A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI), showing an adnexal mass, later confirmed at the pelvic examination. The patient's routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful.

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Oral communication abstracts and LR2, the simple rules and the RMI were applied to each of the three groups. Sensitivity, specificity, positive and negative likelihood ratio (LR+, LR−), Diagnostic Odds Ratio (DOR), and area under the receiver operating characteristic curve (AUC) were used to describe diagnostic performance. The gold standard was the histological diagnosis of the surgically removed adnexal mass. Results: The rate of invasive malignancy was 10% in the small tumors, 19% in the medium sized tumors and 40% in the large tumors; 11% of the large tumors were borderline tumors versus 3% and 4% of the small and medium sized tumors. The type of benign histology also differed between the three subgroups. For all methods, the sensitivity with regard to malignancy was lowest in the small tumors, while the specificity was lowest in the large tumors; the DOR and the AUC were highest in the medium sized tumors. The AUC was largest in tumors with a largest diameter 7-11 cm. Conclusions: Tumor size affects the ability of subjective assessment, LR1 and LR2, the IOTA simple rules and the RMI to correctly discriminate between benign and malignant adnexal masses.

Short oral presentation abstractsaccording to the IOTA protocol. A proper counselling on a low ovarian cancer risk was given and an adequate informed consent was obtained. Sonographic follow-up was proposed at 3 and 9 months, than yearly. Surgery was proposed in case of changes of ovarian cyst volume (> 50%) and/or sonographic parameters at TVS-CD. Demographic, medical, sonographic and pathologic data were recorded. Results: 98 post-menopausal patients with 106 ovarian cysts were enrolled. Median age (IR) was 69 years (59-74). Median years after menopause (IR) were 18 (8-24). Median BMI (IR) was 26 kg/m 2 (24-29). Mean parity (±sd) was 2 ± 1.8 women reported bilateral cysts. 53 cysts were unilocular, 53 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 50 mm (34-56). At a median follow-up period of 36 months, surgery was performed in 28 cases: 14 patients required immediate removal, 5 drop-out, 9 volume changes. One successfully managed cardiac arrest occurred during laparoscopic procedure. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular > 5 cm and multilocular < 7 cm ovarian cysts in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management. Objectives: To evaluate ROC curves and reproducibility of ultrasonographic subjective evaluation (B-mode and color Doppler evaluation) in the diagnosis of adnexal masses in operators with different degree of experience using virtual navigation of 3D stored volumes. Methods: One-hundred volumes from adnexal masses submitted to surgery were retrieved from our database for analysis. A single examiner acquired all the volumes using a longitudinal plane of scanning. All the volumes were evaluated by 7 different examiners with different degrees of experience. Using virtual navigation of 3D volumes operators move the cursor on coronal plane and express their diagnostic confidence in a five-degree scale: 1 (certainly benign), 2 (probably benign), 3 (uncertain), 4 (probably malignant), 5 (certainly malignant). Each examiner reviewed the volumes twice, two weeks apart. ROC curve analysis and Area Under the Curve (AUC) were calculated for each operator. Reproducibility was calculated using the weighted kappa index. Results: In our population the prevalence of malignant masses was 40%. Expert examiner had the highest AUC (0.949) with a statistically significant difference in with other six examiners that had a lower AUC (P values < 0.05). We found the best intraobserver agreement in the more expert operators (weighted kappa = 0.723-0.759) whereas in less expert operators the values were suboptimal (weighted kappa = 0.453-0.588). More than the 90% of operators reported a sensitivity ∼90% but a wide range of specificity (ranging from 58 to 88%). The inter-observer analysis showed that the agreement in the diagnostic confidence among ...

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