566 results on '"Fischerova, D."'
Search Results
202. OC231: Transrectal ultrasound (TRUS) and MRI in staging of early cervical cancer
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Fischerova, D., primary, Cibula, D., additional, Zikan, M., additional, Freitag, P., additional, Slama, J., additional, Vondrichova, H., additional, Stenhova, H., additional, and Calda, P., additional
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- 2007
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203. OC167: Ultrasound‐guided tru‐cut biopsy in the diagnosis and management of inoperable pelvic tumors
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Fischerova, D., primary, Cibula, D., additional, Freitag, P., additional, Janousek, M., additional, Slama, J., additional, Strunova, M., additional, Pavlista, D., additional, Jancarkova, N., additional, and Calda, P., additional
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- 2006
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204. P08.01: Clear cell adenofibroma/fibrocarcinoma of the ovary: ultrasound, macroscopic and histopathologic findings. A case report
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Fischerova, D., primary, Cibula, D., additional, Dundr, P., additional, and Calda, P., additional
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- 2005
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205. Dědičná dispozice ke vzniku karcinomu endometria.
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Zikán, M., Sláma, J., Pinkavová, L., Fischerova, D., Freitag, P., and Cibula, D.
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- 2011
206. Urgent care in gynaecology: resuscitation and management of sepsis and acute blood loss.
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Fischerova D
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- 2009
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207. PREOPERATIVE ULTRASOUND EVALUATION OF INGUINAL LYMPH NODE STATUS IN PATIENTS WITH VULVAR CANCER
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Fruhauf, F., Pinto, A. P., Zikan, M., Semeradova, I., Cibula, D., Pavel Dundr, and Fischerova, D.
208. Molecular characterization of epithelial ovarian borderline tumors with respect to clinical management and prognosis,Molekulární charakteristiky borderline ovariá lních tumorů ve vztahu k biologickému chování nádorů
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Zikán, M., Pinkavová, I., Sláma, J., Freitag, P., Janoušek, M., Fischerova, D., David Pavlišta, and Cibula, D.
209. FOLLOW-UP OF PATIENTS AFTER FERTILITY SPARING SURGERY FOR CERVICAL CANCER
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Slama, J., Cibula, D., Fischerova, D., Zikan, M., Kocian, R., Cerny, A., and Ondřej Sosna
210. AGREEMENT OF ULTRASOUND WITH MAGNETIC RESONANCE IMAGING WITH REGARD TO RECTOSIGMOID INFILTRATION IN PRIMARY OR RECURRENT OVARIAN CANCER: DIAGNOSTIC ACCURACY
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Chiappa, V., Michal Zikan, Kocian, R., Fruhauf, F., Dueckelmann, A., Dundr, P., Cibula, D., and Fischerova, D.
211. ULTRASOUND ACCURACY IN PREDICTION OF RECTOSIGMOID INVOLVEMENT IN ADVANCED OVARIAN CANCER PATIENTS
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Zikan, M., Fischerova, D., Kocian, R., Fruehauf, F., Jiri Slama, and Cibula, D.
212. 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, A. C., Franchi, D., Sladkevicius, P., Filip, F., Mascilini, F., Fruscio, R., Haak, L. A., Opolskiene, G., Pascual, M. A., Alcazar, J. L., Chiappa, V., Guerriero, S., Bourne, T., Installe, A., Timmerman, D., Jan Verbakel, and Den Bosch, T.
213. ULTRASOUND EVALUATION OF THE PELVIC AND INTRA-ABDOMINAL SPREAD OF OVARIAN CANCER: A PROSPECTIVE STUDY
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Fischerova, D., Kocian, R., Slama, J., Michal Zikan, Germanova, A., Fruhauf, F., Dundr, P., Dusek, L., and Cibula, D.
214. THE DIAGNOSTIC ACCURACY OF ULTRASOUND IN ASSESSMENT OF MYOMETRIAL INVASION IN ENDOMETRIAL CANCER -SUBJECTIVE ASSESSMENT VS. OBJECTIVE MEASUREMENTS
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Fruhauf, F., Fischerova, D., Michal Zikan, Pinkavova, I., Dusek, L., Dundr, P., and Cibula, D.
215. FACTORS AFFECTING PREOPERATIVE LOCAL STAGING OF ENDOMETRIAL CANCER
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Fischerova, D., Fruhauf, F., Zikan, M., Pinkavova, I., Kocian, R., Dusek, L., Dundr, P., and David Cibula
216. FOLLOW-UP OF PATIENTS AFTER LESS RADICAL FERTILITY SPARING SURGERY FOR CERVICAL CANCER
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Jiri Slama, Fischerova, D., Zikan, M., Kocian, R., Cerny, A., Sosna, O., and Cibula, D.
217. ULTRASOUND ACCURACY IN DETECTION OF PELVIC CARCINOMATOSIS AND RECTOSIGMOID INVOLVEMENT IN ADVANCED OVARIAN CANCER PATIENTS
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Michal Zikan, Fischerova, D., Slama, J., and Cibula, D.
218. PROSPECTIVE EVALUATION OF LYMPHOCELE INCIDENCE IN PATIENTS AFTER PELVIC AND PARAAORTIC LYMPHADENECTOMY AND ANALYSIS OF RISK FACTORS FOR THEIR DEVELOPMENT
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Michal Zikan, Fischerova, D., Slama, J., Kocian, R., Fruhauf, F., and Cibula, D.
219. RISK OF MICROMETASTASIS IN NON-SENTINEL PELVIC LYMPH NODES IN CERVICAL CANCER
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Cibula, D., Zikan, M., Slama, J., Fischerova, D., Kocian, R., Germanova, A., Andrea Burgetova, Dundr, P., and Nemejcova, K.
220. HOW SURGICAL RADICALITY INFLUENCES THE LOCALIZATION OF RECURRENCE IN PATIENTS WITH ADVANCED OVARIAN CANCER
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Kocian, R., Fischerova, D., Germanova, A., Slama, J., Michal Zikan, and Cibula, D.
221. MINIMALLY INVASIVE TREATMENT OF SYMPTOMATIC LYMPHOCELES WITH ULTRASOUND-GUIDED DRAINAGE
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Zikan, M., Fischerova, D., Jiri Slama, Kocian, R., Fruhauf, F., and Cibula, D.
222. LYMPHADENECTOMY AND MINIINVASIVE TREATMENT WITH ULTRASOUND-GUIDED DRAINAGE
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Zikan, M., Pinkavova, I., Fischerova, D., Slama, J., and David Cibula
223. SENSITIVITY OF FOLLOW-UP METHODS IN PATIENTS AFTER FERTILITY SPARING SURGERY FOR CERVICAL CANCERS
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Slama, J., Cibula, D., Michal Zikan, Fischerova, D., Kocian, R., Germanova, A., and Fruhauf, F.
