| 11. |
- Timmerman, Dirk, et al.
(författare)
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Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group
- 2010
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Ingår i: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 341, s. 6839-6839
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. Design Prospective temporal and external validation of simple ultrasound rules to distinguish benign from malignant adnexal masses. The rules comprised five ultrasonic features (including shape, size, solidity, and results of colour Doppler examination) to predict a malignant tumour (M features) and five to predict a benign tumour (B features). If one or more M features were present in the absence of a B feature, the mass was classified as malignant. If one or more B features were present in the absence of an M feature, it was classified as benign. If both M features and B features were present, or if none of the features was present, the simple rules were inconclusive. Setting 19 ultrasound centres in eight countries. Participants 1938 women with an adnexal mass examined with ultrasound by the principal investigator at each centre with a standardised research protocol. Reference standard Histological classification of the excised adnexal mass as benign or malignant. Main outcome measures Diagnostic sensitivity and specificity. Results Of the 1938 patients with an adnexal mass, 1396 (72%) had benign tumours, 373 (19.2%) had primary invasive tumours, 111 (5.7%) had borderline malignant tumours, and 58 (3%) had metastatic tumours in the ovary. The simple rules yielded a conclusive result in 1501 (77%) masses, for which they resulted in a sensitivity of 92% (95% confidence interval 89% to 94%) and a specificity of 96% (94% to 97%). The corresponding sensitivity and specificity of subjective assessment were 91% (88% to 94%) and 96% (94% to 97%). In the 357 masses for which the simple rules yielded an inconclusive result and with available results of CA-125 measurements, the sensitivities were 89% (83% to 93%) for subjective assessment, 50% (42% to 58%) for the risk of malignancy index, 89% (83% to 93%) for logistic regression model 1, and 82% (75% to 87%) for logistic regression model 2; the corresponding specificities were 78% (72% to 83%), 84% (78% to 88%), 44% (38% to 51%), and 48% (42% to 55%). Use of the simple rules as a triage test and subjective assessment for those masses for which the simple rules yielded an inconclusive result gave a sensitivity of 91% (88% to 93%) and a specificity of 93% (91% to 94%), compared with a sensitivity of 90% (88% to 93%) and a specificity of 93% (91% to 94%) when subjective assessment was used in all masses. Conclusions The use of the simple rules has the potential to improve the management of women with adnexal masses. In adnexal masses for which the rules yielded an inconclusive result, subjective assessment of ultrasonic findings by an experienced ultrasound examiner was the most accurate diagnostic test; the risk of malignancy index and the two regression models were not useful.
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| 12. |
- Valentin, Lil, et al.
(författare)
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The risk of malignancy in unilocular cysts: a study on 1148 adnexal masses classified as unilocular cysts at transvaginal scan with review of the literature.
- 2013
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Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 41:1, s. 80-89
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination, to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. Methods: 3511 patients with an adnexal mass underwent transvaginal ultrasound examination between 1999 and 2007. The sonologists used the International Ovarian Tumor Analysis terms and definitions to describe their ultrasound findings. Gold standard was the histopathological diagnosis of the mass. Results: Of the 3511 masses, 1148 (33%) were classified as unilocular cysts at scan. Of these, 11 i.e. 0.96 % (95%CI 0.48-1.71) were malignant. The malignancy rate was lower in pre- than post-menopausal women: 0.54% (5/931) (0.17-1.25) versus 2.76% (6/217) (1.02-5.92), P = 0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% versus 2%, P = 0.02) or ovarian cancer (18% versus 0.6%, P = 0.003). Hemorrhagic cyst contents at scan was more common in malignant than benign unilocular cysts (18% versus 2%, P = 0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. Conclusions: The malignancy rate in surgically removed adnexal lesions judged to be unilocular cysts at transvaginal scan is around 1%. Postmenopausal status, personal history of breast or ovarian cancer and hemorrhagic cyst contents at scan increase the risk of malignancy. To avoid misclassifying adnexal lesions as unilocular cysts at scan, it is important to scrutinize unilocular cysts for the presence of solid components. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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| 15. |
- Van Belle, Vanya, et al.
