20 results on '"Fischerova, D."'
Search Results
2. Interobserver agreement of transvaginal ultrasound and magnetic resonance imaging in local staging of cervical cancer.
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Pálsdóttir K, Fridsten S, Blomqvist L, Alagic Z, Fischerova D, Gaurilcikas A, Hasselrot K, Jäderling F, Testa AC, Sundin A, and Epstein E
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- Adult, Cervix Uteri diagnostic imaging, Female, Gynecology statistics & numerical data, Humans, Magnetic Resonance Imaging methods, Middle Aged, Neoplasm Staging methods, Observer Variation, Radiology statistics & numerical data, Reproducibility of Results, Ultrasonography methods, Uterine Cervical Neoplasms pathology, Vagina diagnostic imaging, Clinical Competence statistics & numerical data, Magnetic Resonance Imaging statistics & numerical data, Neoplasm Staging statistics & numerical data, Ultrasonography statistics & numerical data, Uterine Cervical Neoplasms diagnostic imaging
- Abstract
Objective: To evaluate interobserver agreement for the assessment of local tumor extension in women with cervical cancer, among experienced and less experienced observers, using transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI)., Methods: The TVS observers were all gynecologists and consultant ultrasound specialists, six with and seven without previous experience in cervical cancer imaging. The MRI observers were five radiologists experienced in pelvic MRI and four less experienced radiology residents without previous experience in MRI of the pelvis. The less experienced TVS observers and all MRI observers underwent a short basic training session in the assessment of cervical tumor extension, while the experienced TVS observers received only a written directive. All observers were assigned the same images from cervical cancer patients at all stages (n = 60) and performed offline evaluation to answer the following three questions: (1) Is there a visible primary tumor? (2) Does the tumor infiltrate > ⅓ of the cervical stroma? and (3) Is there parametrial invasion? Interobserver agreement within the four groups of observers was assessed using Fleiss kappa (κ) with 95% CI., Results: Experienced and less experienced TVS observers, respectively, had moderate interobserver agreement with respect to tumor detection (κ (95% CI), 0.46 (0.40-0.53) and 0.46 (0.41-0.52)), stromal invasion > ⅓ (κ (95% CI), 0.45 (0.38-0.51) and 0.53 (0.40-0.58)) and parametrial invasion (κ (95% CI), 0.57 (0.51-0.64) and 0.44 (0.39-0.50)). Experienced MRI observers had good interobserver agreement with respect to tumor detection (κ (95% CI), 0.70 (0.62-0.78)), while less experienced MRI observers had moderate agreement (κ (95% CI), 0.51 (0.41-0.62)), and both experienced and less experienced MRI observers, respectively, had good interobserver agreement regarding stromal invasion (κ (95% CI), 0.80 (0.72-0.88) and 0.71 (0.61-0.81)) and parametrial invasion (κ (95% CI), 0.69 (0.61-0.77) and 0.71 (0.61-0.81))., Conclusions: We found interobserver agreement for the assessment of local tumor extension in patients with cervical cancer to be moderate for TVS and moderate-to-good for MRI. The level of interobserver agreement was associated with experience among TVS observers only for parametrial invasion. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., (© 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)
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- 2021
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3. An ultrasound-based risk model to predict lymph node metastases before surgery in women with endometrial cancer: a model development study
- Author
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Eriksson, LSE, Epstein, E, Testa, AC, Fischerova, D, Valentin, L, Sladkevicius, P, Franchi, D, Frühauf, F, Fruscio, R, Haak, LA, Opolskiene, G, Mascilini, F, Alcazar, JL, Van Holsbeke, C, Chiappa, V, Bourne, T, Lindqvist, PG, Van Calster, B, Timmerman, D, Verbakel, JY, Van den Bosch, T, and Wynants, L
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diagnostic imaging ,decision support model ,1114 Paediatrics and Reproductive Medicine ,endometrial neoplasm ,lymphatic metastasis ,ultrasonography ,neoplasm staging ,Obstetrics & Reproductive Medicine - Abstract
OBJECTIVES: To develop a pre-operative risk model using endometrial biopsy results, clinical and ultrasound variables to predict the individual risk of lymph node metastases in women with endometrial cancer. METHODS: A mixed effects logistic regression model was developed on 1501 prospectively included women with endometrial cancer subjected to transvaginal ultrasound examination before surgery. Missing data, including missing lymph node status, was imputed. Discrimination, calibration and clinical utility were evaluated using leave-center-out cross-validation. The predictive performance was compared with risk classification from endometrial biopsy alone (high-risk = endometrioid cancer grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk = endometrioid cancer grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). RESULTS: Lymphadenectomy was performed in 691 women, of which 127 had lymph node metastases. The model included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and "undefined tumor with an unmeasurable endometrium". The model's AUC was 0.73 (95% CI 0.68 to 0.78), calibration slope 1.06 (95% CI 0.79 to 1.34) and calibration intercept 0.06 (95% CI 0.15 to 0.27). Using risk thresholds for lymph node metastases 5% vs. 20% the model had sensitivity 98% vs. 48% and specificity 11% vs. 80%. The model had higher sensitivity and specificity than high-risk according to endometrial biopsy alone (50% vs. 35% and 80% vs. 77%) or combined endometrial biopsy and ultrasound (80% vs. 75% and 53% vs. 52%). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. CONCLUSIONS: Based on endometrial biopsy results, clinical and ultrasound characteristics, the individual risk of lymph node metastases in women with endometrial cancer can be reliably estimated before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound. This article is protected by copyright. All rights reserved.
