our results suggest that the risk of malignancy and acute complications is low if adnexal masses with benign ultrasound morphology are managed conservatively, which could be of value when counselling patients, and supports conservative management of adnexal masses classified as benign by use of ultrasound. Funding: Research Foundation Flanders, KU Leuven, Swedish Research Council.
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| 5. |
- Guerriero, Stefano, et al.
(författare)
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Age-related differences in the sonographic characteristics of endometriomas
- 2016
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 31:8, s. 1723-1731
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Tidskriftsartikel (refereegranskat)abstract
- Study Question Do sonographic characteristics of ovarian endometriomas vary with age in premenopausal women? Summary Answer With increasing age, multilocular cysts and cysts with papillations and other solid components become more common whereas ground glass echogenicity of cyst fluid becomes less common. What is Known Already Expectant or medical management of women with endometriomas is now accepted. Therefore, the accuracy of non-invasive diagnosis of these cysts is pivotal. A clinically relevant question is whether the sonographic characteristics of ovarian endometriomas are the same irrespective of the age of the woman. Study Design, Size, Duration This is a secondary analysis of cross-sectional data in the International Ovarian Tumor Analysis (IOTA) database. The database contains clinical and ultrasound information collected pre-operatively between 1999 and 2012 from 5914 patients with adnexal masses in 24 ultrasound centres in 10 countries. Participants/Materials, Setting, Methods There were 1005 histologically confirmed endometriomas in adult premenopausal patients found in the database and these were used in our analysis. The following ultrasound variables (defined using IOTA terminology) were used to describe the ultrasound appearance of the endometriomas: tender mass at ultrasound, largest diameter of lesion, tumour type (unilocular, unilocular-solid, multilocular, multilocular-solid, solid), echogenicity of cyst content, presence of papillations, number of papillations, height (mm) of largest papillation, presence and proportion of solid tissue and number of cyst locules, as well as vascularity in papillations and colour content of the tumour scan (colour score) on colour or power Doppler ultrasounds. Results are reported as median difference or odds ratio (OR) per 10 years increase in age. Main Results and the Role of Chance Maximal lesion diameter did not vary substantially with age (+1.3 mm difference per 10 years increase in age, 95% confidence interval (CI)-1.4 to 4.0). Tender mass at scan was less common in the older the woman (OR 0.75, 95% CI 0.63-0.89), as were unilocular cysts relative to multilocular cysts (OR 0.70, 95% CI 0.57-0.85) and to lesions with solid components (OR 0.61, 95% CI 0.48-0.77), and ground glass echogenicity relative to homogeneous low-level echogenicity (OR 0.74, 95% CI 0.58-0.94) and other types of echogenicity of cyst contents (OR 0.64, 95% CI 0.50-0.81). Papillations were more common the older the woman (OR 1.65, 95% CI 1.24-2.21), but their height and vascularization showed no clear relation to age. LIMITATIONS, REASONS FOR CAUTION It is a limitation that we have little clinical information on the women included, e.g. previous surgery or medical treatment for endometriosis. It is important to emphasize that we do not know the age of the endometrioma itself and that our study is not longitudinal and so does not describe changes in endometriomas over time. The differences in the ultrasound appearance of endometriomas between women of different ages might be explained by previous surgery or medical treatment and might not be an effect of age per se. Wider Implications of the Findings Awareness of physicians that the ultrasound appearance of endometriomas differs between women of different ages may facilitate a correct diagnosis of endometrioma. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by the Regione Autonoma della Sardegna (project code CPR-24750). B.V.C., A.C. and D.T. are supported by the Fund for Scientific Research Flanders, Belgium (FWO). The authors declare that there is no conflict of interest.
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| 6. |
- Landolfo, Chiara, et al.
(författare)
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Comparison of the ADNEX and ROMA risk prediction models for the diagnosis of ovarian cancer : a multicentre external validation in patients who underwent surgery
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Ingår i: British Journal of Cancer. - 0007-0920.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several diagnostic prediction models to help clinicians discriminate between benign and malignant adnexal masses are available. This study is a head-to-head comparison of the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model with that of the Risk of Ovarian Malignancy Algorithm (ROMA). Methods: This is a retrospective study based on prospectively included consecutive women with an adnexal tumour scheduled for surgery at five oncology centres and one non-oncology centre in four countries between 2015 and 2019. The reference standard was histology. Model performance for ADNEX and ROMA was evaluated regarding discrimination, calibration, and clinical utility. Results: The primary analysis included 894 patients, of whom 434 (49%) had a malignant tumour. The area under the receiver operating characteristic curve (AUC) was 0.92 (95% CI 0.88–0.95) for ADNEX with CA125, 0.90 (0.84–0.94) for ADNEX without CA125, and 0.85 (0.80–0.89) for ROMA. ROMA, and to a lesser extent ADNEX, underestimated the risk of malignancy. Clinical utility was highest for ADNEX. ROMA had no clinical utility at decision thresholds <27%. Conclusions: ADNEX had better ability to discriminate between benign and malignant adnexal tumours and higher clinical utility than ROMA. Clinical trial registration: clinicaltrials.gov NCT01698632 and NCT02847832.