224. SLN biopsy in cervical cancer patients with tumors larger than 2 cm and 4 cm.
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Dostálek, L., Zikan, M., Fischerova, D., Kocian, R., Germanova, A., Frühauf, F., Dusek, L., Slama, J., Dundr, P., Nemejcova, K., and Cibula, D.
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CERVICAL cancer diagnosis , *LYMPHADENECTOMY , *SENTINEL lymph node biopsy , *METASTASIS , *TUMOR classification - Abstract
Objectives The aim of this study was to assess the detection rate, false-negative rate and sensitivity of SLN in LN staging in tumors over 2 cm on a large cohort of patients. Methods Data from patients with stages pT1a – pT2 cervical cancer who underwent surgical treatment, including SLN biopsy followed by systematic pelvic lymphadenectomy, were retrospectively analyzed. A combined technique with blue dye and radiocolloid was modified in larger tumors to inject the tracer into the residual cervical stroma. Results The study included 350 patients with stages pT1a - pT2. Macrometastases, micrometastases, and isolated tumor cells were found in 10%, 8%, and 4% of cases. Bilateral detection rate was similar in subgroups with tumors < 2 cm, 2–3.9 cm, and ≥ 4 cm (79%, 83%, 76%) (P = 0.460). There were only two cases with false-negative SLN ultrastaging for pelvic LN status among those with bilateral SLN detection. The false negative rate was very low in all three subgroups of different tumor sizes (0.9%, 0.9%, and 0.0%; P = 0.999). Sensitivity reached 96% in the whole group and was high in all three groups (93%, 93%, 100%; P = 0.510). Conclusions If the tracer application technique is adjusted in larger tumors, SLN biopsy can be equally reliable in pelvic LN staging in tumors smaller and larger than 2 cm. The bilateral detection rate and false negative rate did not differ in subgroups of patients with tumors < 2 cm, 2–3.9 cm, and ≥ 4 cm. [ABSTRACT FROM AUTHOR]
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- 2018
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225. Pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after pelvic exenterations.
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Cibula, D, Zikan, M, Fischerova, D, Kocian, R, Germanova, A, Burgetova, A, Dusek, L, Fartáková, Z, Schneiderová, M, Nemejcová, K, and Slama, J
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PELVIC exenteration , *SURGICAL complications , *PELVIC floor , *BODY mass index , *REOPERATION , *POSTOPERATIVE period , *DISEASES - Abstract
Objective To describe the technique and report experiences with pelvic floor reconstruction by modified rectus abdominis myoperitoneal (MRAM) flap after extensive pelvic procedures. Methods Surgical technique of MRAM harvest and transposition is carefully described. The patients in whom pelvic floor reconstruction with MRAM after either infralevator pelvic exenteration and/or extended lateral pelvic sidewall excision was carried out were enrolled into the study (MRAM group, n = 16). Surgical data, post-operative morbidity, and disease status were retrospectively assessed. The results were compared with a historical cohort of patients, in whom an exenterative procedure without pelvic floor reconstruction was performed at the same institution (control group, n = 24). Results Both groups were balanced in age, BMI, tumor types, and previous treatment. Substantially less patients from the MRAM group required reoperation within 60 days of the surgery (25% vs. 50%) which was due to much lower rate of complications potentially related to empty pelvis syndrome (1 vs. 7 reoperations) ( p = 0.114). Late post-operative complication rate was substantially lower in the MRAM group (any grade: 79% vs. 44%; grade ≥ 3: 37% vs. 6%) ( p = 0.041). The performance status 6 months after the surgery was ≤ 1 in the majority of patients in MRAM (81%) while in only 38% of patients from the control group ( p = 0.027). There was one incisional hernia in MRAM group while three cases were reported in the controls. Conclusions Pelvic floor reconstruction by MRAM in patients after pelvic exenterative procedures is associated with a substantial decrease in postoperative complications that are potentially related to empty pelvis syndrome. [ABSTRACT FROM AUTHOR]
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- 2017
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226. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline.
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Sessa, C., Balmaña, J., Bober, S.L., Cardoso, M.J., Colombo, N., Curigliano, G., Domchek, S.M., Evans, D.G., Fischerova, D., Harbeck, N., Kuhl, C., Lemley, B., Levy-Lahad, E., Lambertini, M., Ledermann, J.A., Loibl, S., Phillips, K.-A., and Paluch-Shimon, S.
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HEREDITARY cancer syndromes , *EARLY detection of cancer , *OVARIAN cancer , *MEDICAL screening , *BREAST cancer - Abstract
• It provides recommendations for risk reduction and screening in hereditary breast and ovarian cancer syndrome. • It focuses on risk reduction and screening mainly in unaffected carriers and high-resource settings. • The panel encompasses an international multidisciplinary group of experts. • Recommendations are based on available scientific data and the authors' collective expert opinion. [ABSTRACT FROM AUTHOR]
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- 2023
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227. Imaging in gynecological disease (23): clinical and ultrasound characteristics of ovarian carcinosarcoma.
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Ciccarone, F., Biscione, A., Moro, F., Fischerova, D., Savelli, L., Munaretto, M., Jokubkiene, L., Sladkevicius, P., Chiappa, V., Fruscio, R., Franchi, D., Epstein, E., Timmerman, D., Froyman, W., Valentin, L., Scambia, G., and Testa, A. C.
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IMAGE analysis , *ULTRASONIC imaging , *OVARIAN cancer , *PATTERN recognition systems , *OVARIAN tumors , *POSTMENOPAUSE - Abstract
Objective: To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma.Methods: This was a retrospective multicenter study. Patients with a histological diagnosis of ovarian carcinosarcoma, who had undergone preoperative ultrasound examination between 2010 and 2019, were identified from the International Ovarian Tumor Analysis (IOTA) database. Additional patients who were examined outside of the IOTA study were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two experienced ultrasound examiners reviewed all available images to identify typical ultrasound features using pattern recognition.Results: Ninety-one patients with ovarian carcinosarcoma who had undergone ultrasound examination were identified, of whom 24 were examined within the IOTA studies and 67 were examined outside of the IOTA studies. Median age at diagnosis was 66 (range, 33-91) years and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, with the most common complaint being pain (51/91, 56.0%). Most tumors (67/91, 73.6%) were International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5%) patients. Ascites was present in 38/91 (41.8%) patients. The median largest tumor diameter was 100 (range, 18-260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular-solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 (range, 11-238) mm. Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images and videoclips using pattern recognition in 73 cases revealed that all tumors had irregular margins and inhomogeneous echogenicity of the solid components. Forty-seven of 73 (64.4%) masses appeared as a solid tumor with cystic areas. Cooked appearance of the solid tissue was identified in 28/73 (38.4%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found.Conclusions: Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is a large solid tumor with irregular margins, inhomogeneous echogenicity of the solid tissue and cystic areas. The second most common pattern is a large multilocular-solid mass with inhomogeneous echogenicity of the solid tissue. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]- Published
- 2022
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228. Gray-scale and color Doppler ultrasound characteristics of endometrial cancer in relation to stage, grade and tumor size.
