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American Journal of Obstetrics and... Aug 2019To compare the treatment success and failure rates, as well as side effects and surgery rates, between methotrexate protocols. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the treatment success and failure rates, as well as side effects and surgery rates, between methotrexate protocols.
DATA SOURCES
PubMed, Embase, and the Cochrane library searched up to July 2018.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials that compared women with ectopic pregnancies receiving the single-dose, two-dose, or multi-dose methotrexate protocols.
STUDY APPRAISAL AND SYNTHESIS METHODS
Odds of treatment success, treatment failure, side effects, and surgery for tubal rupture, as well as length of follow-up until treatment success, were compared using random and fixed effects meta-analysis. Sensitivity analyses compared treatment success in the groups with high human chorionic gonadatropin (hCG) values and a large adnexal mass, as defined by individual studies. The Cochrane Collaboration tool was used to assess risk of bias.
RESULTS
The 2-dose protocol was associated with higher treatment success compared to the single-dose protocol (odds ratio [OR], 1.84; 95% CI, 1.13, 3.00). The 2-dose protocol was more successful in women with high hCG (OR, 3.23; 95% CI, 1.53, 6.84) and in women with a large adnexal mass (OR, 2.93; 95% CI, 1.23, 6.9). The odds of surgery for tubal rupture were lower in the 2-dose protocol (OR, 0.65; 95% CI, 0.26, 1.63), but this was not statistically significant. The length of follow-up was 7.9 days shorter for the 2-dose protocol (95% CI, -12.2, -3.5). The odds of side effects were higher in the 2-dose protocol (OR, 1.53; 95% CI, 1.01, 2.30). Compared to the single-dose protocol, the multi-dose protocol was associated with a nonsignificant reduction in treatment failure (OR, 0.56; 95% CI, 0.28, 1.13) and a higher chance of side effects (OR, 2.10; 95% CI, 1.24, 3.54). The odds of surgery for tubal rupture (OR, 1.62; 95% CI, 0.41, 6.49) and time to follow-up (OR, -1.3; 95% CI, -5.4, 2.7) were similar.
CONCLUSION
The 2-dose methotrexate protocol is superior to the single-dose protocol for the treatment of ectopic pregnancy in terms of treatment success and time to success. Importantly, these findings hold true in patients thought to be at a lower likelihood of responding to medical management, such as those with higher hCGs and a large adnexal mass.
Topics: Abortifacient Agents, Nonsteroidal; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Fallopian Tubes; Female; Humans; Methotrexate; Pregnancy; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Rupture
PubMed: 30629908
DOI: 10.1016/j.ajog.2019.01.002 -
The Cochrane Database of Systematic... May 2016About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
About 10% of reproductive-aged women suffer from endometriosis, a costly chronic disease causing pelvic pain and subfertility. Laparoscopy is the gold standard diagnostic test for endometriosis, but is expensive and carries surgical risks. Currently, there are no non-invasive or minimally invasive tests available in clinical practice to accurately diagnose endometriosis. Although other reviews have assessed the ability of blood tests to diagnose endometriosis, this is the first review to use Cochrane methods, providing an update on the rapidly expanding literature in this field.
OBJECTIVES
To evaluate blood biomarkers as replacement tests for diagnostic surgery and as triage tests to inform decisions on surgery for endometriosis. Specific objectives include:1. To provide summary estimates of the diagnostic accuracy of blood biomarkers for the diagnosis of peritoneal, ovarian and deep infiltrating pelvic endometriosis, compared to surgical diagnosis as a reference standard.2. To assess the diagnostic utility of biomarkers that could differentiate ovarian endometrioma from other ovarian masses.
SEARCH METHODS
We did not restrict the searches to particular study designs, language or publication dates. We searched CENTRAL to July 2015, MEDLINE and EMBASE to May 2015, as well as these databases to 20 April 2015: CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, DARE and PubMed.
SELECTION CRITERIA
We considered published, peer-reviewed, randomised controlled or cross-sectional studies of any size, including prospectively collected samples from any population of reproductive-aged women suspected of having one or more of the following target conditions: ovarian, peritoneal or deep infiltrating endometriosis (DIE). We included studies comparing the diagnostic test accuracy of one or more blood biomarkers with the findings of surgical visualisation of endometriotic lesions.