- Published
- 2019
4. Ultrasound characteristics of endometrial cancer as defined by the International Endometrial Tumor Analysis (IETA) consensus nomenclature - A prospective multicenter study
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Epstein, E, Fischerova, D, Valentin, L, Testa, AC, Franchi, D, Sladkevicius, P, Filip, F, Lindqvist, PG, Mascilini, F, Fruscio, R, Haak, LA, Opolskiene, G, Pascual, MA, Alcazar, JL, Chiappa, V, Guerriero, S, Carlson, J, Van Holsbeke, C, Leone, FPG, De Moor, B, Bourne, T, Van Calster, B, Installe, A, Timmerman, D, Verbakel, JY, Van den Bosch, T, Epstein, E, Fischerova, D, Valentin, L, Testa, A, Franchi, D, Sladkevicius, P, Frühauf, F, Lindqvist, P, Mascilini, F, Fruscio, R, Haak, L, Opolskiene, G, Pascual, M, Alcazar, J, Chiappa, V, Guerriero, S, Carlson, J, Van Holsbeke, C, Leone, F, De Moor, B, Bourne, T, van Calster, B, Installe, A, Timmerman, D, Verbakel, J, and Van den Bosch, T
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MALIGNANCY ,Technology ,OUTCOMES ,Science & Technology ,CARCINOMA ,diagnostic imaging ,Radiology, Nuclear Medicine & Medical Imaging ,Doppler ,Obstetrics & Gynecology ,WOMEN ,VASCULARITY ,Acoustics ,ultrasonography ,Oncology ,DISCRIMINATION ,COLOR DOPPLER ,1114 Paediatrics And Reproductive Medicine ,INTEROBSERVER REPRODUCIBILITY ,MORPHOLOGY ,endometrial neoplasm ,ultrasonography Doppler ,Obstetrics & Reproductive Medicine ,neoplasm staging ,Life Sciences & Biomedicine ,GRAY-SCALE - Abstract
OBJECTIVES: To describe the sonographic features of endometrial cancer in relation to stage, grade, and histological type using the International Endometrial Tumor Analysis (IETA) terminology. METHODS: Prospective multicenter study on 1714 women with endometrial cancer undergoing a standardized transvaginal grayscale and Doppler ultrasound examination by an experienced ultrasound examiner using a high-end ultrasound system. Clinical and sonographic data were entered into a web-based protocol. We assessed how strongly sonographic characteristics, according to IETA, were associated to outcome at hysterectomy, i.e. tumor stage, grade, and histological type. RESULTS: After excluding 176 women (no or delayed hysterectomy, final diagnosis other than endometrial cancer, or incomplete data), 1538 women were included in our statistical analysis. Median age was 65 years (range 27-98), and median BMI 28.4 (range 16-67), 1378 (89.7%) women were postmenopausal, and 1296 (84.2%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage. High-risk tumors (stage 1A, grade 3 or non-endometrioid or ≥ stage 1B) were less likely to have regular endometrial myometrial border (difference of -23%, 95% CI -27 to -18%), whilst they were larger (mean endometrial thickness; difference of +9 mm, 95% CI +8 to +11 mm), more frequently had non-uniform echogenicity (difference of +10%, 95% CI +5 to +15%), a multiple, multifocal vessel pattern (difference of +21%, 95% CI +16 to +26%), and a moderate or high color score (difference of +22%, 95% CI +18 to +27%), than low-risk tumors. CONCLUSION: Grayscale and color Doppler ultrasound features are associated with grade and stage, and differ between high and low risk endometrial cancer.
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- 2018
5. [Contribution of sentinel lymph-node biopsy to treatment of locally advanced stages of cervical cancers]
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Jiri Slama, Zikan, M., Fischerova, D., Kocian, R., Germanova, A., Fruhauf, F., and Cibula, D.
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Adult ,Sentinel Lymph Node Biopsy ,Uterine Cervical Neoplasms ,Antineoplastic Agents ,Chemoradiotherapy ,Middle Aged ,Hysterectomy ,Combined Modality Therapy ,Neoadjuvant Therapy ,Cohort Studies ,Lymphatic Metastasis ,Humans ,Female ,Neoplasm Invasiveness ,Aged ,Neoplasm Staging ,Retrospective Studies - Abstract
Usage of sentinel lymph-node (SLN) concept in locally advanced cervical cancers might help to individualise management. According to SLN status could be patients refered to neoadjuvant chemotherapy (NAC) with subsequent surgery or to primary chemoradiation. The aim of our study was to evaluate sensitivity of SLN detection in locally advanced cervical cancers and to assess the impact of NAC on frequency of their metastatic involvement.Retrospective clinical study.Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.Included were patients with cervical cancer stages FIGO IB1 (3 cm), IB2, IIA2 and selected cases of stages IIB with incipient parametrial involvement. Patients were distributed into two different protocols - patients in group NAC-SLN were refered to radical hysterectomy with SLN biopsy after 3 cycles of NAC, other patients (group SLN) underwent SLN biopsy and NAC was administered only in SLN-negative cases.Altogether 101 patients were included (group SLN = 62, group NAC-SLN = 39). Detection of SLN in whole cohort reached 90.1% per patient and 68.3% bilaterally. No differences were found between SLN group and NAC-SLN group in frequency of per patient SLN detection (90.3% vs 89.7%) and bilateral detection (69.4% vs 66.7%). Prevalence of macrometastases, micrometastases and ITC in the SLN group was 37.1% (23/62), 11.3% (7/62) and 8.1% (5/62), respectively. In the NAC-SLN group macrometastases in SLN were detected in 17.9% (7/39) patients, in 1 patient was detected micrometastis in SLN and no patient had ITC. Difference in frequency of metastases in SLN was significant (p = 0,013). No patient had progressed during NAC, complete response was seen in 15.1% (11/73) patients and reduction of tumour volume30% in 84.9% (62/73) patients.Detection of SLN in locally advanced cervical cancers reached comparable results to early stages. NAC did not influence frequency of SLN detection, but it significantly decreased prevalence of metastatic SLN involvement.
- Published
- 2016
6. Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer: model-development study.
- Author
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Eriksson, L. S. E., Epstein, E., Testa, A. C., Fischerova, D., Valentin, L., Sladkevicius, P., Franchi, D., Frühauf, F., Fruscio, R., Haak, L. A., Opolskiene, G., Mascilini, F., Alcazar, J. L., Van Holsbeke, C., Chiappa, V., Bourne, T., Lindqvist, P. G., Van Calster, B., Timmerman, D., and Verbakel, J. Y.