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Epstein E, Van Holsbeke C, Mascilini F, Måsbäck A, Kannisto P, Ameye L, Fischerova D, Zannoni G, Vellone V, Timmerman D, Testa AC, Epstein, E, Van Holsbeke, C, Mascilini, F, Måsbäck, A, Kannisto, P, Ameye, L, Fischerova, D, Zannoni, G, and Vellone, V
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Objectives: To describe the gray-scale and vascular characteristics of endometrial cancer in relation to stage, grade and size using two-dimensional (2D)/three-dimensional (3D) transvaginal ultrasound.Methods: This was a prospective multicenter study including 144 women with endometrial cancer undergoing transvaginal ultrasound before surgery. The sonographic characteristics assessed were echogenicity, endometrial/myometrial border, fibroids, vascular pattern, color score and tumor/uterus anteroposterior (AP) ratio. Histological assessment of tumor stage, grade, type and growth pattern was performed.Results: Hyperechoic or isoechoic tumors were more often seen in Stage IA cancer, whereas mixed or hypoechoic tumors were more often found in cancers of Stage IB or greater (P = 0.003). Hyperechogenicity was more common in Grade 1-2 tumors (i.e. well or moderately differentiated) (P = 0.02) and in tumors with a tumor/uterine AP ratio of < 50% (P = 0.002), whereas a non-hyperechoic appearance was more commonly found in Grade 3 tumors (i.e. poorly differentiated) and in tumors with a tumor/uterine AP ratio of ≥ 50%. Multiple global vessels were more often seen in tumors of Stage IB or greater than in Stage IA tumors (P = 0.02), in Grade 3 tumors than in Grade 1 and 2 tumors (P = 0.02) and in tumors with a tumor/uterine AP ratio of ≥ 50% (P < 0.001). A moderate/high color score was significantly more common in tumors of higher stage (P = 0.03) and larger size (P = 0.001).Conclusion: The sonographic appearance of endometrial cancer is significantly associated with tumor stage, grade and size. More advanced tumors often have a mixed/hypoechoic echogenicity, a higher color score and multiple globally entering vessels, whereas less advanced tumors are more often hyperechoic and have no or a low color score. [ABSTRACT FROM AUTHOR]- Published
- 2011
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229. 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, A. C., Sundin, A., and Epstein, E.
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MAGNETIC resonance imaging , *TRANSVAGINAL ultrasonography , *CERVICAL cancer , *ULTRASONIC imaging , *TUMOR classification , *GYNECOLOGY , *VAGINA , *CERVIX uteri , *CLINICAL competence , *RESEARCH bias , *MEDICAL specialties & specialists ,RESEARCH evaluation ,CERVIX uteri tumors - 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. [ABSTRACT FROM AUTHOR]- Published
- 2021
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230. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors.
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Timmerman, D., Planchamp, F., Bourne, T., Landolfo, C., du Bois, A., Chiva, L., Cibula, D., Concin, N., Fischerova, D., Froyman, W., Gallardo, G., Lemley, B., Loft, A., Mereu, L., Morice, P., Querleu, D., Testa, A. C., Vergote, I., Vandecaveye, V., and Scambia, G.
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OVARIAN epithelial cancer , *OVARIAN cancer , *OVARIAN tumors , *TUMOR diagnosis , *DIFFUSION magnetic resonance imaging , *MAGNETIC resonance imaging , *CONTRAST-enhanced magnetic resonance imaging - Abstract
Liquid biopsy in ovarian cancer: recent advances on circulating tumor cells and circulating tumor DNA. 173 Demidov VN, Lipatenkova J, Vikhareva O, Van Holsbeke C, Timmerman D, Valentin L. Imaging of gynecological disease (2): clinical and ultrasound characteristics of Sertoli cell tumors, Sertoli-Leydig cell tumors and Leydig cell tumors. I The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the preoperative diagnosis of ovarian tumors, including imaging techniques, biomarkers and prediction models i . This multiclass prediction model is the first risk model to differentiate between benign and malignant tumors, whilst also offering subclassification of any malignancy into borderline tumors, Stage-I and Stage-II-IV primary cancers and secondary metastatic tumors. Positron emission tomography-computed tomography Positron emission tomography-computed tomography (PET-CT) may be useful in differentiating malignant from borderline or benign ovarian tumors, with the limitation that its diagnostic performance can be impacted negatively by certain tumor histological subtypes, due to the lower fluorodeoxyglucose uptake in clear-cell and mucinous invasive subtypes147-152. [Extracted from the article]
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- 2021
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231. Imaging in gynecological disease (22): clinical and ultrasound characteristics of ovarian embryonal carcinomas, non-gestational choriocarcinomas and malignant mixed germ cell tumors.
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Moro, F., Castellano, L. M., Franchi, D., Epstein, E., Fischerova, D., Froyman, W., Timmerman, D., Zannoni, G. F., Scambia, G., Valentin, L., Testa, A. C., and Mascilini, F.
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CHORIOCARCINOMA , *GERM cell tumors , *ULTRASONIC imaging , *MEDICAL personnel , *OVARIAN tumors , *CANCER cells - Abstract
Objective: To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor.Methods: This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition.Results: One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours.Conclusions: A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]- Published
- 2021
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232. Vessel morphology depicted by three-dimensional power Doppler ultrasound as second-stage test in adnexal tumors that are difficult to classify: prospective diagnostic accuracy study.
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Sladkevicius, P., Jokubkiene, L., Timmerman, D., Fischerova, D., Van Holsbeke, C., Franchi, D., Savelli, L., Epstein, E., Fruscio, R., Kaijser, J., Czekierdowski, A., Guerriero, S., Pascual, M. A., Testa, A. C., Ameye, L., and Valentin, L.