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| 7. |
- Ledger, Ashleigh, et al.
(författare)
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Multiclass risk models for ovarian malignancy : an illustration of prediction uncertainty due to the choice of algorithm
- 2023
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Ingår i: BMC Medical Research Methodology. - 1471-2288. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Assessing malignancy risk is important to choose appropriate management of ovarian tumors. We compared six algorithms to estimate the probabilities that an ovarian tumor is benign, borderline malignant, stage I primary invasive, stage II-IV primary invasive, or secondary metastatic. Methods: This retrospective cohort study used 5909 patients recruited from 1999 to 2012 for model development, and 3199 patients recruited from 2012 to 2015 for model validation. Patients were recruited at oncology referral or general centers and underwent an ultrasound examination and surgery ≤ 120 days later. We developed models using standard multinomial logistic regression (MLR), Ridge MLR, random forest (RF), XGBoost, neural networks (NN), and support vector machines (SVM). We used nine clinical and ultrasound predictors but developed models with or without CA125. Results: Most tumors were benign (3980 in development and 1688 in validation data), secondary metastatic tumors were least common (246 and 172). The c-statistic (AUROC) to discriminate benign from any type of malignant tumor ranged from 0.89 to 0.92 for models with CA125, from 0.89 to 0.91 for models without. The multiclass c-statistic ranged from 0.41 (SVM) to 0.55 (XGBoost) for models with CA125, and from 0.42 (SVM) to 0.51 (standard MLR) for models without. Multiclass calibration was best for RF and XGBoost. Estimated probabilities for a benign tumor in the same patient often differed by more than 0.2 (20% points) depending on the model. Net Benefit for diagnosing malignancy was similar for algorithms at the commonly used 10% risk threshold, but was slightly higher for RF at higher thresholds. Comparing models, between 3% (XGBoost vs. NN, with CA125) and 30% (NN vs. SVM, without CA125) of patients fell on opposite sides of the 10% threshold. Conclusion: Although several models had similarly good performance, individual probability estimates varied substantially.
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| 8. |
- Moro, Francesca, et al.
(författare)
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Ultrasound evaluation of ovarian masses and assessment of the extension of ovarian malignancy
- 2021
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Ingår i: British Journal of Radiology. - : British Institute of Radiology. - 0007-1285 .- 1748-880X. ; 94:1125
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Forskningsöversikt (refereegranskat)abstract
- The current review sums up the literature on the diagnostic performance of models to predict malignancy in adnexal masses and the ability of ultrasound to make a specific diagnosis in adnexal masses. A summary of the role of ultrasound in assessing the extension of malignant ovarian disease is also provided.
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| 9. |
- Moro, Francesca, et al.
(författare)
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Ultrasound, macroscopic and histological features of malignant ovarian tumors
- 2021
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Ingår i: International Journal of Gynecological Cancer. - : BMJ. - 1048-891X .- 1525-1438. ; 31:1, s. 150-151
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Tidskriftsartikel (refereegranskat)abstract
- Ultrasound examination is considered to be the first line imaging method to diagnose an ovarian mass with a high degree of accuracy, discriminating between benign and malignant ovarian masses in the hands of experienced examiners. The International Ovarian Tumor Analysis (IOTA) group provided a standardized terminology of ovarian masses1 and suggested simple ultrasound rules that can be used to classify adnexal masses as benign or malignant.2 The IOTA group has also created logistic regression models (ie, ADNEX (Assessment of Different NEoplasias in the adneXa) model), including clinical and ultrasound information to calculate the likelihood of malignancy in adnexal masses. The IOTA ADNEX model estimates the likelihood not only of an adnexal mass being benign or malignant but also the likelihood that the mass is benign, borderline malignant, stage I primary invasive malignant, stage IIIV primary invasive malignant or a metastasis in the ovary from another primary tumor. 3 Recently, a consensus meeting including European and North American professionals developed a new risk model for the pre-operative assessment of adnexal masses, called O-RADS (Ovarian-Adnexal Reporting and Data System). The O-RADS ultrasound risk stratification and management system was designed to provide consistent interpretations, to decrease or eliminate ambiguity in ultrasound reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. 4 Moreover, during the past 15 years authors of the IOTA group have described the typical ultrasound appearance of several different adnexal pathologies, including various histotypes of malignancy, collected in the series of Imaging in gynecology papers. 510 Indeed, ovarian cancer includes several histological entities which can be grouped into four histological groups: epithelial tumors, germ cell tumors, stromal tumors and metastatic tumors. Each histopathological category is often characterized by some morphological typical features, as described in the textbooks of pathologists. In the pre-operative phase, ultrasound examination can enable assessment of these macroscopic aspects, thus providing a presumptive histological diagnosis. We present a video describing how to apply the simple ultrasound rules, the IOTA ADNEX model and the O-RADS model, and provides explanatory examples for each model.