- Subjects
ENDOMETRIAL cancer ,ENDOMETRIAL surgery ,LYMPHATIC metastasis ,METASTASIS ,ENDOMETRIAL tumors ,PREDICTION models ,LOGISTIC regression analysis ,REGRESSION analysis ,RESEARCH ,ULTRASONIC imaging ,LYMPH nodes ,MEDICAL cooperation ,EVALUATION research ,TUMOR classification ,COMPARATIVE studies ,LONGITUDINAL method - Abstract
Objective: To develop a preoperative risk model, using endometrial biopsy results and clinical and ultrasound variables, to predict the individual risk of lymph-node metastases in women with endometrial cancer.Methods: A mixed-effects logistic regression model for prediction of lymph-node metastases was developed in 1501 prospectively included women with endometrial cancer undergoing transvaginal ultrasound examination before surgery, from 16 European centers. Missing data, including missing lymph-node status, were imputed. Discrimination, calibration and clinical utility of the model were evaluated using leave-center-out cross validation. The predictive performance of the model was compared with that of risk classification from endometrial biopsy alone (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread).Results: Lymphadenectomy was performed in 691 women, of whom 127 had lymph-node metastases. The model for prediction of lymph-node metastases included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and undefined tumor with an unmeasurable endometrium. The model's area under the curve was 0.73 (95% CI, 0.68-0.78), the calibration slope was 1.06 (95% CI, 0.79-1.34) and the calibration intercept was 0.06 (95% CI, -0.15 to 0.27). Using a risk threshold for lymph-node metastases of 5% compared with 20%, the model had, respectively, a sensitivity of 98% vs 48% and specificity of 11% vs 80%. The model had higher sensitivity and specificity than did classification as high-risk, according to endometrial biopsy alone (50% vs 35% and 80% vs 77%, respectively) or combined endometrial biopsy and ultrasound (80% vs 75% and 53% vs 52%, respectively). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold.Conclusions: Based on endometrial biopsy results and clinical and ultrasound characteristics, the individual risk of lymph-node metastases in women with endometrial cancer can be estimated reliably before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2020
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7. Validation of ultrasound strategies to assess tumor extension and to predict high-risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)-4 cohort.
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Verbakel, J. Y., Mascilini, F., Wynants, L., Fischerova, D., Testa, A. C., Franchi, D., Frühauf, F., Cibula, D., Lindqvist, P. G., Fruscio, R., Haak, L. A., Opolskiene, G., Alcazar, J. L., Mais, V., Carlson, J. W., Sladkevicius, P., Timmerman, D., Valentin, L., Bosch, T. Van Den, and Epstein, E.
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ENDOMETRIAL cancer ,ENDOMETRIAL tumors ,TUMORS ,PREDICTION models ,MATHEMATICAL models ,DOPPLER ultrasonography ,RESEARCH ,RESEARCH evaluation ,ULTRASONIC imaging ,CANCER invasiveness ,RESEARCH methodology ,EVALUATION research ,BURDEN of care ,TUMOR classification ,COMPARATIVE studies ,RESEARCH funding ,SENSITIVITY & specificity (Statistics) ,LONGITUDINAL method - Abstract
Objectives: To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall and according to whether they had low- or high-grade disease separately, and to validate published measurement cut-offs and prediction models to identify MI, CSI and high-risk disease (Grade-3 endometrioid or non-endometrioid cancer and/or deep MI and/or CSI).Methods: The study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)-4 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor/uterine anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist-OCO) for detecting CSI. We also validated two two-step strategies for the prediction of high-risk cancer; in the first step, biopsy-confirmed Grade-3 endometrioid or mucinous or non-endometrioid cancers were classified as high-risk cancer, while the second step encompassed the application of a mathematical model to classify the remaining tumors. The 'subjective prediction model' included biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the 'objective prediction model' included biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin. The predictive performance of the two two-step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade-3 endometrioid or mucinous or non-endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard.Results: In 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade-1 or -2 endometrioid or mucinous tumor vs 76% and 64% in patients with a Grade-3 endometrioid or mucinous or a non-endometrioid tumor. The corresponding values for the detection of CSI were 51% and 94% vs 50% and 91%. Tumor AP diameter and tumor/uterine AP diameter ratio showed the best performance for predicting deep MI (area under the receiver-operating characteristics curve (AUC) of 0.76 and 0.77, respectively), and Dist-OCO had the best performance for predicting CSI (AUC, 0.72). The proportion of patients classified correctly as having high-risk cancer was 80% when simply combining SA with biopsy grade vs 80% and 74% when using the subjective and objective two-step strategies, respectively. The subjective and objective models had an AUC of 0.76 and 0.75, respectively, when applied to Grade-1 and -2 endometrioid tumors.Conclusions: In the hands of experienced ultrasound examiners, SA was superior to ultrasound measurements for the prediction of deep MI and CSI of endometrial cancer, especially in patients with a Grade-1 or -2 tumor. The mathematical models for the prediction of high-risk cancer performed as expected. The best strategies for predicting high-risk endometrial cancer were combining SA with biopsy grade and the subjective two-step strategy, both having an accuracy of 80%. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2020
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8. Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer:interobserver reproducibility among ultrasound experts and gynecologists
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Eriksson, L S E, Lindqvist, P G, Flöter Rådestad, A, Dueholm, M, Fischerova, D, Franchi, D, Jokubkiene, L, Leone, F P, Savelli, L, Sladkevicius, P, Testa, A C, Van den Bosch, T, Ameye, L, and Epstein, E
- Subjects
Aged, 80 and over ,Observer Variation ,Reproducibility of Results ,Ultrasonography/methods ,Middle Aged ,Preoperative Care/methods ,Body Mass Index ,Endometrial Neoplasms/diagnostic imaging ,Vagina ,Cervix Uteri/diagnostic imaging ,Humans ,Female ,Myometrium/diagnostic imaging ,Neoplasm Invasiveness ,Aged ,Neoplasm Staging - Abstract
OBJECTIVES: To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer.METHODS: Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard.RESULTS: Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P CONCLUSION: Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion.
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- 2015
9. Transvaginal ultrasound assessment of myometrial and cervical stroma invasion in women with endometrial cancer -interobserver reproducibility among ultrasound experts and gynaecologists
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Ls, Eriksson, Pg, Lindqvist, Flöter Rådestad A, Dueholm M, Fischerova D, Franchi D, Jokubkiene L, Fp, Leone, Savelli L, Sladkevicius P, Ac, Testa, Van den Bosch T, Ameye L, and elisabeth epstein
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Aged, 80 and over ,Observer Variation ,endometrial neoplasms ,diagnostic imaging ,Cervix Uteri ,ultrasonography ,Middle Aged ,Body Mass Index ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Preoperative Care ,Vagina ,Myometrium ,Humans ,Female ,Neoplasm Invasiveness ,reproducibility of results ,neoplasm staging ,uterine neoplasms ,Aged - Abstract
To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer.Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard.Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P 0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P 0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P 0.001).Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion.
