RESUMO
OBJECTIVES: To evaluate the performance of a two-step strategy compared with the International Ovarian Tumor Analysis (IOTA) - Assessment of Different NEoplasias in the adneXa (ADNEX) model for preoperative classification of adnexal masses. METHODS: An ambispective diagnostic accuracy study based on ultrasound data collected at one university hospital between 2012 and 2018. Two ultrasonographers classified the adnexal masses using IOTA Simple Rules (first step). Not classifiable masses were evaluated using the IOTA ADNEX model (second step). Also, all masses were classified using the IOTA ADNEX model. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), and receiver operating characteristic (ROC) curve were estimated. A P value of <.05 was used to determine statistical significance. RESULTS: The study included 548 patients and 606 masses. Patients' median age was 41 years with an interquartile range between 32 and 51 years. In the first step, 89 (14%) masses were not classifiable. In the second step, 55 (61.8%) masses were classified as malignant. Furthermore, for the totality of 606 masses, the IOTA ADNEX model estimated the probability that 126 (20.8%) masses were malignant. The two-step strategy had a sensitivity, specificity, PPV, NPV, LR+, LR-, and ROC curve of 86.8%, 91.01%, 51.9%, 98.4%, 9.7, 0.1, and 0.889, respectively; compared to IOTA ADNEX model that had values of 91.8%, 87.16%, 44.4%, 99%, 7.1, 0.09, and 0.895, respectively. CONCLUSION: The two-step strategy shows a similar diagnostic performance when compared to the IOTA ADNEX model. The IOTA ADNEX model involves only one step and can be more practical, and thus would be recommended to use.
Assuntos
Doenças dos Anexos , Neoplasias Ovarianas , Anexos Uterinos/diagnóstico por imagem , Doenças dos Anexos/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Hospitais , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Sensibilidade e Especificidade , UltrassonografiaRESUMO
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
BACKGROUND: The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. OBJECTIVE: Describe a case series of patients with adnexal mass and pregnancy. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years. RESULTS: The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure. CONCLUSIONS: The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.
Assuntos
Anexos Uterinos/patologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/cirurgia , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Complicações Neoplásicas na Gravidez/cirurgia , Anexos Uterinos/diagnóstico por imagem , Anexos Uterinos/cirurgia , Doenças dos Anexos/sangue , Doenças dos Anexos/diagnóstico por imagem , Doenças dos Anexos/cirurgia , Adolescente , Adulto , Biomarcadores Tumorais/sangue , Carcinoma/sangue , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Cesárea , Cistadenoma/sangue , Cistadenoma/diagnóstico por imagem , Cistadenoma/cirurgia , Cistos/sangue , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Neoplasias dos Genitais Femininos/sangue , Idade Gestacional , Humanos , Incidência , Achados Incidentais , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Estudos Retrospectivos , Teratoma/sangue , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Ultrassonografia Pré-Natal , Adulto JovemRESUMO
Pelvic ultrasonography was systematically performed on 33 girls with idiopathic central precocious puberty to investigate the impact of treatment with gonadotropin-releasing hormone analogues on female internal genitalia. All girls were treated with a long-acting gonadotropin-releasing hormone analogue (Decapeptyl Depot; Ferring Co., Copenhagen, Denmark) 75 micrograms/kg every 4 weeks. Before, during, and after treatment, pelvic ultrasonography was performed and ovarian and uterine volumes were calculated. The size of follicles > 5 mm were accurately measured. The results were related to a normative study of healthy Danish schoolgirls. Our data demonstrated that ovaries and uterus are enlarged in a significant number of girls (50%) with the diagnosis of central precocious puberty at the time of diagnosis. Median ovarian volume at time of diagnosis was 1.1 standard deviation scores (range -0.6 to 3.2 SD), median uterine volume was 1.8 standard deviation scores (range 0.0 to 3.5 SD). Within 3 months of treatment, both ovarian and uterine volumes decreased significantly (p < 0.01) to normal values appropriate for age. Median ovarian volume after 3 months of treatment was 0.0 SD (range -2.4 to 1.5 SD); median uterine volume was 0.7 SD (range -0.6 to 4.1 SD). Ovarian and uterine volume remained within normal range (< 2 standard deviation scores) after discontinuation of treatment. Follicles and macrocysts regressed during treatment. None of the girls' ovaries had a polycystic appearance during or after treatment with the gonadotropin-releasing hormone analogue. Our results confirmed pelvic ultrasonography as a reliable tool for investigation of internal genitalia in girls with precocious puberty and as a valid method for evaluation of the efficacy of treatment with gonadotropin-releasing hormone analogues. We suggest that repeated investigations be performed when evaluating treatment because the morphologic changes, including follicular maturation or regression, reflect ovarian stimulation or suppression. We found no evidence that girls with precocious puberty treated with long-acting gonadotropin-releasing hormone analogues have enlarged polycystic ovaries develop.
Assuntos
Anexos Uterinos , Hormônio Liberador de Gonadotropina/análogos & derivados , Puberdade Precoce/tratamento farmacológico , Pamoato de Triptorrelina/uso terapêutico , Anexos Uterinos/diagnóstico por imagem , Anexos Uterinos/efeitos dos fármacos , Anexos Uterinos/patologia , Criança , Feminino , Humanos , Estatísticas não Paramétricas , Ultrassonografia , Útero/diagnóstico por imagem , Útero/efeitos dos fármacos , Útero/patologiaRESUMO
Objetivos: Establecer la utilidad de la Resonancia Magnética (RMI), Ecografía transvaginal (EcoTV) y Transrectal (EcoTR), en la evaluación de la extensión del cáncer cervical. Métodos: Se estudiaron prospectivamente 57 pacientes: 36 recibieron poliquimioterapia neoadyuvante (PQT) y 18 se operaron directamente. Los estudios se realizaron en la semana previa a la cirugía y los resultados se compararon con la Anatomía Patológica. Resultados: Cuando se obtuvieron resultados positivos con RMI y EcoTR en la evaluación parametrial, la precisión fue de 81 por ciento (grupo PQT); y de 83 por ciento (grupo cirugía exclusivamente). La precisión de la EcoTV más RMI en la evaluación del tabique vésico-vaginal fue de 93,3 por ciento y de 86,7 por ciento respectivamente. Para las adenopatías la RMI tuvo una precisión de 66 por ciento y 33 por ciento. Conclusiones: La EcoTV debe ser utilizada en todas las pacientes en los que se necesite evaluar el septum vésico-vaginal y que no tengan cesáreas previas. La RMI debe ser utilizada en circunstancias seleccionadas como cirugías de invasión mínima o ultraradicales (AU)