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| 10. |
- Pinto, Patrícia, et al.
(författare)
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Patient satisfaction with ultrasound, whole-body CT and whole-body diffusion-weighted MRI for pre-operative ovarian cancer staging : a multicenter prospective cross-sectional survey
- 2024
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Ingår i: International Journal of Gynecological Cancer. - 1048-891X.
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Tidskriftsartikel (refereegranskat)abstract
- Background In addition to the diagnostic accuracy of imaging methods, patient-reported satisfaction with imaging methods is important. Objective To report a secondary outcome of the prospective international multicenter Imaging Study in Advanced ovArian Cancer (ISAAC Study), detailing patients’ experience with abdomino-pelvic ultrasound, whole-body contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for pre-operative ovarian cancer work-up. Methods In total, 144 patients with suspected ovarian cancer at four institutions in two countries (Italy, Czech Republic) underwent ultrasound, CT, and WB-DWI/ MRI for pre-operative work-up between January 2020 and November 2022. After having undergone all three examinations, the patients filled in a questionnaire evaluating their overall experience and experience in five domains: preparation before the examination, duration of examination, noise during the procedure, radiation load of CT, and surrounding space. Pain perception, examination-related patient-perceived unexpected, unpleasant, or dangerous events (‘adverse events’), and preferred method were also noted. Results Ultrasound was the preferred method by 49% (70/144) of responders, followed by CT (38%, 55/144), and WB-DWI/MRI (13%, 19/144) (p<0.001). The poorest experience in all domains was reported for WB-DWI/ MRI, which was also associated with the largest number of patients who reported adverse events (eg, dyspnea). Patients reported higher levels of pain during the ultrasound examination than during CT and WB-DWI/MRI (p<0.001): 78% (112/144) reported no pain or mild pain, 19% (27/144) moderate pain, and 3% (5/144) reported severe pain (pain score >7 of 10) during the ultrasound examination. We did not identify any factors related to patients' preferred method.for diagnosing malignant ovarian tumors3 but has rarely been used for pre-operative ovarian cancer work-up.4–7 In 2022, the results of a prospective single-unit study indicated that ultrasound might be an alternative to CT and whole-body diffusion-weighted (WB-DWI)/ MRI for ovarian cancer work-up and prediction of tumor resectability.8 In the recently published European Society of Gynecological Oncology/European Society of Medical Oncology/European Society of Pathology (ESGO/ESMO/ESP) consensus conference recommendations on ovarian cancer, ultrasound is suggested to be an effective alternative to CT, MRI and PET-CT to assess tumor extent and tumor resectability in the pelvis and abdomen.2 In addition to diagnostic accuracy and costs of an imaging method, patient acceptance and preference are important before an imaging test is implemented in clinical practice.9 10 Although there is evidence regarding patients’ experience of and satisfaction with ultrasound,11 12 CT,13–17 and WB-DWI/MRI,16 18–20 little is known about how these three imaging modalities compare when applied in the same patient. Many factors can influence a patient’s experience with an imaging examination—for example, preparation for, and duration of, the examination; use of contrast agent (especially iodinated contrast agent); radiation dose (which depends on the duration of radiation exposure, distance from the radiation source, and physical shielding); noise, feeling of claustrophobia, and occurrence of unexpected unpleasant or dangerous events (adverse events).21–25 The aim of this study is to report a secondary outcome of the prospective, multicentric Imaging Study in Advanced ovArian Cancer (ISAAC Study)—namely, patients’ experience with ultrasound, CT, and WB-DWI/MRI for pre-operative estimation of the extent of ovarian cancer.
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