- Published
- 2015
10. Preoperative prediction of lymph node metastasis and deep stromal invasion in women with invasive cervical cancer: prospective multicenter study using 2D and 3D ultrasound
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Pálsdóttir K, Fischerova D, Franchi D, Testa A, Ad, Legge, and elisabeth epstein
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deep stromal invasion ,Uterine Cervical Neoplasms ,lymph node ,three dimensional ultrasound ,Sensitivity and Specificity ,Endometrial Neoplasms ,transvaginal ultrasound ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Imaging, Three-Dimensional ,Endometrial Stromal Tumors ,Predictive Value of Tests ,Lymphatic Metastasis ,Cervical cancer ,Humans ,diagnostic accuracy ,Female ,Neoplasm Invasiveness ,Lymph Nodes ,Prospective Studies ,power doppler ,Neoplasm Staging ,Ultrasonography - Abstract
To determine how various objective two-dimensional (2D) and three-dimensional (3D) ultrasound parameters allow prediction of deep stromal tumor invasion and lymph node involvement, in comparison to subjective ultrasound assessment, in women scheduled for surgery for cervical cancer.This was a prospective multicenter trial including 104 women with cervical cancer at FIGO Stages IA2-IIB, verified histologically. Patients scheduled for surgery underwent a preoperative ultrasound examination. The value of various 2D (size, color score) and 3D (volume, vascular indices) ultrasound parameters was compared to that of subjective assessment in the prediction of deep stromal tumor invasion and lymph node involvement. Histology obtained from radical hysterectomy or trachelectomy and pelvic lymphadenectomy was considered as the gold standard for assessment.All women underwent pelvic lymphadenectomy, with 99 (95%) undergoing subsequent radical surgery; five underwent only pelvic lymphadenectomy because of the presence of a positive sentinel lymph node. Women with deep stromal invasion or lymph node involvement had significantly larger tumors (diameter and volume) but there was no correlation with vascular indices measured on 3D ultrasound. Subjective evaluation was superior (AUC, 0.93; sensitivity, 90.5%; specificity, 97.2%) in the prediction of deep stromal invasion when compared to any objective measurement technique, with maximal tumor diameter at 20.5-mm cut-off (AUC, 0.83; sensitivity, 90.5%; specificity, 61.1%) and 3D tumor volume at 9.1-mm(3) cut-off (AUC, 0.85; sensitivity, 79.4%; specificity, 83.3%) providing the best performance among the objective parameters. Both subjective assessment and objective measurements were poorly predictive of lymph node involvement.In women with cervical cancer, subjective ultrasound evaluation allowed better prediction of deep stromal invasion than did objective measurements; however, neither subjective evaluation nor objective parameters were adequate to predict lymph node involvement. 3D vascular indices were ineffective in the prediction of advanced stages of the disease.
- Published
- 2014
11. Imaging in gynecological disease (9): clinical and ultrasound characteristics of tubal cancer
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Ludovisi, M., De Blasis, I., Virgilio, B., Fischerova, D., Franchi, D., Pascual, M. A., Savelli, L., Epstein, E., Van Holsbeke, C., Guerriero, S., Czekierdowski, A., Zannoni, G., Scambia, G., Jurkovic, D., Rossi, A., Timmerman, D., Valentin, L., and Testa, A. C.
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Adult ,retrospective study ,Color ,Diagnosis, Differential ,Predictive Value of Tests ,Diagnosis ,80 and over ,Fallopian Tube Neoplasms ,Humans ,Ultrasonography, Doppler, Color ,tubal cancer ,Fallopian Tubes ,Ultrasonography ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,ultrasound ,pattern recognition ,Doppler ,Middle Aged ,Prognosis ,Female ,Genital Diseases, Female ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Genital Diseases ,Differential - Abstract
To describe clinical history and ultrasound findings in patients with tubal carcinoma.Patients with a histological diagnosis of tubal cancer who had undergone preoperative ultrasound examination were identified from the databases of 13 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed together all available digital ultrasound images and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings.We identified 79 women with a histological diagnosis of primary tubal cancer, 70 of whom (89%) had serous carcinomas and 46 (58%) of whom presented at FIGO stage III. Forty-nine (62%) women were asymptomatic (incidental finding), whilst the remaining 30 complained of abdominal bloating or pain. Fifty-three (67%) tumors were described as solid at ultrasound examination, 14 (18%) as multilocular solid, 10 (13%) as unilocular solid and two (3%) as unilocular. No tumor was described as a multilocular mass. Most tumors (70/79, 89%) were moderately or very well vascularized on color or power Doppler ultrasound. Normal ovarian tissue was identified adjacent to the tumor in 51% (39/77) of cases. Three types of ultrasound appearance were identified as being typical of tubal carcinoma using pattern recognition: a sausage-shaped cystic structure with solid tissue protruding into it like a papillary projection (11/62, 18%); a sausage-shaped cystic structure with a large solid component filling part of the cyst cavity (13/62, 21%); an ovoid or oblong completely solid mass (36/62, 58%).A well vascularized ovoid or sausage-shaped structure, either completely solid or with large solid component(s) in the pelvis, should raise the suspicion of tubal cancer, especially if normal ovarian tissue is seen adjacent to it.
- Published
- 2013
12. Development and external validation of new ultrasound-based mathematical models for preoperative prediction of high-risk endometrial cancer
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Van Holsbeke, C, Ameye, L, Testa, Antonia Carla, Mascilini, Floriana, Lindqvist, P, Fischerova, D, Frühauf, F, Fransis, S, De Jonge, E, Timmerman, D, and Epstein, E.