DATA COLLECTION AND ANALYSIS
Two authors independently collected and performed a quality assessment of data from each study. For each diagnostic test, we classified the data as positive or negative for the surgical detection of endometriosis, and we calculated sensitivity and specificity estimates. We used the bivariate model to obtain pooled estimates of sensitivity and specificity whenever sufficient datasets were available. The predetermined criteria for a clinically useful blood test to replace diagnostic surgery were a sensitivity of 0.94 and a specificity of 0.79 to detect endometriosis. We set the criteria for triage tests at a sensitivity of ≥ 0.95 and a specificity of ≥ 0.50, which 'rules out' the diagnosis with high accuracy if there is a negative test result (SnOUT test), or a sensitivity of ≥ 0.50 and a specificity of ≥ 0.95, which 'rules in' the diagnosis with high accuracy if there is a positive result (SpIN test).
MAIN RESULTS
We included 141 studies that involved 15,141 participants and evaluated 122 blood biomarkers. All the studies were of poor methodological quality. Studies evaluated the blood biomarkers either in a specific phase of the menstrual cycle or irrespective of the cycle phase, and they tested for them in serum, plasma or whole blood. Included women were a selected population with a high frequency of endometriosis (10% to 85%), in which surgery was indicated for endometriosis, infertility work-up or ovarian mass. Seventy studies evaluated the diagnostic performance of 47 blood biomarkers for endometriosis (44 single-marker tests and 30 combined tests of two to six blood biomarkers). These were angiogenesis/growth factors, apoptosis markers, cell adhesion molecules, high-throughput markers, hormonal markers, immune system/inflammatory markers, oxidative stress markers, microRNAs, tumour markers and other proteins. Most of these biomarkers were assessed in small individual studies, often using different cut-off thresholds, and we could only perform meta-analyses on the data sets for anti-endometrial antibodies, interleukin-6 (IL-6), cancer antigen-19.9 (CA-19.9) and CA-125. Diagnostic estimates varied significantly between studies for each of these biomarkers, and CA-125 was the only marker with sufficient data to reliably assess sources of heterogeneity.The mean sensitivities and specificities of anti-endometrial antibodies (4 studies, 759 women) were 0.81 (95% confidence interval (CI) 0.76 to 0.87) and 0.75 (95% CI 0.46 to 1.00). For IL-6, with a cut-off value of > 1.90 to 2.00 pg/ml (3 studies, 309 women), sensitivity was 0.63 (95% CI 0.52 to 0.75) and specificity was 0.69 (95% CI 0.57 to 0.82). For CA-19.9, with a cut-off value of > 37.0 IU/ml (3 studies, 330 women), sensitivity was 0.36 (95% CI 0.26 to 0.45) and specificity was 0.87 (95% CI 0.75 to 0.99).Studies assessed CA-125 at different thresholds, demonstrating the following mean sensitivities and specificities: for cut-off > 10.0 to 14.7 U/ml: 0.70 (95% CI 0.63 to 0.77) and 0.64 (95% CI 0.47 to 0.82); for cut-off > 16.0 to 17.6 U/ml: 0.56 (95% CI 0.24, 0.88) and 0.91 (95% CI 0.75, 1.00); for cut-off > 20.0 U/ml: 0.67 (95% CI 0.50 to 0.85) and 0.69 (95% CI 0.58 to 0.80); for cut-off > 25.0 to 26.0 U/ml: 0.73 (95% CI 0.67 to 0.79) and 0.70 (95% CI 0.63 to 0.77); for cut-off > 30.0 to 33.0 U/ml: 0.62 (95% CI 0.45 to 0.79) and 0.76 (95% CI 0.53 to 1.00); and for cut-off > 35.0 to 36.0 U/ml: 0.40 (95% CI 0.32 to 0.49) and 0.91 (95% CI 0.88 to 0.94).We could not statistically evaluate other biomarkers meaningfully, including biomarkers that were assessed for their ability to differentiate endometrioma from other benign ovarian cysts.Eighty-two studies evaluated 97 biomarkers that did not differentiate women with endometriosis from disease-free controls. Of these, 22 biomarkers demonstrated conflicting results, with some studies showing differential expression and others no evidence of a difference between the endometriosis and control groups.