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ADNEXAL diseases , *DOPPLER ultrasonography , *OVARIAN tumors , *TUMORS , *DIAGNOSIS , *MORPHOLOGY , *RESEARCH , *THREE-dimensional imaging , *RESEARCH methodology , *ADENOMA , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *RESEARCH funding , *RECEIVER operating characteristic curves , *LONGITUDINAL method - Abstract
Objectives: To assess whether vessel morphology depicted by three-dimensional (3D) power Doppler ultrasound improves discrimination between benignity and malignancy if used as a second-stage test in adnexal masses that are difficult to classify.Methods: This was a prospective observational international multicenter diagnostic accuracy study. Consecutive patients with an adnexal mass underwent standardized transvaginal two-dimensional (2D) grayscale and color or power Doppler and 3D power Doppler ultrasound examination by an experienced examiner, and those with a 'difficult' tumor were included in the current analysis. A difficult tumor was defined as one in which the International Ovarian Tumor Analysis (IOTA) logistic regression model-1 (LR-1) yielded an ambiguous result (risk of malignancy, 8.3% to 25.5%), or as one in which the ultrasound examiner was uncertain regarding classification as benign or malignant when using subjective assessment. Even when the ultrasound examiner was uncertain, he/she was obliged to classify the tumor as most probably benign or most probably malignant. For each difficult tumor, one researcher created a 360° rotating 3D power Doppler image of the vessel tree in the whole tumor and another of the vessel tree in a 5-cm3 spherical volume selected from the most vascularized part of the tumor. Two other researchers, blinded to the patient's history, 2D ultrasound findings and histological diagnosis, independently described the vessel tree using predetermined vessel features. Their agreed classification was used. The reference standard was the histological diagnosis of the mass. The sensitivity of each test for discriminating between benign and malignant difficult tumors was plotted against 1 - specificity on a receiver-operating-characteristics diagram, and the test with the point furthest from the reference line was considered to have the best diagnostic ability.Results: Of 2403 women with an adnexal mass, 376 (16%) had a difficult mass. Ultrasound volumes were available for 138 of these cases. In 79/138 masses, the ultrasound examiner was uncertain about the diagnosis based on subjective assessment, in 87/138, IOTA LR-1 yielded an ambiguous result and, in 28/138, both methods gave an uncertain result. Of the masses, 38/138 (28%) were malignant. Among tumors that were difficult to classify as benign or malignant by subjective assessment, the vessel feature 'densely packed vessels' had the best discriminative ability (sensitivity 67% (18/27), specificity 83% (43/52)) and was slightly superior to subjective assessment (sensitivity 74% (20/27), specificity 60% (31/52)). In tumors in which IOTA LR-1 yielded an ambiguous result, subjective assessment (sensitivity 82% (14/17), specificity 79% (55/70)) was superior to the best vascular feature, i.e. changes in the diameter of vessels in the whole tumor volume (sensitivity 71% (12/17), specificity 69% (48/70)).Conclusion: Vessel morphology depicted by 3D power Doppler ultrasound may slightly improve discrimination between benign and malignant adnexal tumors that are difficult to classify by subjective ultrasound assessment. For tumors in which the IOTA LR-1 model yields an ambiguous result, subjective assessment is superior to vessel morphology as a second-stage test. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]- Published
- 2021
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233. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST).
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Ambrosio, M., Testa, A. C., Moro, F., Franchi, D., Scifo, M. C., Rams, N., Epstein, E., Alcazar, J. L., Hidalgo, J. J., Van Holsbeke, C., Burgetova, A., Dundr, P., Cibula, D., and Fischerova, D.
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GASTROINTESTINAL stromal tumors , *GASTROINTESTINAL tumors , *SOFT tissue tumors , *PLATELET-derived growth factor receptors - Published
- 2020
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234. Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer: model-development study.
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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.
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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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235. ISUOG Consensus Statement on rationalization of gynecological ultrasound services in context of SARS-CoV-2.
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Bourne, T., Leonardi, M., Kyriacou, C., Al‐Memar, M., Landolfo, C., Cibula, D., Condous, G., Metzger, U., Fischerova, D., Timmerman, D., Bosch, T., Al-Memar, M, and van den Bosch, T
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MENORRHAGIA , *GYNECOLOGIC care , *DYSMENORRHEA , *COVID-19 , *MEDICAL personnel as patients , *MEDICAL personnel , *COVID-19 pandemic - Abstract
Given the challenges of the current coronavirus (SARS-CoV-2) pandemic and to protect both patients and ultrasound providers (physicians, sonographers, allied professionals), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has compiled the following expert-opinion-based guidance for the rationalization of ultrasound investigations for gynecological indications. If patients are troubled by their symptoms during this time, they should consider arranging a telephone/video consultation with their family physician or gynecologist to help them manage their symptoms empirically. Abdominopelvic "mass" with associated symptoms ( B NOW b or B SOON b ): depending on the severity of the presenting associated symptoms, the healthcare provider should consider referring the patient to the emergency department for urgent evaluation. Patients with suspicion of COVID-19 requiring admission If a patient with suspicion of COVID-19 is stable, they should be sent home to self-isolate for 7 days, if clinically appropriate. [Extracted from the article]
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- 2020
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236. Diagnostic Accuracy of Ultrasound and MRI in the Mapping of Deep Pelvic Endometriosis Using the International Deep Endometriosis Analysis (IDEA) Consensus.
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Indrielle-Kelly, T., Frühauf, F., Fanta, M., Burgetova, A., Lavu, D., Dundr, P., Cibula, D., and Fischerova, D.
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DIAGNOSIS of endometriosis , *BLADDER , *COLON (Anatomy) , *CONSENSUS (Social sciences) , *ENDOMETRIOSIS , *ENDOSCOPIC ultrasonography , *HISTOLOGICAL techniques , *LIGAMENTS , *LONGITUDINAL method , *MAGNETIC resonance imaging , *MEDICAL protocols , *SCIENTIFIC observation , *PELVIS , *RECTUM , *REFERENCE values , *STATISTICS , *SURGICAL therapeutics , *VAGINA - Abstract
Objectives. The primary aim was to investigate the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the mapping of deep pelvic endometriosis (DE) in a diseased population. The secondary aim was to offer first insights into the clinical applicability of the new International Deep Endometriosis Analysis group (IDEA) consensus for sonographic evaluation, which was also adapted for MRI and surgical reporting in this study. Methods. The study was a prospective observational cohort study. In this study, consecutive women planned for surgical treatment for DE underwent preoperative mapping of pelvic disease using TVS and MRI (index tests). The results were compared against the intraoperative findings with histopathological confirmation (reference standard). In case of disagreement between intraoperative and pathology findings, the latter was prioritised. Index tests and surgical findings were reported using a standardised protocol based on the IDEA consensus. Results. The study ran from 07/2016 to 02/2018. One-hundred and eleven women were approached, but 60 declined participation. Out of the 51 initially recruited women, two were excluded due to the missing reference standard. Both methods (TVS and MRI) had the same sensitivity and specificity in the detection of DE in the upper rectum (UpR) and rectosigmoid (RS) (UpR TVS and MRI sensitivity and specificity 100%; RS TVS and MRI sensitivity 94%; TVS and MRI specificity 84%). In the assessment of DE in the bladder (Bl), uterosacral ligaments (USL), vagina (V), rectovaginal septum (RVS), and overall pelvis (P), TVS had marginally higher specificity but lower sensitivity than MRI (Bl TVS sensitivity 89%, specificity 100%, MRI sensitivity 100%, specificity 95%; USL TVS sensitivity 74%, specificity 67%, MRI sensitivity 94%, specificity 60%; V TVS sensitivity 55%, specificity 100%, MRI sensitivity 73%, specificity 95%; RVS TVS sensitivity 67%, specificity 100%, MRI sensitivity 83%, specificity 93%; P TVS sensitivity 78%, specificity 97%, MRI sensitivity 91%, specificity 91%). No significant differences in diagnostic accuracy between TVS and MRI were observed except USL assessment (p = 0.04) where MRI was significantly better and pouch of Douglas obliteration (p = 0.04) where TVS was significantly better. Overall, there was a good agreement between reference standards and both index tests (TVS kappa value (κ) = 0.727 [ p ≤ 0.001), MRI κ = 0.755 [ p = p ≤ 0.001 ]). Conclusion. We found that both imaging techniques had overall good agreement with the reference standard in the detection of deep pelvic endometriosis. This is the first study to date involving the IDEA consensus for ultrasound, its modified version for MRI, and intraoperative reporting of deep pelvic endometriosis in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2020
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237. 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 , *ULTRASONIC imaging , *CANCER invasiveness , *RESEARCH methodology , *EVALUATION research , *BURDEN of care , *TUMOR classification , *COMPARATIVE studies , *RESEARCH funding , *SENSITIVITY & specificity (Statistics) , *LONGITUDINAL method ,RESEARCH evaluation - 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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238. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma.