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Adult ,Color ,high risk ,Cervix Uteri ,Risk Assessment ,Sensitivity and Specificity ,Theoretical ,Models ,80 and over ,Humans ,Neoplasm Invasiveness ,Ultrasonics ,Prospective Studies ,Ultrasonography, Doppler, Color ,Early Detection of Cancer ,Ultrasonography ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Doppler ,Reproducibility of Results ,prediction ,Middle Aged ,Models, Theoretical ,Endometrial Neoplasms ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,endometrial cancer ,Myometrium ,Female ,mathematical models - Abstract
To develop and validate strategies, using new ultrasound-based mathematical models, for the prediction of high-risk endometrial cancer and compare them with strategies using previously developed models or the use of preoperative grading only.Women with endometrial cancer were prospectively examined using two-dimensional (2D) and three-dimensional (3D) gray-scale and color Doppler ultrasound imaging. More than 25 ultrasound, demographic and histological variables were analyzed. Two logistic regression models were developed: one 'objective' model using mainly objective variables; and one 'subjective' model including subjective variables (i.e. subjective impression of myometrial and cervical invasion, preoperative grade and demographic variables). The following strategies were validated: a one-step strategy using only preoperative grading and two-step strategies using preoperative grading as the first step and one of the new models, subjective assessment or previously developed models as a second step.One-hundred and twenty-five patients were included in the development set and 211 were included in the validation set. The 'objective' model retained preoperative grade and minimal tumor-free myometrium as variables. The 'subjective' model retained preoperative grade and subjective assessment of myometrial invasion. On external validation, the performance of the new models was similar to that on the development set. Sensitivity for the two-step strategy with the 'objective' model was 78% (95% CI, 69-84%) at a cut-off of 0.50, 82% (95% CI, 74-88%) for the strategy with the 'subjective' model and 83% (95% CI, 75-88%) for that with subjective assessment. Specificity was 68% (95% CI, 58-77%), 72% (95% CI, 62-80%) and 71% (95% CI, 61-79%) respectively. The two-step strategies detected up to twice as many high-risk cases as preoperative grading only. The new models had a significantly higher sensitivity than did previously developed models, at the same specificity.Two-step strategies with 'new' ultrasound-based models predict high-risk endometrial cancers with good accuracy and do this better than do previously developed models.
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- 2013
13. Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study.
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Epstein, E., Fischerova, D., Valentin, L., Testa, A. C., Franchi, D., Sladkevicius, P., Frühauf, F., Lindqvist, P. G., Mascilini, F., Fruscio, R., Haak, L. A., Opolskiene, G., Pascual, M. A., Alcazar, J. L., Chiappa, V., Guerriero, S., Carlson, J. W., Van Holsbeke, C., Giuseppe Leone, F. P., and De Moor, B.
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UTERINE hemorrhage , *ENDOMETRIAL tumors , *ENDOMETRIAL cancer , *LONGITUDINAL method - Abstract
Objective: To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. Methods: This was a prospective multicenter study of 1714 women with biopsy‐confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high‐end ultrasound equipment. Clinical and sonographic data were entered into a web‐based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c‐statistic. Results: In total, 1538 women were included in the final analysis. Median age was 65 (range, 27–98) years, median body mass index was 28.4 (range 16–67) kg/m2, 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High‐risk tumors, compared with low‐risk tumors, were less likely to have regular endometrial–myometrial junction (difference of −23%; 95% CI, −27 to −18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non‐uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). Conclusion: Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high‐ and low‐risk endometrial cancer. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
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- 2018
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14. Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists.
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Eriksson, L. S. E., Lindqvist, P. G., Flöter Rådestad, A., Dueholm, M., Fischerova, D., Franchi, D., Jokubkiene, L., Leone, F. P., Savelli, L., Sladkevicius, P., Testa, A. C., Van den Bosch, T., Ameye, L., and Epstein, E.
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ENDOMETRIAL cancer ,TRANSVAGINAL ultrasonography ,UTERINE contraction ,PRENATAL care ,PREGNANCY complications - Abstract
ABSTRACT Objectives To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer. Methods Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard. Results Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P < 0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P < 0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P < 0.001). Conclusion Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
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- 2015
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15. Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer: model-development study
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T. Van den Bosch, Antonia Carla Testa, C. Van Holsbeke, Valentina Chiappa, B. Van Calster, J. L. Alcazar, Dirk Timmerman, Laure Wynants, Lil Valentin, Povilas Sladkevicius, L.A. Haak, Jan Y Verbakel, Daniela Fischerova, Elisabeth Epstein, D. Franchi, Tom Bourne, F. Frühauf, G. Opolskiene, L. S. E. Eriksson, Robert Fruscio, Pelle G. Lindqvist, Floriana Mascilini, Epidemiologie, RS: CAPHRI - R5 - Optimising Patient Care, Eriksson, L, Epstein, E, Testa, A, Fischerova, D, Valentin, L, Sladkevicius, P, Franchi, D, Frühauf, F, Fruscio, R, Haak, L, Opolskiene, G, Mascilini, F, Alcazar, J, Van Holsbeke, C, Chiappa, V, Bourne, T, Lindqvist, P, Van Calster, B, Timmerman, D, Verbakel, J, Van den Bosch, T, and Wynants, L
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medicine.medical_treatment ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,030212 general & internal medicine ,Prospective Studies ,lymphatic metastasis ,Lymph node ,Ultrasonography ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Ultrasound ,Obstetrics and Gynecology ,General Medicine ,ultrasonography ,Middle Aged ,medicine.anatomical_structure ,GRADE ,Lymphatic Metastasis ,TRIAL ,Female ,endometrial neoplasm ,Radiology ,Carcinoma, Endometrioid ,Endometrial Neoplasm ,Adult ,medicine.medical_specialty ,CARCINOMA ,diagnostic imaging ,Sensitivity and Specificity ,VALIDATION ,03 medical and health sciences ,Carcinoma ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,neoplasm staging ,Aged ,Neoplasm Staging ,business.industry ,Endometrial cancer ,Cancer ,medicine.disease ,LYMPHADENECTOMY ,Endometrial Neoplasms ,Reproductive Medicine ,lymphatic metastasi ,decision support model ,Linear Models ,Lymphadenectomy ,Lymph Nodes ,business ,Endometrial biopsy - Abstract