AUTHORS' CONCLUSIONS
Of the biomarkers that were subjected to meta-analysis, none consistently met the criteria for a replacement or triage diagnostic test. A subset of blood biomarkers could prove useful either for detecting pelvic endometriosis or for differentiating ovarian endometrioma from other benign ovarian masses, but there was insufficient evidence to draw meaningful conclusions. Overall, none of the biomarkers displayed enough accuracy to be used clinically outside a research setting. We also identified blood biomarkers that demonstrated no diagnostic value in endometriosis and recommend focusing research resources on evaluating other more clinically useful biomarkers.
Topics: Adult; Autoantibodies; Biomarkers; CA-125 Antigen; CA-19-9 Antigen; Endometriosis; Endometrium; Female; Humans; Interleukin-6; Ovarian Diseases; Pelvis; Peritoneal Diseases; Randomized Controlled Trials as Topic
PubMed: 27132058
DOI: 10.1002/14651858.CD012179 -
Journal of Minimally Invasive Gynecology Jun 2021The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies.
DATA SOURCES
We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020.
METHODS OF STUDY SELECTION
There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709).
TABULATION, INTEGRATION, AND RESULTS
Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively).
CONCLUSION
Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
Topics: Adnexal Diseases; Female; Humans; Infant, Newborn; Laparoscopy; Laparotomy; Pregnancy; Retrospective Studies; Treatment Outcome
PubMed: 33515746
DOI: 10.1016/j.jmig.2021.01.020 -
Gland Surgery Feb 2022With the increasing incidence of gynecological ovarian tumors, the differential diagnosis of benign and malignant ovarian tumors is of great significance for subsequent...
BACKGROUND
With the increasing incidence of gynecological ovarian tumors, the differential diagnosis of benign and malignant ovarian tumors is of great significance for subsequent treatment. Currently, ovarian examinations commonly use computed tomography (CT) or magnetic resonance imaging (MRI). This study sought to compare the value of CT and MRI in differentiating between benign and malignant ovarian tumors.
METHODS
The PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and Weipu databases were searched for published articles using the following terms "CT" or "Computed Tomography" or "MRI" or "Magnetic Resonance imaging" and "ovarian cancer" or "ovarian tumor" or "ovarian neoplasm" or "adnexal mass" or "adnexal lesion". The articles were screened and the data were extracted based on the inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and the network meta-analysis was performed by Stata 15.0.
RESULTS
The results showed that the overall sensitivity and specificity of CT were 0.79 [95% confidence intervals (CI): 0.70-0.87] and 0.87 (95% CI: 0.80-0.92), respectively. The overall sensitivity and specificity of MRI were 0.94 (95% CI: 0.91-0.95) and 0.91 (95% CI: 0.90-0.93), respectively. The area under the curve of the CT and MRI summary receiver operating characteristics were 0.9016 and 0.9764, respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CT were 5.26 (95% CI: 2.78-9.93), 0.26 (95% CI: 0.13-0.50), and 22.19 (95% CI: 7.54-65.30), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of MRI were 8.69 (95% CI: 5.06-14.92), 0.07 (95% CI: 0.04-0.13), and 146.19 (95% CI: 68.88-310.24), respectively.
CONCLUSIONS
Compared to CT, MRI has a stronger ability to differentiate between benign and malignant ovarian tumors. It's a promising non-radiological imaging technique and a more favorable choice for patients with ovarian tumors. However, in the future, large-sample, multi-center prospective studies need to be conducted to compare the performance of MRI and CT in distinguishing between benign and malignant ovarian tumors.
PubMed: 35284306
DOI: 10.21037/gs-21-889 -
Ultrasound in Obstetrics & Gynecology :... Mar 2023To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard.
METHODS
This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined.
RESULTS
The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses.