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Ludovisi, M., Moro, F., Pasciuto, T., Di Noi, S., Giunchi, S., Savelli, L., Pascual, M. A., Sladkevicius, P., Alcazar, J. L., Franchi, D., Mancari, R., Moruzzi, M. C., Jurkovic, D., Chiappa, V., Guerriero, S., Exacoustos, C., Epstein, E., Frühauf, F., Fischerova, D., and Fruscio, R.
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SARCOMA , *UTERINE hemorrhage , *LEIOMYOSARCOMA , *ULTRASONIC imaging , *MYOMETRIUM - Abstract
Objective: To describe the clinical and ultrasound characteristics of uterine sarcomas.Methods: This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology.Results: We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26-86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91 mm (range, 7-321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan-shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color-Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar.Conclusions: Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan-shaped shadowing. Most are moderately or very well vascularized. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2019
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239. Role of CA125/CEA ratio and ultrasound parameters in identifying metastases to the ovaries in patients with multilocular and multilocular-solid ovarian masses.
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Moro, F., Pasciuto, T., Djokovic, D., Di Legge, A., Granato, V., Moruzzi, M. C., Mancari, R., Zannoni, G. F., Fischerova, D., Franchi, D., Scambia, G., Testa, A. C., and Annoni, G F
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Objectives: To investigate ultrasound features and the best cut-off value of the cancer antigen 125/carcinoembryonic antigen (CA125/CEA) ratio to discriminate ovarian metastases from benign and primary malignant ovarian neoplasms in two selected groups of morphological ovarian masses, namely multilocular masses with five or more locules and multilocular-solid masses.Methods: Patients with multilocular (five or more locules) or multilocular-solid ovarian masses, operated on within 3 months of ultrasound examination, and with tumor markers (CEA and CA125) available at diagnosis, were identified retrospectively from three ultrasound centers. The masses were described using the International Ovarian Tumor Analysis (IOTA) terminology. Ultrasound and clinical characteristics were compared between those with an ovarian neoplasm (including benign and primary malignant neoplasms) and those with an ovarian metastasis. Receiver-operating characteristics curve (ROC) analysis was used to evaluate the ability of CA125, CEA and CA125/CEA to differentiate between ovarian neoplasms and ovarian metastases, and their predictive performance was assessed.Results: In total, 350 (88.4%) patients with an ovarian neoplasm (including 99 benign, 43 borderline and 197 primary epithelial ovarian carcinomas, seven malignant rare tumors and four other types of invasive ovarian tumor) and 46 (11.6%) patients with an ovarian metastasis were analyzed. On ultrasound examination, ovarian neoplasms were smaller than ovarian metastases (median largest diameter, 97 (range, 20-387) mm vs 146 (range, 43-259) mm, respectively; P < 0.0001) and presented with a lower number of cysts with > 10 locules (18.9% vs 54.3%; P < 0.0001). ROC curve analysis showed that the best cut-off value of CEA for distinguishing between ovarian neoplasms and ovarian metastases was 2.33 ng/mL. The predictive performance of this CEA cut-off value was: area under the curve (AUC), 0.791 (95% CI, 0.711-0.870); accuracy, 73.7%; sensitivity, 73.1%; specificity, 78.3%; positive predictive value (PPV), 96.2%; and negative predictive value (NPV), 27.7%. The best cut-off value of CA125/CEA for distinguishing between ovarian neoplasms and ovarian metastases was 11.92. The predictive performance of this CA125/CEA cut-off value was: AUC, 0.758 (95% CI, 0.683-0.833); accuracy, 79.8%; sensitivity, 82.3%; specificity, 60.9%; PPV, 94.1%; and NPV, 31.1%.Conclusions: CA125/CEA ratio and CEA alone did not show any significant difference in their ability to distinguish between ovarian neoplasms (including benign and malignant) and ovarian metastases in masses with multilocular and those with multilocular-solid morphology. Therefore, in this morphological subgroup of ovarian masses, CEA alone is sufficient to differentiate between ovarian neoplasms and ovarian metastases. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2019
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240. Imaging in gynecological disease (14): clinical and ultrasound characteristics of ovarian clear cell carcinoma.
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Pozzati, F., Moro, F., Pasciuto, T., Gallo, C., Ciccarone, F., Franchi, D., Mancari, R., Giunchi, S., Timmerman, D., Landolfo, C., Epstein, E., Chiappa, V., Fischerova, D., Fruscio, R., Zannoni, G. F., Valentin, L., Scambia, G., and Testa, A. C.