OBJECTIVE: To develop a preoperative risk model, using endometrial biopsy results and clinical and ultrasound variables, to predict the individual risk of lymph-node metastases in women with endometrial cancer. METHODS: A mixed-effects logistic regression model for prediction of lymph-node metastases was developed in 1501 prospectively included women with endometrial cancer undergoing transvaginal ultrasound examination before surgery, from 16 European centers. Missing data, including missing lymph-node status, were imputed. Discrimination, calibration and clinical utility of the model were evaluated using leave-center-out cross validation. The predictive performance of the model was compared with that of risk classification from endometrial biopsy alone (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). RESULTS: Lymphadenectomy was performed in 691 women, of whom 127 had lymph-node metastases. The model for prediction of lymph-node metastases included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and undefined tumor with an unmeasurable endometrium. The model's area under the curve was 0.73 (95% CI, 0.68-0.78), the calibration slope was 1.06 (95% CI, 0.79-1.34) and the calibration intercept was 0.06 (95% CI, -0.15 to 0.27). Using a risk threshold for lymph-node metastases of 5% compared with 20%, the model had, respectively, a sensitivity of 98% vs 48% and specificity of 11% vs 80%. The model had higher sensitivity and specificity than did classification as high-risk, according to endometrial biopsy alone (50% vs 35% and 80% vs 77%, respectively) or combined endometrial biopsy and ultrasound (80% vs 75% and 53% vs 52%, respectively). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. CONCLUSIONS: Based on endometrial biopsy results and clinical and ultrasound characteristics, the individual risk of lymph-node metastases in women with endometrial cancer can be estimated reliably before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:56 issue:3 pages:443-452 ispartof: location:England status: published
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- 2020
16. Validation of ultrasound strategies to assess tumor extension and to predict high-risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)-4 cohort
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Juan Luis Alcázar, Robert Fruscio, Pelle G. Lindqvist, Floriana Mascilini, L.A. Haak, Lil Valentin, Elisabeth Epstein, T. Van den Bosch, Dirk Timmerman, David Cibula, Valerio Mais, G. Opolskiene, Povilas Sladkevicius, Antonia Carla Testa, Laure Wynants, F. Frühauf, Joseph W. Carlson, Daniela Fischerova, D. Franchi, Jan Y Verbakel, Verbakel, J, Mascilini, F, Wynants, L, Fischerova, D, Testa, A, Franchi, D, Frühauf, F, Cibula, D, Lindqvist, P, Fruscio, R, Haak, L, Opolskiene, G, Alcazar, J, Mais, V, Carlson, J, W, Sladkevicius, P, Timmerman, D, Valentin, L, Van den Bosch, T, Epstein, E, Epidemiologie, and RS: CAPHRI - R5 - Optimising Patient Care
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medicine.medical_treatment ,MULTICENTER ,0302 clinical medicine ,PREOPERATIVE ASSESSMENT ,030212 general & internal medicine ,Prospective Studies ,Early Diagnosis of Cancer ,Ultrasonography ,Aged, 80 and over ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Ultrasound ,Doppler ultrasonography ,early diagnosis of cancer ,endometrial neoplasms ,neoplasm staging ,ultrasonography ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,ASSESSING MYOMETRIAL INVASION ,CERVICAL INVASION ,Europe ,Cohort ,Female ,Radiology ,Mucinous Tumor ,MRI ,Adult ,medicine.medical_specialty ,Doppler Ultrasonography ,CARCINOMA ,Sensitivity and Specificity ,Stromal Invasion ,03 medical and health sciences ,Biopsy ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Endometrial Neoplasm ,Neoplasm Invasiveness ,Aged ,Neoplasm Staging ,TRANSVAGINAL SONOGRAPHY ,Hysterectomy ,business.industry ,Endometrial cancer ,Cancer ,Reproducibility of Results ,medicine.disease ,Endometrial Neoplasms ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Reproductive Medicine ,INTEROBSERVER REPRODUCIBILITY ,business - Abstract
OBJECTIVES: To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall and according to whether they had low- or high-grade disease separately, and to validate published measurement cut-offs and prediction models to identify MI, CSI and high-risk disease (Grade-3 endometrioid or non-endometrioid cancer and/or deep MI and/or CSI). METHODS: The study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)-4 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor/uterine anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist-OCO) for detecting CSI. We also validated two two-step strategies for the prediction of high-risk cancer; in the first step, biopsy-confirmed Grade-3 endometrioid or mucinous or non-endometrioid cancers were classified as high-risk cancer, while the second step encompassed the application of a mathematical model to classify the remaining tumors. The 'subjective prediction model' included biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the 'objective prediction model' included biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin. The predictive performance of the two two-step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade-3 endometrioid or mucinous or non-endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard. RESULTS: In 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade-1 or -2 endometrioid or mucinous tumor vs 76% and 64% in patients with a Grade-3 endometrioid or mucinous or a non-endometrioid tumor. The corresponding values for the detection of CSI were 51% and 94% vs 50% and 91%. Tumor AP diameter and tumor/uterine AP diameter ratio showed the best performance for predicting deep MI (area under the receiver-operating characteristics curve (AUC) of 0.76 and 0.77, respectively), and Dist-OCO had the best performance for predicting CSI (AUC, 0.72). The proportion of patients classified correctly as having high-risk cancer was 80% when simply combining SA with biopsy grade vs 80% and 74% when using the subjective and objective two-step strategies, respectively. The subjective and objective models had an AUC of 0.76 and 0.75, respectively, when applied to Grade-1 and -2 endometrioid tumors. CONCLUSIONS: In the hands of experienced ultrasound examiners, SA was superior to ultrasound measurements for the prediction of deep MI and CSI of endometrial cancer, especially in patients with a Grade-1 or -2 tumor. The mathematical models for the prediction of high-risk cancer performed as expected. The best strategies for predicting high-risk endometrial cancer were combining SA with biopsy grade and the subjective two-step strategy, both having an accuracy of 80%. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:1 pages:115-124 ispartof: location:England status: published
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- 2019