CONCLUSIONS
The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Pregnancy; Humans; Ovarian Torsion; Torsion Abnormality; Adnexal Diseases; Ovarian Diseases; Edema
PubMed: 35751902
DOI: 10.1002/uog.24976 -
Cureus Oct 2021In this study, we aimed to systematicallyreview the current evidence regarding the diagnostic accuracy of ultrasound in assessing adnexal masses in pregnancy. The... (Review)
Review
In this study, we aimed to systematicallyreview the current evidence regarding the diagnostic accuracy of ultrasound in assessing adnexal masses in pregnancy. The Cochrane Register of Controlled Trials, PubMed, and EMBASE databases were searched for all types of clinical studies that utilised ultrasound for the diagnosis of adnexal masses in pregnancy. Only studies that used outcome measures of either histological diagnosis or significant regression of the adnexal mass on imaging follow-up were included. The quality of each study was assessed for risk of bias. The diagnostic performance of ultrasound in each study type was calculated, along with the pooled diagnostic performance of ultrasound in differentiating benign from malignant masses. The initial search yielded 4,915 articles, of which 2,547 qualified for abstract screening. A total of 83 articles were included in this review, including one prospective cohort study, six retrospective observational studies, seven case series, and 69 case reports. In the included studies, the total number of adnexal masses was 559. The mean patient age was 29.2 years (95% confidence interval [CI]: 28.7-29.7), with a mean gestational age at diagnosis of 13.8 weeks (95% CI: 13.2-14.4). The mean quality assessment score was 75%. The International Ovarian Tumour Analysis Simple Rules were used in two articles, whereas subjective impression was used in the remaining 81 articles. The most frequently diagnosed mass was a simple or physiological cyst (35%). The prevalence of malignancy in the entire sample was 46/559 (8%; 95% CI: 34-61%). The overall pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound in detecting ovarian malignancy were 64% (95% CI: 30-88%), 88% (95% CI: 64-97%), 5.6 (95% CI: 1.2-25.4), and 0.4 (95% CI: 0.15-1), respectively. In conclusion, currently, there is a lack of high-quality prospective studies to guide the management of adnexal masses in pregnancy. Ultrasound appears to have an adequate accuracy in differentiating benign from malignant masses; however, more research is required to assess the role of ultrasound models, rules, and subjective assessment in pregnancy compared to non-pregnant women.
PubMed: 34849310
DOI: 10.7759/cureus.19079 -
Mediators of Inflammation 2022The goal of this systematic review and meta-analysis was to consolidate the available data on the role of the neutrophil to lymphocyte ratio (NLR) in predicting adnexal... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The goal of this systematic review and meta-analysis was to consolidate the available data on the role of the neutrophil to lymphocyte ratio (NLR) in predicting adnexal torsion (AT), to help guide clinical decision-making and outcomes.
METHODS
We used Web of Science, PubMed, and Scopus to conduct a systematic search for relevant publications published before June 26, 2022. We reported standardized mean difference (SMD) with a 95% confidence interval (CI). Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) too for quality assessment.
RESULTS
Overall, 15 articles were included in the analysis. A random-effects model revealed that patients with AT had elevated levels of NLR compared to those with other adnexal masses (SMD = 1.06, 95%CI = 0.67 to 1.45, < 0.001). So, NLR had diagnostic value. In the subgroup analysis according to ethnicity, we found that Caucasian patients with AT had elevated levels of NLR compared to patients who were operated due to adnexal mass and reported as having a benign ovarian cyst, without torsion (SMD = 1.12, 95%CI = 0.71 to 1.54, < 0.001). However, in the case of East Asian patients, there was no difference between cases and controls (SMD = 0.86, 95%CI = -0.21 to 1.94, = 0.11). The pooled sensitivity of NLR was 0.79 (95%CI = 0.72-0.85), and the pooled specificity was 0.84 (95% CI, 0.74-0.91).
CONCLUSION
In conclusion, there has been an interest in the use of NLR as a diagnostic marker for AT.
Topics: Female; Humans; Neutrophils; Ovarian Torsion; Lymphocytes
PubMed: 36387932
DOI: 10.1155/2022/9680591 -
International Journal of Gynaecology... Mar 2017The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The safety of laparoscopic surgery during the second trimester of pregnancy remains a controversial subject.
OBJECTIVES
To compare the safety of laparoscopic surgery and laparotomy for suspected adnexal mass during the second trimester.
SEARCH STRATEGY
Articles published in any language prior to April 31, 2016, were retrieved from PubMed, Scopus, EMBSCO, and the Cochrane Library using keywords including pregnant, adnexal mass, laparoscopy, laparotomy, pregnancy outcomes, and surgical outcomes.
SELECTION CRITERIA
Randomized and non-randomized controlled trials reporting at least one obstetric or surgical outcome were included if they compared laparoscopic surgery and laparotomy for adnexal masses during the second trimester.
DATA COLLECTION AND ANALYSIS
Data were independently extracted by two reviewers. Homogeneous data were pooled using a fixed effects model and heterogeneous data were qualitatively analyzed.