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RENAL cell carcinoma , *OVARIAN tumors , *OVARIAN cancer diagnosis , *ULTRASONIC imaging , *OVARIAN cancer , *CANCER chemotherapy , *ADENOCARCINOMA , *AGE distribution , *COMPARATIVE studies , *ENDOMETRIOSIS , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *EVALUATION research , *RETROSPECTIVE studies , *DISEASE complications - Abstract
Objective: To describe the clinical and ultrasound characteristics of ovarian pure clear cell carcinoma.Methods: This was a retrospective study involving data from 11 ultrasound centers. From the International Ovarian Tumor Analysis (IOTA) database, 105 patients who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016 were identified with a histologically confirmed pure clear cell carcinoma of the ovary. An additional 47 patients diagnosed with pure clear cell carcinoma between 1999 and 2016 and with available complete preoperative ultrasound reports were identified retrospectively from the databases of the departments of gynecological oncology in the participating centers. The ultrasound images of all tumors were described using IOTA terminology. Clinical and ultrasound characteristics were analyzed for the whole group, and separately, for patients with and those without histologically confirmed endometriosis, and for patients with evidence of tumor developing from endometriosis.Results: Median age of the 152 patients was 53.5 (range, 28-92) years and 92/152 (60.5%) tumors were FIGO Stage I. Most tumors (128/152, 84.2%) were unilateral. On ultrasound examination, all tumors contained solid components and 36/152 (23.7%) were completely solid masses. The median largest diameter of the lesion was 117 (range, 25-310) mm. Papillary projections were present in 58/152 (38.2%) masses and, in most of these (51/56, 91.1%), vascularized papillary projections were seen. Information regarding the presence, site and type of pelvic endometriosis at histology was available for 130/152 patients. Endometriosis was noted in 54 (41.5%) of these. In 24/130 (18.6%) patients, the tumor was judged to have developed from endometriosis. Patients with, compared to those without, evidence of tumor developing from endometriosis were younger (median 47.5 vs 55.0 years, respectively), and ground-glass echogenicity of cyst fluid was more common in pure clear cell cancers developing from endometriosis (10/20 vs 13/79 (50.0% vs 16.5%), respectively).Conclusions: Ovarian pure clear cell carcinoma is usually diagnosed at an early stage and typically appears as a large unilateral mass with solid components. Patients with clear cell carcinoma developing from endometriosis are younger than other patients with clear cell carcinoma, and clear cell cancers developing from endometriosis more often manifest ground-glass echogenicity of cyst fluid. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2018
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241. Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer.
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Moro, F., Pasciuto, T., Mascilini, F., Moruzzi, M. C., Scambia, G., Chiappa, V., Guerriero, S., Zannoni, G. F., Valentin, L., Magoga, G., Testa, A. C., Fischerova, D., Savelli, L., Giunchi, S., Mancari, R., Franchi, D., Czekierdowski, A., Froyman, W., Timmerman, D., and Verri, D.
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OVARIAN cancer , *OVARIAN diseases , *CARCINOMA , *ADENOCARCINOMA , *ULTRASONIC imaging , *ASCITES , *COMPARATIVE studies , *ENDOMETRIOSIS , *RESEARCH methodology , *MEDICAL cooperation , *OVARIAN tumors , *RESEARCH , *ENDOMETRIAL tumors , *EVALUATION research , *COLOR Doppler ultrasonography , *RETROSPECTIVE studies - Abstract
Objective: To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinomas.Methods: This was a retrospective multicenter study of patients with a histological diagnosis of pure endometrioid carcinoma. We identified 161 patients from the International Ovarian Tumor Analysis (IOTA) database who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016, and another 78 patients from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. In addition, one author reviewed all available ultrasound images and described them using pattern recognition.Results: Median age of the 239 patients was 55 years (range, 19-88 years). On ultrasound examination, two (0.8%) endometrioid carcinomas were described as unilocular cysts, three (1.3%) as multilocular cysts, 37 (15.5%) as unilocular-solid cysts, 115 (48.1%) as multilocular-solid cysts and 82 (34.3%) as solid masses. Median largest tumor diameter was 102.5 mm (range, 20-300 mm) and median largest diameter of the largest solid component was 63 mm (range, 9-300 mm). Papillary projections were present in 70 (29.3%) masses. Most cancers (188 (78.7%)) were unilateral. In 49 (20.5%) cases, the cancer was judged by the pathologist to develop from endometriosis. These cancers, compared with those without evidence of tumor developing from endometriosis, more often manifested papillary projections on ultrasound (46.9% (23/49) vs 24.7% (47/190)), were less often bilateral (8.2% (4/49) vs 24.7% (47/190)) and less often associated with ascites (6.1% (3/49) vs 28.4% (54/190)) and fluid in the pouch of Douglas (24.5% (12/49) vs 48.9% (93/190)). Retrospective analysis of available ultrasound images using pattern recognition revealed that many tumors without evidence of tumor developing from endometriosis (36.3% (41/113)) had a large central solid component entrapped within locules, giving the tumor a cockade-like appearance.Conclusions: Endometrioid cancers are usually large, unilateral, multilocular-solid or solid tumors. The ultrasound characteristics of endometrioid carcinomas developing from endometriosis differ from those without evidence of tumor developing from endometriosis, the former being more often unilateral cysts with papillary projections and no ascites. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2018
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242. Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation on IOTA 5 multicenter cohort
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C. Landolfo, T. Bourne, W. Froyman, B. Van Calster, J. Ceusters, A. C. Testa, L. Wynants, P. Sladkevicius, C. Van Holsbeke, E. Domali, R. Fruscio, E. Epstein, D. Franchi, M. J. Kudla, V. Chiappa, J. L. Alcazar, F. P. G. Leone, F. Buonomo, M. E. Coccia, S. Guerriero, N. Deo, L. Jokubkiene, L. Savelli, D. Fischerova, A. Czekierdowski, J. Kaijser, A. Coosemans, G. Scambia, I. Vergote, D. Timmerman, L. Valentin, Epidemiologie, RS: CAPHRI - R5 - Optimising Patient Care, Landolfo, C, Bourne, T, Froyman, W, Van Calster, B, Ceusters, J, Testa, A, Wynants, L, Sladkevicius, P, Van Holsbeke, C, Domali, E, Fruscio, R, Epstein, E, Franchi, D, Kudla, M, Chiappa, V, Alcazar, J, Leone, F, Buonomo, F, Coccia, M, Guerriero, S, Deo, N, Jokubkiene, L, Savelli, L, Fischerova, D, Czekierdowski, A, Kaijser, J, Coosemans, A, Scambia, G, Vergote, I, Timmerman, D, and Valentin, L
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Radiological and Ultrasound Technology ,Benign simple descriptor ,Validation study ,IOTA ,Obstetrics and Gynecology ,ultrasonography ,General Medicine ,benign simple descriptors ,ovarian neoplasms ,benign simple descriptor ,ovarian neoplasm ,Ovarian neoplasm ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Reproductive Medicine ,validation study ,ADNEX model ,Radiology, Nuclear Medicine and imaging ,Ultrasonography - Abstract