17. Clinical and ultrasound characteristics of the microcystic elongated and fragmented (MELF) pattern in endometrial cancer according to the International Endometrial Tumor Analysis (IETA) criteria
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Vaclav Hejda, M. Angela Pascual, G. Opolskiene, Kristyna Nemejcova, Francisco Tresserra, Denis Nastic, Francesca Bono, L.A. Haak, Robert Fruscio, Elisabeth Epstein, Antonia Carla Testa, Linda S E Eriksson, Dorella Franchi, Raimundas Meskauskas, Mariacristina Ghioni, Daniela Fischerova, Joseph W. Carlson, Gian Franco Zannoni, F. Frühauf, Eriksson, L, Nastic, D, Frühauf, F, Fischerova, D, Nemejcova, K, Bono, F, Franchi, D, Fruscio, R, Ghioni, M, Haak, L, Hejda, V, Meskauskas, R, Opolskiene, G, Pascual, M, Testa, A, Tresserra, F, Zannoni, G, Carlson, J, and Epstein, E
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medicine.medical_specialty ,diagnostic imaging ,Hysterectomy ,Endometrium ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Medical imaging ,Humans ,Neoplasm Invasiveness ,Adenomyosis ,Prospective Studies ,neoplasm staging ,Lymph node ,Aged ,Endometrial Tumor ,030219 obstetrics & reproductive medicine ,business.industry ,Endometrial cancer ,Advanced stage ,Ultrasound ,Obstetrics and Gynecology ,Histiocytes ,ultrasonography ,Middle Aged ,Prognosis ,medicine.disease ,MELF ,Endometrial Neoplasms ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,Myometrium ,Lymph Node Excision ,Female ,endometrial neoplasm ,Lymph Nodes ,Radiology ,business ,Follow-Up Studies - Abstract
ObjectivesTo describe sonographic features of the microcystic elongated and fragmented (MELF) pattern of myometrial invasion (MI) using the International Endometrial Tumor Analysis (IETA) criteria; to assess the effect of the MELF pattern on preoperative ultrasound evaluation of MI; and to determine the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases in women with endometrioid endometrial cancer.Methods/materialsWe included 850 women with endometrioid endometrial cancer from the prospective IETA 4 study. Ultrasound experts performed all ultrasound examinations, according to the IETA protocol. Reference pathologists assessed the presence or absence of the MELF pattern. Sonographic features and accuracy of ultrasound assessment of MI were compared in cases with the presence and the absence of the MELF pattern. The MELF pattern was correlated to more advanced stage (≥IB) and lymph node metastases.ResultsThe MELF pattern was present in 197 (23.2%) women. On preoperative ultrasound imaging the endometrium was thicker (p = 0.031), more richly vascularized (p = 0.003) with the multiple multifocal vessel pattern (p < 0.001) and the assessment of adenomyosis was more often uncertain (p < 0.001). The presence or the absence of the MELF pattern did not affect the accuracy of the assessment of MI. The MELF pattern was associated with deep myometrial invasion ≥ 50% (p < 0.001), cervical stromal invasion (p = 0.037), more advanced stage (≥ IB) (p < 0.001) and lymph node metastases (p = 0.011).ConclusionsTumors with the MELF pattern were slightly larger, more richly vascularized with multiple multifocal vessels and assessment of adenomyosis was more uncertain on ultrasound imaging. The MELF pattern did not increase the risk of underestimating MI in preoperative ultrasound staging. Tumors with the MELF pattern were more than twice as likely to have more advanced stage (≥ IB) and lymph node metastases.
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- 2019
18. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients with Cervical Cancer
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Christine Haie Meder, W. Glenn McCluggage, Patrice Mathevet, Alexandros Rodolakis, David Cibula, Sigurd Lax, Elisabeth Åvall-Lundqvist, Mary McCormack, Daniela Fischerova, Maria Rosaria Raspollini, François Planchamp, Francesco Raspagliesi, Christhardt Köhler, Karl Tamussino, Sandro Pignata, Raj Naik, Remi A. Nout, Jordi Ponce, Richard Pötter, Umesh Mahantshetty, Pauline Wimberger, Fabio Landoni, Jacob Christian Lindegaard, Denis Querleu, Cibula, D, Potter, R, Planchamp, F, Avall-Lundqvist, E, Fischerova, D, Haie Meder, C, Kohler, C, Landoni, F, Lax, S, Lindegaard, J, Mahantshetty, U, Mathevet, P, Mccluggage, W, Mccormack, M, Naik, R, Nout, R, Pignata, S, Ponce, J, Querleu, D, Raspagliesi, F, Rodolakis, A, Tamussino, K, Wimberger, P, Raspollini, M, Pötter, R, and Köhler, C
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Oncology ,Pathology ,Staging ,medicine.medical_treatment ,Aftercare ,Uterine Cervical Neoplasms ,Cervix Uteri ,Disease ,Guideline ,Medical Oncology ,030218 nuclear medicine & medical imaging ,Scientific evidence ,0302 clinical medicine ,Pregnancy ,Radiation Oncology/methods ,Fertility preservation ,Stage (cooking) ,Radiotherapy/standards ,Cervical cancer ,Uterine Cervical Neoplasms/pathology ,030219 obstetrics & reproductive medicine ,Pathology, Clinical ,Follow-up ,Gynaecological oncology ,Fertility Preservation ,Obstetrics and Gynecology ,General Medicine ,Hematology ,Management ,Europe ,Pathology, Clinical/methods ,030220 oncology & carcinogenesis ,Evidence-Based Practice ,Pathologists/standards ,Female ,Pregnancy Complications, Neoplastic ,Human ,medicine.medical_specialty ,Evidence-based practice ,Consensus ,MEDLINE ,Consensu ,Guidelines ,Pathology and Forensic Medicine ,Gynecology/methods ,03 medical and health sciences ,Uterine Cervical Neoplasms/diagnosis ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Molecular Biology ,Cervical cancer, Follow-up, Guidelines, Management, Staging ,Neoplasm Staging ,Gynecology/standards ,Radiotherapy ,business.industry ,General surgery ,Cancer ,Cell Biology ,medicine.disease ,Occult ,Pathologists ,Radiation therapy ,Gynecology ,Radiation Oncology ,Medical Oncology/standards ,business ,Organ Sparing Treatments - Abstract
BackgroundDespite significant advances in the screening, detection, and treatment of preinvasive cervical lesions, invasive cervical cancer is the fifth most common cancer in European women. There are large disparities in Europe and worldwide in the incidence, management, and mortality of cervical cancer.ObjectiveThe European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly develop clinically relevant and evidence-based guidelines in order to improve the quality of care for women with cervical cancer across Europe and worldwide.MethodsThe ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of cervical cancer (23 experts across Europe). To ensure that the guidelines are evidence based, the current literature identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 159 international reviewers, selected through ESGO/ESTRO/ESP and including patient representatives.ResultsThe guidelines cover comprehensively staging, management, and follow-up for patients with cervical cancer. Management includes fertility sparing treatment; stage T1a, T1b1/T2a1, clinically occult cervical cancer diagnosed after simple hysterectomy; early and locally advanced cervical cancer; primary distant metastatic disease; cervical cancer in pregnancy; and recurrent disease. Principles of radiotherapy and pathological evaluation are defined.