MAIN RESULTS
Four comparative effectiveness studies including a total of 240 patients were identified. Laparoscopic surgery was associated with a reduced risk of post-operative adverse events (relative risk 0.20, 95% confidence interval 0.06-0.72); no difference was recorded in the risk of post-operative spontaneous abortion (P=0.26) or threatened spontaneous abortion (P=0.13).
CONCLUSIONS
Laparoscopic surgery could be preferable to laparotomy for suspected adnexal mass during the second trimester of pregnancy.
Topics: Abortion, Spontaneous; Adnexal Diseases; Female; Humans; Laparoscopy; Laparotomy; Non-Randomized Controlled Trials as Topic; Postoperative Complications; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Randomized Controlled Trials as Topic; Ultrasonography
PubMed: 28099685
DOI: 10.1002/ijgo.12069 -
Journal of Minimally Invasive Gynecology Feb 2022To determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal... (Meta-Analysis)
Meta-Analysis Review
Recurrence Rate and Morbidity after Ultrasound-guided Transvaginal Aspiration of Ultrasound Benign-appearing Adnexal Cystic Masses with and without Sclerotherapy: A Systematic Review and Meta-analysis.
OBJECTIVE
To determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal ultrasound-guided aspiration, with or without sclerotherapy.
DATA SOURCES
Search of studies published in PubMed and Web of Science databases between January 1990 and December 2020.
METHODS OF STUDY SELECTION
A systematic search strategy was done using Medical Subject Heading terms. Only randomized trials and prospective studies published in English language were included.
TABULATION, INTEGRATION, AND RESULTS
A total of 395 articles were screened. After applying inclusion and exclusion criteria, 20 studies were included in this review comprising data from 1386 patients with a mean follow-up of 11.4 months (range 0.5-26.5 months). The overall pooled rate of recurrence of adnexal masses was 27%, (95% confidence interval [CI], 18%-39%). Recurrence rate was significantly higher after only aspiration than after sclerotherapy (53%; 95% CI, 46%-60% vs 14%; 95% CI, 8%-22%; p <.001). However, a high heterogeneity across the studies was found. A total of 10 major complications were recorded in the different publications.
CONCLUSION
In a selected population, aspiration with sclerotherapy had a lower recurrence rate than aspiration without sclerotherapy. However, these results should be interpreted with caution given the heterogeneity of the studies and the paucity of randomized controlled trials. Regarding the adoption of this procedure in routine clinical practice, we believe that aspiration should be considered an experimental procedure as there are few studies addressing long-term recurrence rate, and data comparing this technique with surgical cystectomy are lacking.
Topics: Humans; Morbidity; Prospective Studies; Recurrence; Sclerotherapy; Ultrasonography; Ultrasonography, Interventional
PubMed: 34571216
DOI: 10.1016/j.jmig.2021.09.708 -
Annals of Internal Medicine Dec 2014Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or... (Review)
Review
BACKGROUND
Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations.
PURPOSE
To update the 2005 and 2007 systematic reviews for the U.S. Preventive Services Task Force on screening for gonorrhea and chlamydia in men and women, including pregnant women and adolescents.
DATA SOURCES
MEDLINE (1 January 2004 to 13 June 2014), Cochrane databases (May 2014), ClinicalTrials.gov, and reference lists.
STUDY SELECTION
English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms.
DATA EXTRACTION
Extracted study data were confirmed by a second investigator, and study quality and applicability were dual-rated using prespecified criteria.
DATA SYNTHESIS
Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not significantly reduce the incidence of pelvic inflammatory disease over the following year (relative risk, 0.39 [95% CI, 0.14 to 1.08]); however, 1 previous trial reported a reduction. An observational study evaluating a risk prediction tool to identify persons with chlamydia in high-risk populations had low predictive ability and applicability. In 10 new studies of asymptomatic patients, nucleic acid amplification tests demonstrated sensitivity of 86% or greater and specificity of 97% or greater for diagnosing gonorrhea and chlamydia, regardless of specimen type or test.
LIMITATIONS
There were few relevant studies of screening benefits and harms. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy.
CONCLUSION
Chlamydia screening in young women may reduce the incidence of pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Asymptomatic Diseases; Bacteriological Techniques; Chlamydia Infections; Female; Gonorrhea; Humans; Male; Mass Screening; Nucleic Acid Amplification Techniques; Risk Factors
PubMed: 25244000
DOI: 10.7326/M14-1022