OBJECTIVE: Previous work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. METHODS: This was a retrospective analysis using data from the 2-year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase-5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. RESULTS: A total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow-up at recruitment and all patients from 19 centers that did not fulfil our criteria for good-quality surgical and follow-up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver-operating-characteristics curve (AUC) of 0.94 (95% CI, 0.92-0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). CONCLUSION: A large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:61 issue:2 pages:231-242 ispartof: location:England status: published
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- 2022
243. Endometriomas: their ultrasound characteristics
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Stefano Guerriero, Dirk Timmerman, Artur Czekierdowski, Lil Valentin, G Mestdagh, C. Van Holsbeke, B. Van Calster, Dario Paladini, Luca Savelli, Andrea Lissoni, Antonia Carla Testa, J. Zhang, Daniela Fischerova, Tom Bourne, Van Holsbeke, C., Van Calster, B., Guerriero, S., Savelli, L., Paladini, Dario, Lissoni, A. A., Czekierdowski, A., Fischerova, D., Zhang, J., Mestdagh, G., Testa, A. C., Bourne, T., Valentin, L., Timmerman, D., Van Holsbeke, C, Van Calster, B, Guerriero, S, Savelli, L, Paladini, D, Lissoni, A, Czekierdowski, A, Fischerova, D, Zhang, J, Mestdagh, G, Testa, A, Bourne, T, Valentin, L, and Timmerman, D
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Adult ,medicine.medical_specialty ,Adolescent ,Endometriosis ,Adnexal mass ,law.invention ,Young Adult ,Ovarian tumor ,law ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cyst ,Ultrasonography, Doppler, Color ,Endometriosi ,Child ,Aged ,Ultrasonography ,Aged, 80 and over ,Ovarian Neoplasms ,Gynecology ,Radiological and Ultrasound Technology ,endometrioma ,ultrasound ,business.industry ,Ultrasound ,Obstetrics and Gynecology ,Echogenicity ,General Medicine ,Middle Aged ,medicine.disease ,Ovarian neoplasm ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Reproductive Medicine ,Adnexal Diseases ,Female ,Radiology ,business ,Ground glass - Abstract
Objectives To describe the ultrasound characteristics of endometriomas in pre- and postmenopausal patients and to develop rules that characterize endometriomas. Methods All patients included in the International Ovarian Tumor Analysis (IOTA) studies were used in our analysis. Patients with an adnexal mass were scanned by experienced sonologists using a standardized research protocol. The gold standard was the histology of the surgically removed adnexal mass. The gray-scale and Doppler ultrasound characteristics of the endometriomas were compared with those of other benign and malignant masses. Based on decision-tree analysis, the existing literature and clinical experience, ultrasound rules for the detection of endometriomas were created and evaluated. Results Of all 3511 patients included in the IOTA studies, 713 (20%) had endometriomas. Fifty-one per cent of the endometriomas were unilocular cysts with ground glass echogenicity of the cyst fluid. These characteristics were found less often among other benign tumors or malignancies, or among the small set of endometriomas (4%) that were found in postmenopausal patients. Based on the decision-tree analysis, the optimal rule to detect endometriomas was an adnexal mass in a premenopausal patient with ground glass echogenicity of the cyst fluid, one to four locules and no papillations with detectable blood flow'. Based on clinical considerations, the following rule: 'premenopausal status, ground glass echogenicity of the cyst fluid, one to four locules and no solid parts' seems preferable. Conclusions Several rules had a good ability to characterize endometriomas. The ultrasound characteristics of endometriomas differ between pre- and postmenopausal patients. Masses in postmenopausal women whose cystic contents have a ground glass appearance have a high risk of malignancy. Copyright (C) 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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- 2010
244. Risk of micrometastases in non-sentinel pelvic lymph nodes in cervical cancer.
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Cibula, D., Zikan, M., Slama, J., Fischerova, D., Kocian, R., Germanova, A., Burgetova, A., Dusek, L., Dundr, P., Gregova, M., and Nemejcova, K.
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MICROMETASTASIS , *CERVICAL cancer patients , *LYMPHADENECTOMY , *HISTOPATHOLOGY , *PREOPERATIVE care - Abstract
Objective A high sensitivity of sentinel lymph nodes (SLN) for pelvic lymph node (LN) staging has been repeatedly shown in patients with cervical cancer. However, since only SLN are evaluated by pathologic ultrastaging, the risk of small metastases, including small macrometastases (MAC) and micrometastases (MIC), in non-SLN is unknown. This can be a critical limitation for the oncological safety of abandoning a pelvic lymphadenectomy. Methods The patients selected for the study had cervical cancer and were at high risk for LN positivity (stage IB–IIA, biggest diameter ≥ 3 cm). The patients had no enlarged or suspicious LN on pre-operative imaging; SLNs were detected bilaterally and were negative on intra-operative pathologic evaluation. All SLNs and all other pelvic LNs were examined using an ultrastaging protocol and processed completely in intervals of 150 μm. Results In all, 17 patients were enrolled into the study. The mean number of removed pelvic LNs was 30. A total of 573 pelvic LNs were examined through ultrastaging protocol (5762 slides). Metastatic involvement was detected in SLNs of 8 patients (1 × MAC; 4 × MIC; 3 × ITC) and in non-SLNs in 2 patients (2 × MIC). In both cases with positive pelvic non-SLNs, there were found MIC in ipsilateral SLNs. No metastasis in pelvic non-SLNs was found by pathologic ultrastaging in any of the patients with negative SLN Side-specific sensitivity was 100% for MAC and MIC. There was one case of ITC detected in non-SLN, negative ipsilateral SLN, but MIC in SLN on the other pelvic side. Conclusions After processing all pelvic LNs by pathologic ultrastaging, there were found no false-negative cases of positive non-SLN (MAC or MIC) and negative SLN. SLN ultrastaging reached 100% sensitivity for the presence of both MAC and MIC in pelvic LNs. [ABSTRACT FROM AUTHOR]
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- 2016
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245. Imaging in gynecological disease (14): clinical and ultrasound characteristics of ovarian clear cell carcinoma
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Francesca Ciccarone, Dirk Timmerman, Francesca Moro, Giovanni Scambia, C. Gallo, F. Pozzati, S. Giunchi, Gianfranco Zannoni, Elisabeth Epstein, Daniela Fischerova, Valentina Chiappa, D. Franchi, R. Mancari, Chiara Landolfo, Lil Valentin, Robert Fruscio, Tina Pasciuto, Antonia Carla Testa, Pozzati, F, Moro, F, Pasciuto, T, Gallo, C, Ciccarone, F, Franchi, D, Mancari, R, Giunchi, S, Timmerman, D, Landolfo, C, Epstein, E, Chiappa, V, Fischerova, D, Fruscio, R, Zannoni, G, Valentin, L, Scambia, G, and Testa, A
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Adult ,medicine.medical_specialty ,Endometriosis ,ovarian neoplasm ,clear cell ovarian carcinoma ,03 medical and health sciences ,Ovarian tumor ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Cyst ,Clear-cell ovarian carcinoma ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,Ovarian Neoplasms ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Age Factors ,Obstetrics and Gynecology ,Echogenicity ,ultrasonography ,General Medicine ,ovarian neoplasms ,Middle Aged ,medicine.disease ,pure clear cell ovarian carcinoma ,Reproductive Medicine ,030220 oncology & carcinogenesis ,Clear cell carcinoma ,Female ,Radiology ,business ,Clear cell ,Adenocarcinoma, Clear Cell - Abstract
