Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach

Guerriero, S.; Ajossa, Silvia; Garau, Nicoletta; Piras, Bruno; Paoletti, Anna Maria; Melis, Gian Benedetto

doi:10.1016/j.ajog.2004.09.002

Cited by 58 publications

(52 citation statements)

References 22 publications

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“…Sonography is considered the firstline imaging technique for discriminating between malignant and benign lesions, and it has been shown to be useful for determining optimal treatment. [1][2][3] In most institutions, a different person from the one who treats the patient and makes clinical decisions performs the sonographic examination. Usually the clinical management decision is based on data provided in the sonographic report.…”

Section: Discussionmentioning

confidence: 99%

“…When used by experienced examiners, this technique achieves high sensitivity for identifying ovarian cancer, and it has been shown to be useful for selecting the best surgical approach. [1][2][3] However, despite the tremendous progress in the diagnostic capability of TVS, a large multicenter study reported that the false-positive rate could be as high as 24%. 4 One explanation for this high false-positive rate may be operator experience, as has been shown in a recent randomized trial.…”

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confidence: 99%

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Gynecologic Imaging Reporting and Data System

Amor¹,

Vaccaro²,

Alcázar

et al. 2009

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to describe a new reporting system called the Gynecologic Imaging Reporting and Data System (GI-RADS) for reporting findings in adnexal masses based on transvaginal sonography. Methods. A total of 171 women (mean age, 39 years; range, 16-77 years) suspected of having an adnexal mass were evaluated by transvaginal sonography before treatment. Pattern recognition analysis and color Doppler blood flow location were used for determining the presumptive diagnosis. Then the GI-RADS was used, with the following classifications: GI-RADS 1, definitively benign; GI-RADS 2, very probably benign; GI-RADS 3, probably benign; GI-RADS 4, probably malignant; and GI-RADS 5, very probably malignant. Patients with GI-RADS 1 and 2 tumors were treated expectantly. All GI-RADS 3, 4, and 5 tumors were removed surgically, and a definitive histologic diagnosis was obtained. The GI-RADS classification was compared with final histologic diagnosis. Results. A total of 187 masses were evaluated. The prevalence rate for malignant tumors was 13.4%. Overall GI-RADS classification rates were as follows: GI-RADS 1, 4 cases (2.1%); GI-RADS 2, 52 cases (27.8%); GI-RADS 3, 90 cases (48.1%); GI-RADS 4, 13 cases (7%); and GI-RADS 5, 28 cases (15%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92%, 97%, 85%, 99%, and 96%, respectively. Conclusions. Our proposed reporting system showed good diagnostic performance. It is simple and could facilitate communication between sonographers/ sonologists and clinicians. Key words: adnexal mass; reporting system; sonography. ransvaginal sonography (TVS) has become the first-step imaging technique for characterizing adnexal masses. When used by experienced examiners, this technique achieves high sensitivity for identifying ovarian cancer, and it has been shown to be useful for selecting the best surgical approach. [1][2][3] However, despite the tremendous progress in the diagnostic capability of TVS, a large multicenter study reported that the false-positive rate could be as high as 24%. 4 One explanation for this high false-positive rate may be operator experience, as has been shown in a recent randomized trial.5 Another reason could be a problem in the transmission of information about findings from the sonologist or sonographer to the clinician who makes final decision. As a matter of fact, reports describing sonographic findings are sometimes confusing.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Gynecologic Imaging Reporting and Data System

Amor¹,

Vaccaro²,

Alcázar

et al. 2009

Journal of Ultrasound in Medicine

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“…5 Most studies assessing the role of ultrasound for surgical or referral triaging of adnexal masses have been performed in series in which clinical complaints were not taking into account. [15][16][17][18][19] It could be speculated that the performance of this diagnostic technique could be different in women complaining symptoms suggestive of ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

Assessment of an Ultrasound-based Scoring System for Triaging Ovarian Tumors in Symptomatic Women

