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- Sladkevicius, P., et al.
(author)
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Vessel morphology depicted by three-dimensional power Doppler ultrasound as second-stage test in adnexal tumors that are difficult to classify : prospective diagnostic accuracy study
- 2021
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In: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 57:2, s. 324-334
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Journal article (peer-reviewed)abstract
- Objectives: To assess whether vessel morphology depicted by three-dimensional (3D) power Doppler ultrasound improves discrimination between benignity and malignancy if used as a second-stage test in adnexal masses that are difficult to classify. Methods: This was a prospective observational international multicenter diagnostic accuracy study. Consecutive patients with an adnexal mass underwent standardized transvaginal two-dimensional (2D) grayscale and color or power Doppler and 3D power Doppler ultrasound examination by an experienced examiner, and those with a ‘difficult’ tumor were included in the current analysis. A difficult tumor was defined as one in which the International Ovarian Tumor Analysis (IOTA) logistic regression model-1 (LR-1) yielded an ambiguous result (risk of malignancy, 8.3% to 25.5%), or as one in which the ultrasound examiner was uncertain regarding classification as benign or malignant when using subjective assessment. Even when the ultrasound examiner was uncertain, he/she was obliged to classify the tumor as most probably benign or most probably malignant. For each difficult tumor, one researcher created a 360° rotating 3D power Doppler image of the vessel tree in the whole tumor and another of the vessel tree in a 5-cm3 spherical volume selected from the most vascularized part of the tumor. Two other researchers, blinded to the patient's history, 2D ultrasound findings and histological diagnosis, independently described the vessel tree using predetermined vessel features. Their agreed classification was used. The reference standard was the histological diagnosis of the mass. The sensitivity of each test for discriminating between benign and malignant difficult tumors was plotted against 1 – specificity on a receiver-operating-characteristics diagram, and the test with the point furthest from the reference line was considered to have the best diagnostic ability. Results: Of 2403 women with an adnexal mass, 376 (16%) had a difficult mass. Ultrasound volumes were available for 138 of these cases. In 79/138 masses, the ultrasound examiner was uncertain about the diagnosis based on subjective assessment, in 87/138, IOTA LR-1 yielded an ambiguous result and, in 28/138, both methods gave an uncertain result. Of the masses, 38/138 (28%) were malignant. Among tumors that were difficult to classify as benign or malignant by subjective assessment, the vessel feature ‘densely packed vessels’ had the best discriminative ability (sensitivity 67% (18/27), specificity 83% (43/52)) and was slightly superior to subjective assessment (sensitivity 74% (20/27), specificity 60% (31/52)). In tumors in which IOTA LR-1 yielded an ambiguous result, subjective assessment (sensitivity 82% (14/17), specificity 79% (55/70)) was superior to the best vascular feature, i.e. changes in the diameter of vessels in the whole tumor volume (sensitivity 71% (12/17), specificity 69% (48/70)). Conclusion: Vessel morphology depicted by 3D power Doppler ultrasound may slightly improve discrimination between benign and malignant adnexal tumors that are difficult to classify by subjective ultrasound assessment. For tumors in which the IOTA LR-1 model yields an ambiguous result, subjective assessment is superior to vessel morphology as a second-stage test.
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| 3. |
- Ciccarone, F., et al.
(author)
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Imaging in gynecological disease (23) : clinical and ultrasound characteristics of ovarian carcinosarcoma
- 2022
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In: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 59:2, s. 241-247
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Journal article (peer-reviewed)abstract
- Objective: To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma. Methods: This was a retrospective multicenter study. Patients with a histological diagnosis of ovarian carcinosarcoma, who had undergone preoperative ultrasound examination between 2010 and 2019, were identified from the International Ovarian Tumor Analysis (IOTA) database. Additional patients who were examined outside of the IOTA study were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two experienced ultrasound examiners reviewed all available images to identify typical ultrasound features using pattern recognition. Results: Ninety-one patients with ovarian carcinosarcoma who had undergone ultrasound examination were identified, of whom 24 were examined within the IOTA studies and 67 were examined outside of the IOTA studies. Median age at diagnosis was 66 (range, 33–91) years and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, with the most common complaint being pain (51/91, 56.0%). Most tumors (67/91, 73.6%) were International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5%) patients. Ascites was present in 38/91 (41.8%) patients. The median largest tumor diameter was 100 (range, 18–260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular-solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 (range, 11–238) mm. Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images and videoclips using pattern recognition in 73 cases revealed that all tumors had irregular margins and inhomogeneous echogenicity of the solid components. Forty-seven of 73 (64.4%) masses appeared as a solid tumor with cystic areas. Cooked appearance of the solid tissue was identified in 28/73 (38.4%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found. Conclusions: Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is a large solid tumor with irregular margins, inhomogeneous echogenicity of the solid tissue and cystic areas. The second most common pattern is a large multilocular-solid mass with inhomogeneous echogenicity of the solid tissue.
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| 5. |
- Savelli, Elisa, et al.