(författare)
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On the use of a clinical kernel in survival analysis
- 2010
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Ingår i: Proc. 18th European Symposium on Artificial Neural Networks. - Evere, Belgium : d-side publications. - 2930307102 ; , s. 451-456
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Konferensbidrag (refereegranskat)
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| 16. |
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| 19. |
- Stoica, Peter, et al.
(författare)
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Using prior knowledge in SVD-based parameter estimation for magnetic resonance spectroscopy--the ATP example
- 2004
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Ingår i: IEEE Transactions on Biomedical Engineering. ; 51:9, s. 1568-1578
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Tidskriftsartikel (refereegranskat)abstract
- We introduce the KNOB-SVD (knowledge based singularvalue decomposition)method for exploiting prior knowledge in MRspectroscopy based on the singular value decomposition (SVD) ofthe data matrix. More specifically we assume that the MR datais well modeled by the superposition of a given number of exponentiallydamped sinusoidal components, and that the dampings $\alpha_k$,frequencies $\omega_k$ and complex amplitudes $\rho_k$of some components satisfy the following relations:$\alpha_k = \alpha$ ($\alpha = \textrm{unknown}$),$\omega_k = \omega + (k-1) \Delta$ ($\omega = \textrm{unknown}$,$\Delta = \textrm{known}$), and $\rho_k = c_k \rho$($\rho = \textrm{unknown}$, $c_k = \textrm{known real constants}$).The ATP (adenosine triphosphate) complex,which has one triple peak and two double peaks whosedampings, frequencies and amplitudes may in some cases be known tosatisfy the above type of relations, is used as a vehicle for describingour SVD-based method throughout the paper. By means of numericalexamples we show that our method provides more accurate parameterestimates than a commonly-used general-purpose SVD-based methodand a previously suggested prior knowledge-based SVD method.
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| 20. |
- Valentin, Lil, et al.
(författare)
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Ultrasound characteristics of different types of adnexal malignancies.
- 2006
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 1095-6859 .- 0090-8258. ; 102:1, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe ultrasound characteristics of adnexal malignancies, i.e., borderline ovarian tumors, primary invasive ovarian epithelial cancer stage 1, primary invasive ovarian epithelial cancer stages 2–4, rare types of malignancy, and metastatic tumors. Methods. In a prospective international study involving nine European ultrasound centers, 1066 women with a pelvic mass judged to be of adnexal origin underwent transvaginal gray scale and color Doppler ultrasound examination by a skilled examiner before surgery. A standardized examination technique and predefined definitions of ultrasound characteristics were used. Results. Of 1066 masses, 266 were malignant and are included: 55 ovarian borderline tumors, 144 primary invasive epithelial ovarian cancers (42 stage 1, 102 stages 2–4), 25 rare malignancies, and 42 metastatic tumors. Most (56%) metastatic tumors and most (60%) rare types of tumor were solid and richly vascularized at color Doppler ultrasound examination (on a scale ranging from 1 to 4, color score based on subjective evaluation was 3 or 4 in 88% and 86%, respectively). Borderline ovarian tumors and stage 1 primary invasive ovarian epithelial cancers differed from stages 2–4 primary invasive ovarian epithelial cancers: they were larger (median volume 375 ml and 695 ml vs. 209 ml; P = 0.0213 and 0.0001), a larger proportion contained papillary projections (64% and 67% vs. 41%; P = 0.0072 and 0.0054), they were more often multilocular cysts without solid components (18% and 14% vs. 2%; P < 0.0017 and 0.0204), but they were less often purely solid (5% and 7% vs. 38%; P ≤ 0.0001 and 0.0005). With increasing degree of invasiveness – from borderline epithelial ovarian tumors via stage 1 invasive epithelial ovarian tumors to stages 2–4 invasive epithelial ovarian tumors – ascites became more common (9% vs. 31% vs. 61%; P = 0.0082, <0.0001, and 0.0017), and, among tumors with solid components (n = 179), the proportion of tumor consisting of solid tissue increased (median 2%–10%–34%; P = 0.0212, <0.0001, and 0.0003). Conclusion. Papillary projections are characteristic of borderline tumors and stage 1 primary invasive epithelial ovarian cancer. A small proportion of solid tissue at ultrasound examination makes a malignant mass more likely to be a borderline tumor or a stage 1 epithelial ovarian cancer than an advanced ovarian cancer, a metastasis, or a rare type of tumor.
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