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- 2018
19. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study
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Chiara Lanzani, Luca Savelli, Stefano Guerriero, Dorella Franchi, Caroline Van Holsbeke, Robert Fruscio, Elisabeth Epstein, Antonia Carla Testa, Tom Bourne, Kirsten Van Hoorde, Daniela Fischerova, Lil Valentin, J. Kaijser, Felice Scala, Artur Czekierdowski, Ben Van Calster, Dirk Timmerman, Vanya Van Belle, Van Calster, B, Van Hoorde, K, Valentin, L, Testa, A, Fischerova, D, Van Holsbeke, C, Savelli, L, Franchi, D, Epstein, E, Kaijser, J, Van Belle, V, Czekierdowski, A, Guerriero, S, Fruscio, R, Lanzani, C, Scala, F, Bourne, T, and Timmerman, D
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EXTERNAL VALIDATION ,PREDICTION ,Predictive Value of Test ,International Ovarian Tumour Analysis Group ,Models ,Ascites ,Cyst ,Prospective Studies ,Stage (cooking) ,CA-125 ,Prospective cohort study ,ULTRASOUND ,health care economics and organizations ,Ultrasonography ,Ovarian Neoplasms ,SISTA ,General Medicine ,Statistical ,Adnexal Disease ,Predictive value of tests ,Adnexal Diseases ,SURVIVAL ,Female ,medicine.symptom ,Life Sciences & Biomedicine ,Human ,Adult ,medicine.medical_specialty ,education ,Risk Assessment ,1117 Public Health and Health Services ,Medicine, General & Internal ,PROSPECTIVE VALIDATION ,MATHEMATICAL-MODELS ,Predictive Value of Tests ,General & Internal Medicine ,Obstetrics, Gynecology and Reproductive Medicine ,DISTINGUISH ,medicine ,Humans ,MASSES ,Neoplasm Staging ,Science & Technology ,Models, Statistical ,Receiver operating characteristic ,business.industry ,Research ,Ovarian Neoplasm ,Cancer ,1103 Clinical Sciences ,medicine.disease ,Surgery ,Prospective Studie ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,LOGISTIC-REGRESSION MODELS ,Ovarian cancer ,business - Abstract
OBJECTIVES: To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours. DESIGN: Observational diagnostic study using prospectively collected clinical and ultrasound data. SETTING: 24 ultrasound centres in 10 countries. PARTICIPANTS: Women with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 patients recruited between 1999 and 2007, temporally validated on 2403 patients recruited between 2009 and 2012, and then updated on all 5909 patients. MAIN OUTCOME MEASURES: Histological classification and surgical staging of the mass. RESULTS: The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. CONCLUSIONS: The ADNEX model discriminates well between benign and malignant tumours and offers fair to excellent discrimination between four types of ovarian malignancy. The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology. ispartof: BMJ - British Medical Journal vol:349 issue:oct07 3 ispartof: location:England status: published
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- 2014
20. Prospective external validation of the 'ovarian crescent sign' as a single ultrasound parameter to distinguish between benign and malignant adnexal pathology
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Stefano Guerriero, Daniela Fischerova, E De Jonge, C. Van Holsbeke, S. Van Huffel, S. Greggi, G. B. Melis, Lil Valentin, F. P. G. Leone, Tom Bourne, Dirk Timmerman, Patrick Neven, Dario Paladini, Vanya Van Belle, Van Holsbeke, C., Van Belle, V., Leone, F. P., Guerriero, S., Paladini, Dario, Melis, G. B., Greggi, S., Fischerova, D., De Jonge, E., Neven, P., Bourne, T., Valentin, L., Van Huffel, S., and Timmerman, D.
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Pathology ,medicine.medical_specialty ,Malignancy ,Sensitivity and Specificity ,Adnexal mass ,Diagnosis, Differential ,Ovarian tumor ,Predictive Value of Tests ,medicine ,Humans ,Crescent sign ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Stage (cooking) ,Neoplasm Staging ,Ovarian Neoplasms ,Radiological and Ultrasound Technology ,business.industry ,Ovary ,Obstetrics and Gynecology ,Ultrasonography, Doppler ,General Medicine ,Malignant Struma Ovarii ,medicine.disease ,Reproductive Medicine ,Adnexal Diseases ,Female ,medicine.symptom ,Differential diagnosis ,business - Abstract
Objective To determine the sensitivity and specificity of the 'ovarian crescent sign' (OCS) - a rim of normal ovarian tissue seen adjacent to an ipsilateral adnexal mass as a sonographic feature to discriminate between benign and malignant adnexal masses. Methods The patients included were a subgroup of patients participating in the International Ovarian Tumor Analysis (IOTA) Phase 2 study, which is an international multicenter study. The subgroup comprised 1938 patients, with an adnexal mass, recruited from 19 ultrasound centers in different countries. All patients were scanned using the same standardized ultrasound protocol. Information on more than 40 demographic and ultrasound variables were collected, but the evaluation of the OCS was optional. Only patients from centers that had evaluated the OCS in >= 90% of their cases were included. The gold standard was the histological diagnosis of the adnexal mass. The ability of the OCS to discriminate between borderline or invasively malignant vs. benign adnexal masses, as well as between invasively malignant vs. other (benign and borderline) tumors, was determined and compared with the performance of subjective evaluation of ultrasound findings by the ultrasound examiner. Results The OCS was evaluated in 1377 adnexal masses from 12 centers, 938 (68%) masses being benign, 86 (6%) borderline, 305 (22%) primary invasive and 48 (3%) metastases. The OCS was present in 398 (42%) of 938 benign masses, in 14 (16%) of 86 borderline tumors, in 18 (6%) of 305 primary invasive tumors (one malignant struma ovarii, one uterine clear cell adenocarcinoma and 16 epithelial carcinomas, i.e. four Stage I and 12 Stage II-IV) and in two (4%) of 48 ovarian metastases. Hence, the sensitivity and specificity for absent OCS to identify a malignancy was 92% and 42%, respectively, and the positive and negative likelihood ratios (LR+ and LR-, respectively) were 1.60 and 0.18. Subjective impression performed significantly better than the OCS. Sensitivity and specificity were 90% and 92%, respectively, LR+ was 11.0 and LR- was 0.10. For discrimination between invasive vs. benign or borderline tumors, the sensitivity for absent OCS was 94%, the specificity was 40%, the LR+ was 1.58 and the LR- was 0.14. Conclusion This study confirms previous reports that the presence of the OCS decreases the likelihood of invasive malignancy in adnexal masses. However it is a poor discriminator between benign and malignant adnexal masses. Copyright (C) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2010
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