(author)
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All dried up: the materiality of drought in Ladismith, South Africa
- 2022
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In: Environmental and Planning E: Nature and Space. - : Elsevier. - 2514-8486 .- 2514-8494. ; , s. 1-28
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Journal article (peer-reviewed)abstract
- This paper conceptualizes droughts as socioecological phenomena coproduced by the recursive engagement of human and non-human transformations. Through an interdisciplinary approach that integrates political ecology, material geographies and hydroclimatology, this work simultaneously apprehends the role of politics and power in reshaping drought, along with the agency of biophysical processes —soil, vegetation, hydrology and microclimate— that co-produce droughts and their spatiotemporal patterning. The drought-stricken Ladismith in Western Cape, South Africa, is the instrumental case study and point of departure of our empirical analysis. To advance a materiality of drought that seriously accounts for the coevolution of biophysical and political transformations, we alter the spatiotemporal and empirical foci of drought analyses thereby retracing Ladismith’s socioecological history since colonial times. In turn, such extended framework exposes the agency of soil, vegetation, hydrology and microclimate and their metabolic exchanges with processes of colonization, apartheid, capitalist and neoliberal transformations of South African economy. We argue that the narrow pursuit of profits and capital accumulation of the few has produced a fundamental disruption between nature and society which contributed to transform Ladismith’s drought into a socioecological crisis. Whilst advancing debates on materiality, we note two fundamental contributions to the study of drought. First, our approach makes hydrological accounts of droughts less politically naive and socially blind. Second, it develops a political ecology of droughts and socioecological crises more attuned to the materiality of drought. We contend that apprehending the materiality of drought and the active role of its non-human processes can further understandings of the workings of power and the production of socioecological injustices.
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| 6. |
- Savelli, Elisa, et al.
(author)
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Don't blame the rain : Social power and the 2015-2017 drought in Cape Town
- 2021
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In: Journal of Hydrology. - : Elsevier. - 0022-1694 .- 1879-2707. ; 594
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Journal article (peer-reviewed)abstract
- Sociohydrology has advanced understandings of water related phenomena by conceptualizing changes in hydrological flows and risks as the result of the interplay between water and society. However, social power and the heterogeneity of human societies, which are crucial to unravel the feedback mechanisms underlying human-water systems, have not been sufficiently considered. In response, this paper proposes an interdisciplinary approach that draws on political ecology perspectives to combine sociohydrological insights with analyses of social power and of the ways in which different social groups distinctively interact with water systems. We draw on empirical evidence of Cape Town's water insecurity before and during the prolonged drought (2015-2017) that escalated into a severe water crisis, also known as Day Zero. The study integrates times series of reservoir storage and water consumption with 40 interviews and focus group discussions to firstly retrace the historical legacy of Colonial rules, Apartheid and, more recently, neoliberal policies. Within this human-water system, we show how Cape Town's political legacy has encouraged unsustainable levels of water consumption amongst the (white) elite and tolerated chronic water insecurity amongst (black) informal dwellers. This uneven geography of water insecurity is also discernible in the unequal experiences of drought and water resilience trajectories of diverse social groups across Cape Town. We conclude that accounting for social power and inequalities can advance sociohydrology by identifying those mechanisms (within society) that determine what water is secured and what human-water interactions and dynamics will be sustained over time. Furthermore, by engaging with social power, sociohydrology can play a significant role in informing policies that reduce inequalities in water access and unsustainable water use.
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| 7. |
- Savelli, Elisa, et al.
(author)
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Drought and society : Scientific progress, blind spots, and future prospects
- 2022
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In: Wiley Interdisciplinary Reviews. - : John Wiley & Sons. - 1757-7780 .- 1757-7799. ; 13:3
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Journal article (peer-reviewed)abstract
- Human activities have increasingly intensified the severity, frequency, and negative impacts of droughts in several regions across the world. This trend has led to broader scientific conceptualizations of drought risk that account for human actions and their interplays with natural systems. This review focuses on physical and engineering sciences to examine the way and extent to which these disciplines account for social processes in relation to the production and distribution of drought risk. We conclude that this research has significantly progressed in terms of recognizing the role of humans in reshaping drought risk and its socioenvironmental impacts. We note an increasing engagement with and contribution to understanding vulnerability, resilience, and adaptation patterns. Moreover, by advancing (socio)hydrological models, developing numerical indexes, and enhancing data processing, physical and engineering scientists have determined the extent of human influences in the propagation of drought hazard. However, these studies do not fully capture the complexities of anthropogenic transformations. Very often, they portray society as homogeneous, and decision‐making processes as apolitical, thereby concealing the power relations underlying the production of drought and the uneven distribution of its impacts. The resistance in engaging explicitly with politics and social power—despite their major role in producing anthropogenic drought—can be attributed to the strong influence of positivist epistemologies in engineering and physical sciences. We suggest that an active engagement with critical social sciences can further theorizations of drought risk by shedding light on the structural and historical systems of power that engender every socioenvironmental transformation.
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| 8. |
- Van Calster, Ben, et al.
(author)
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Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively : multicentre cohort study
- 2020
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In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833. ; 370
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively. DESIGN: Multicentre cohort study. SETTING: 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre. PARTICIPANTS: Consecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up. MAIN OUTCOME MEASURES: Overall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (±2) months. Multiple imputation was used when outcome based on follow-up was uncertain. RESULTS: The primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the best calibrated. Calibration of the estimated risks for the tumour subtypes was good for ADNEX irrespective of whether or not CA125 was included as a predictor. Overall clinical utility (net benefit) was highest for the ADNEX models and SRRisk, and lowest for RMI. For patients who received at least one follow-up scan (n=1958), overall area under the receiver operating characteristic curve ranged from 0.76 (95% confidence interval 0.66 to 0.84) for RMI to 0.89 (0.81 to 0.94) for ADNEX with CA125. CONCLUSIONS: Our study found the ADNEX models and SRRisk are the best models to distinguish between benign and malignant masses in all patients presenting with an adnexal mass, including those managed conservatively. TRIAL REGISTRATION: ClinicalTrials.gov NCT01698632.
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