Galván¹,

Alcázar

Royo³

et al. 2009

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Objective: To evaluate prospectively an ultrasound-based scoring system as a method for triaging symptomatic women presenting with an adnexal mass for surgical treatment.Methods: 151 symptomatic women scheduled for surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound prior to surgery. Patients were classified as low-risk or high-risk for malignancy according an ultrasound-based scoring system. Patients with low risk for malignancy were scheduled for laparoscopy and patients for high risk for malignancy were scheduled for laparotomy. Some patients with high-risk were scheduled for advanced oncologic laparoscopic surgery. Patients with low risk but tumor size > 10 cm were scheduled for laparotomy.Results: 82 women presented with pelvic pain, 8 had uterine bleeding and 61 referred symptoms suggestive for ovarian malignancy, such as abdominal swelling, bloating and abdominal discomfort. 75 (49.7%) masses were considered as "low-risk" and treated by laparoscopy in 58 cases and by laparotomy in 7 cases, because emergency or associated pathology (All tumors were benign). 76 (50.3%) masses were considered as "high-risk" and all treated by laparotomy (56 malignant and 4 benign tumors) or by advanced laparoscopy (16 malignant tumors). Ten (6.7%) tumors were considered as "low-risk" but scheduled for primary laparotomy because of size > 10 cm (9 benign and 1 malignant). Sensitivity, specificity, PPV and NPV for this scoring system were 98.6%, 94.9%, 94.7% and 98.7%, respectively. The scoring system were more sensitive than patient's complaints (98.6% vs 79.5%, p < 0.0001) and more specific than physical examination (94.9% vs 85.9%, p < 0.0001) Conclusions: Ultrasound based triage of symptomatic women diagnosed, as having an adnexal mass is effective for selecting surgical approach.

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“…They could also be presented as mixed lesions consisting of a multiplicity of loci constructed by fine, horizontally orientated, hyperechogenic sparkling lines and/or a hyperechogenic solid part. Accumulation of hair and sebaceous fat tissue leads in the ultrasonographic reported appearance of white lines and hyperechogenic solid formations that characterize mature teratomas [16,17] (Figure 4). …”

Section: Discussionmentioning

confidence: 99%

Immature Ovarian Teratoma in a 21 Year –Old Woman: A Case Report and Review of the Literature.

Stavrou¹

2015

J Gen Pract

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with specific tumor markers .So, tumor markers Ca 15-3, Ca19-9, Ca 125, and CEA were fluctuated in normal ranges. Serum levels of alphafetoprotein (a-FP) were significantly elevated reaching the plateau of 392 iu/ ml (normal ranges: <9.5 iu/ml), supporting the sonographically evoked opinion of underlying malignancy. Except that AST (62 IU/L), ALT (73 IU/L) and LDH (309 IU/L) were mildly increased.Because of the young profile of the patient, MRI of upper and lower abdomen has been also performed; similarly to ultrasonographic report, MRI noticed the presence of excessive ascites; it also described a heterogeneous right ovarian mass of 88 × 81 × 100 mm presenting cystic, solid and hemorrhagic contents, fixed to the broad ligament of the uterus. It also revealed 2 thin walled cysts of 4, 3 cm and 2, 4 cm in the left ovary without solid parts. Intraperitoneal tissue in the region of upper abdomen was described, implying the possibility of underlying peritoneal carcinomatosis. The liver, the biliary system, the spleen, the pancreas and the adrenals were normal. MRI didn't reveal enlarged paraaortic, mesenteric, iliac or inguinal lymph nodes (Figure 2). Chest X-ray and ultrasonographically breast examination were normal. Initially, ascites suction was realized in order to alleviate from pressing symptoms. In the operation theater under general anesthesia, laparoscopy was performed with the technique of the four ports for better abdominal exploration in the overweight patient; 4 to 5 liters of ascites were aspirated for cytological examination. The organs of the upper abdomen were normal, without implantations in the peritoneum or omental disease. The uterus and the left adnexa were normal but a mass 10-12 cm of right ovary characterized by abnormal surface was revealed. So exploratory laparotomy followed with vertical incision .Then the cystic lesion was removed and sent for frozen section. The rapid biopsy was positive for

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Ultrasonography and color Doppler-based triage for adnexal masses to provide the most appropriate surgical approach

Cited by 58 publications

References 22 publications

Gynecologic Imaging Reporting and Data System

Gynecologic Imaging Reporting and Data System

Assessment of an Ultrasound-based Scoring System for Triaging Ovarian Tumors in Symptomatic Women

Immature Ovarian Teratoma in a 21 Year –Old Woman: A Case Report and Review of the Literature.

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