Correlation of ultrasound features and the Risk of Ovarian Malignancy Algorithm score for different histopathological subtypes of benign adnexal masses

Abstract

Ovarian masses are one of the most frequently identified entities in gynecological practice. Early differential diagnosis is a key factor in the medical management of each patient. Transvaginal ultrasound along with additional preoperative testing, such as serum cancer antigen 125 (CA-125) levels and the Risk of Ovarian Malignancy Algorithm (ROMA) score, usually provide sufficient information for a presumptive diagnosis. Minimally invasive surgery as a therapeutic approach is the standard procedure for uncomplicated and benign adnexal masses. Histopathological examination alone, or in conjunction with immunohistochemical testing establishes a more certain diagnosis in the final step of the patient management plan. We developed a retrospective descriptive observational study based on the evaluation of 107 patients admitted to the Department of Obstetrics and Gynecology at “Sf Pantelimon” Clinical Emergency Hospital in Bucharest between January 2000 and July 2017. Each patient was diagnosed with an ovarian mass and underwent laparoscopic surgery for treatment. All data underwent descriptive statistical analysis in order to establish correlations between preoperative test results and definitive diagnoses. The typical ultrasound findings of endometriotic cysts were histopathologically confirmed in 52.6% of the examined patients. Using ultrasound, benign teratomas were suspected in 66.6% of all documented dermoid cysts and 90% of the patients with a calculated ROMA score had corresponding values less than 15%. Mean CA-125 value was 26.58 U/mL. Laparoscopic surgery with ovarian cystectomy was performed for 78.5% of the cases. Histopathological examinations established endometriosis was present in 26.16% of cases. According to an independent samples t test (with 2 extreme values eliminated), patients in the premenopausal group had a significantly lower mean ROMA score than postmenopausal patients (6.87% vs 20.98%, respectively; P < .001). The groups had similar homogeneity (P = .131 according to the Levene test). Our results showed that transvaginal ultrasound established a presumptive diagnosis for almost half of our patients. Cystectomy was the main surgical procedure used for the management of benign ovarian masses. Endometriosis was the most common benign ovarian pathology evaluated and treated in our study.

The comparison of pelvic mass score and risk of malignancy index-3 in discrimination of benign and malignant adnexal masses

“…Several scoring systems were developed according to the morphologic characteristics of benign and malignant adnexal masses in transvaginal ultrasonographic examination. [10,11] Although there are little differences between those scoring systems, the size of the mass, the echogenicity, the presence of septa and/or papillary projections, the thickness of the cyst wall and the presence of ascites are generally identical.…”

Breast cancer mortality gaps in Romanian women compared to the EU after 10 years of accession: Is breast cancer screening a priority for action in Romania? (Review of the Statistics)

“…At present, the access to breast screening mammography in Romanian women is fragmentary, often imposing out-of-pocket payment for the investigation. No population screening has been organized to date, despite some attempts to include mammography screening in the national health programs or to some pilot projects that have been implemented, in conformity of Order of the Health Minister and of the president of the National Health Insurance House no 574/269/2008 regarding the implementing norms for the national health programs (27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Therefore, a small section of the female population in Romania regularly undergoes clinical and imaging examinations, in the context of which in Romania breast cancer is the first cause of cancer-related death in females, with a long gap to colon or lung cancer.…”

Impact of histological subtype on the response to chemoradiation in locally advanced cervical cancer and the possible role of surgery

“…Regarding the advanced stages of cervical cancer, primary chemoradiation which has demonstrated superior positive results compared to radiotherapy alone is recommended by the latest studies. Radiotherapy in conjunction with chemotherapy, especially brachytherapy results in significant higher rates of survival (43)(44)(45)(46)(47). Most centers do not perform hysterectomy after chemoradiation and the results of research performed in this field until now show that after a 3-year follow-up women who underwent hysterectomy exhibit no difference in survival rate (48).…”