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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
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- Sladkevicius, P. (författare)
- Lund University,Lunds universitet,Obstetrisk, gynekologisk och prenatal ultraljudsdiagnostik,Forskargrupper vid Lunds universitet,Obstetric, Gynaecological and Prenatal Ultrasound Research,Lund University Research Groups,Skåne University Hospital
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- Jokubkiene, L. (författare)
- Lund University,Lunds universitet,Urogynekologi och reproduktionsfarmakologi,Forskargrupper vid Lunds universitet,Urogynaecology and Reproductive Pharmacology,Lund University Research Groups,Skåne University Hospital
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- Timmerman, D. (författare)
- University Hospitals Leuven,Catholic University of Leuven
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- Fischerova, D. (författare)
- Charles University in Prague
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- Van Holsbeke, C. (författare)
- Hospital Oost-Limburg
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- Franchi, D. (författare)
- European Institute of Oncology
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- Savelli, L. (författare)
- St. Orsola-Malpighi University Hospital,University of Bologna
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- Epstein, E. (författare)
- Karolinska Institutet,Karolinska Institute,Stockholm South General Hospital
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- Fruscio, R. (författare)
- San Gerardo Hospital,University of Milano-Bicocca
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- Kaijser, J. (författare)
- Ikazia Hospital
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- Czekierdowski, A. (författare)
- Medical University of Lublin
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- Guerriero, S. (författare)
- University of Cagliari,Cagliari University hospital
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- Pascual, M. A. (författare)
- University Hospital Dexeus
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- Testa, A. C. (författare)
- Catholic University of the Sacred Heart, Rome
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- Ameye, L. (författare)
- Catholic University of Leuven,Université Libre de Bruxelles (ULB)
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- Valentin, L. (författare)
- Lund University,Lunds universitet,Obstetrisk, gynekologisk och prenatal ultraljudsdiagnostik,Forskargrupper vid Lunds universitet,Obstetric, Gynaecological and Prenatal Ultrasound Research,Lund University Research Groups,Skåne University Hospital
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(creator_code:org_t)
- 2021-02
- 2021
- Engelska 11 s.
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Ingår i: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 57:2, s. 324-334
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Abstract
Ämnesord
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- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)
Nyckelord
- Doppler
- ovarian neoplasm
- three-dimensional ultrasound
- ultrasonography
- vascular morphology
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Sladkevicius, P.
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Jokubkiene, L.
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Timmerman, D.
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Fischerova, D.
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Van Holsbeke, C.
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Franchi, D.
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visa fler...
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Savelli, L.
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Epstein, E.
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Fruscio, R.
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Kaijser, J.
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Czekierdowski, A ...
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Guerriero, S.
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Pascual, M. A.
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Testa, A. C.
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Ameye, L.
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Valentin, L.
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Lunds universitet
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Karolinska Institutet