OBJECTIVE: To describe the clinical and ultrasound characteristics of ovarian pure clear cell carcinoma. METHODS: This was a retrospective study involving data from 11 ultrasound centers. From the International Ovarian Tumor Analysis (IOTA) database, 105 patients who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016 were identified with a histologically confirmed pure clear cell carcinoma of the ovary. An additional 47 patients diagnosed with pure clear cell carcinoma between 1999 and 2016 and with available complete preoperative ultrasound reports were identified retrospectively from the databases of the departments of gynecological oncology in the participating centers. The ultrasound images of all tumors were described using IOTA terminology. Clinical and ultrasound characteristics were analyzed for the whole group, and separately, for patients with and those without histologically confirmed endometriosis, and for patients with evidence of tumor developing from endometriosis. RESULTS: Median age of the 152 patients was 53.5 (range, 28-92) years and 92/152 (60.5%) tumors were FIGO Stage I. Most tumors (128/152, 84.2%) were unilateral. On ultrasound examination, all tumors contained solid components and 36/152 (23.7%) were completely solid masses. The median largest diameter of the lesion was 117 (range, 25-310) mm. Papillary projections were present in 58/152 (38.2%) masses and, in most of these (51/56, 91.1%), vascularized papillary projections were seen. Information regarding the presence, site and type of pelvic endometriosis at histology was available for 130/152 patients. Endometriosis was noted in 54 (41.5%) of these. In 24/130 (18.6%) patients, the tumor was judged to have developed from endometriosis. Patients with, compared to those without, evidence of tumor developing from endometriosis were younger (median 47.5 vs 55.0 years, respectively), and ground-glass echogenicity of cyst fluid was more common in pure clear cell cancers developing from endometriosis (10/20 vs 13/79 (50.0% vs 16.5%), respectively). CONCLUSIONS: Ovarian pure clear cell carcinoma is usually diagnosed at an early stage and typically appears as a large unilateral mass with solid components. Patients with clear cell carcinoma developing from endometriosis are younger than other patients with clear cell carcinoma, and clear cell cancers developing from endometriosis more often manifest ground-glass echogenicity of cyst fluid. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. ispartof: Ultrasound In Obstetrics & Gynecology vol:52 issue:6 pages:792-800 ispartof: location:England status: published
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- 2018
246. 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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247. 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, A. C., Mascilini, F., Lindqvist, P., Fischerova, D., Frühauf, F., Fransis, S., de Jonge, E., Timmerman, D., and Epstein, E.
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ENDOMETRIAL cancer , *DIAGNOSTIC ultrasonic imaging , *MATHEMATICAL models , *UTERINE contraction , *MEDICAL imaging systems - Abstract
ABSTRACT Objectives 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. Methods 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. Results 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. Conclusion 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. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
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- 2014
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248. 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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FALLOPIAN tubes , *FEMALE reproductive organ diseases , *ULTRASONIC imaging , *ABDOMINAL bloating , *ABDOMINAL pain , *CANCER - Abstract
ABSTRACT Objectives To describe clinical history and ultrasound findings in patients with tubal carcinoma. Methods 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. Results 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%). Conclusions 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. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]
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- 2014
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249. 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
250. Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study
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Ekaterini Domali, An Coosemans, Giovanni Scambia, Laure Wynants, J. Kaijser, Valentina Chiappa, Dirk Timmerman, Jolien Ceusters, Juan Luis Alcázar, Luca Savelli, Daniela Fischerova, Caroline Van Holsbeke, Elisabeth Epstein, Dorella Franchi, Povilas Sladkevicius, Nandita Deo, Ignace Vergote, Artur Czekierdowski, Tom Bourne, Maria Elisabetta Coccia, Ben Van Calster, Antonia Carla Testa, Marek Kudla, Lil Valentin, Chiara Landolfo, Ligita Jokubkiene, F. Leone, Wouter Froyman, Robert Fruscio, Stefano Guerriero, F. Buonomo, Van Calster, B, Valentin, L, Froyman, W, Landolfo, C, Ceusters, J, Testa, A, Wynants, L, Sladkevicius, P, Van Holsbeke, C, Domali, E, Fruscio, R, Epstein, E, Franchi, D, Kudla, M, Chiappa, V, Alcazar, J, Leone, F, Buonomo, F, Coccia, M, Guerriero, S, Deo, N, Jokubkiene, L, Savelli, L, Fischerova, D, Czekierdowski, A, Kaijser, J, Coosemans, A, Scambia, G, Vergote, I, Bourne, T, Timmerman, D, Epidemiologie, and RS: CAPHRI - R5 - Optimising Patient Care
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EXTERNAL VALIDATION ,RISK MODELS ,SURGERY ,PREDICTION ,Conservative Treatment ,Adnexal mass ,0302 clinical medicine ,Prospective Studies ,Stage (cooking) ,Prospective cohort study ,Membrane Protein ,ULTRASOUND ,Ultrasonography ,Ovarian Neoplasms ,Aged, 80 and over ,CALIBRATION ,030219 obstetrics & reproductive medicine ,General Medicine ,Middle Aged ,TUMORS ,030220 oncology & carcinogenesis ,Female ,Radiology ,Life Sciences & Biomedicine ,Cohort study ,Human ,Adult ,IOTA ADNEX MODEL ,medicine.medical_specialty ,Adolescent ,Ovariectomy ,Malignancy ,Risk Assessment ,1117 Public Health and Health Services ,03 medical and health sciences ,Young Adult ,Medicine, General & Internal ,General & Internal Medicine ,medicine ,Fallopian Tube Neoplasms ,Humans ,Fallopian Tube Neoplasm ,MASSES ,Aged ,MALIGNANCY ,Science & Technology ,Receiver operating characteristic ,business.industry ,Research ,Ovarian Neoplasm ,Membrane Proteins ,1103 Clinical Sciences ,medicine.disease ,Confidence interval ,Clinical trial ,Prospective Studie ,Logistic Models ,CA-125 Antigen ,business - Abstract
ObjectiveTo evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively.DesignMulticentre cohort study.Setting36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre.ParticipantsConsecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up.Main outcome measuresOverall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (±2) months. Multiple imputation was used when outcome based on follow-up was uncertain.ResultsThe primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the best calibrated. Calibration of the estimated risks for the tumour subtypes was good for ADNEX irrespective of whether or not CA125 was included as a predictor. Overall clinical utility (net benefit) was highest for the ADNEX models and SRRisk, and lowest for RMI. For patients who received at least one follow-up scan (n=1958), overall area under the receiver operating characteristic curve ranged from 0.76 (95% confidence interval 0.66 to 0.84) for RMI to 0.89 (0.81 to 0.94) for ADNEX with CA125.ConclusionsOur study found the ADNEX models and SRRisk are the best models to distinguish between benign and malignant masses in all patients presenting with an adnexal mass, including those managed conservatively.Trial registrationClinicalTrials.gov NCT01698632.
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- 2020
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