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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 -
Radiology Case Reports Sep 2021An adnexal mass is a common gynecological finding. Most adnexal masses are benign neoplasms, especially in premenopausal women. Yet, here we report a premenopausal woman...
An adnexal mass is a common gynecological finding. Most adnexal masses are benign neoplasms, especially in premenopausal women. Yet, here we report a premenopausal woman with an adnexal mass that turned out to be an ovarian metastasis from colon cancer. This case emphasizes the importance of considering an ovarian metastasis in patients with (partially) solid adnexal masses and low serum CA125 levels. In addition, we identified the same mutation in the biopsied liver metastasis and resected right ovarian metastasis. This is in accordance with a previous molecular study of matched tumor pairs/trios of colorectal cancer patients with ovarian metastases, suggesting that mutated is a universal driver of the metastatic disease in women with -mutated colorectal cancer with ovarian metastases. More than half of all colorectal cancer patients with ovarian metastases harbor mutations. Future studies may investigate the efficacy of KRAS inhibitors in the treatment of these patients.
PubMed: 34367398
DOI: 10.1016/j.radcr.2021.06.072 -
Ultrasound in Obstetrics & Gynecology :... Feb 2023Previous work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an...
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.
Topics: Female; Humans; Retrospective Studies; Ovarian Neoplasms; Adnexal Diseases; Ultrasonography; CA-125 Antigen; Sensitivity and Specificity; Diagnosis, Differential
PubMed: 36178788
DOI: 10.1002/uog.26080 -
The Journal of Maternal-fetal &... Dec 2023The aim of the present study was to assess the impact of different maternal Body Mass Index (BMI) classes on the risk of postpartum endometritis, wound infection, and... (Observational Study)
Observational Study
OBJECTIVE
The aim of the present study was to assess the impact of different maternal Body Mass Index (BMI) classes on the risk of postpartum endometritis, wound infection, and breast abscess after different modes of delivery. Secondly to estimate how the risk of postpartum infection varies with different maternal BMI groups after induction of labor and after obstetric anal sphincter injuries.
METHODS
A population-based observational study including women who gave birth during eight years ( = 841,780). Data were collected from three Swedish Medical Health Registers, the Swedish Medical Birth Register, the Swedish National Patient Register, and the Swedish Prescribed Drug Register. Outcomes were defined by ICD-10 codes given within eight weeks postpartum. The reference population was uninfected women. Odds ratios were determined using Mantel-Haenszel technique. Year of delivery, maternal age, parity and smoking in early pregnancy were considered as confounders.
RESULTS
There was a dose-dependent relationship between an increasing maternal BMI and a higher risk for postpartum infections. Women in obesity class II and III had an increased risk for endometritis after normal vaginal delivery aOR 1.45 (95% CI: 1.29-1.63) and for wound infections after cesarean section aOR 3.83 (95% CI: 3.39-4.32). There was no difference in how maternal BMI affected the association between cesarean section and wound infection, regardless of whether it was planned or emergent. Women in obesity class II and III had a lower risk of breast abscess compared with normal-weight women, aOR 0.47 (95% CI: 0.38-0.58). The risk of endometritis after labor induction decreased with increasing maternal BMI. The risk of wound infection among women with an obstetrical sphincter injury decreased with increasing BMI.
CONCLUSION
This study provides new knowledge about the impact of maternal BMI on the risk of postpartum infections after different modes of delivery. There was no difference in how BMI affected the association between cesarean section and wound infections, regardless of whether it was a planned cesarean section or an emergency cesarean section.
Topics: Pregnancy; Female; Humans; Cesarean Section; Obesity, Maternal; Endometritis; Abscess; Parturition; Obesity; Postpartum Period; Wound Infection
PubMed: 37574213
DOI: 10.1080/14767058.2023.2245102 -
Advances in Clinical and Experimental... Apr 2019Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be...
BACKGROUND
Pregnancy with an adnexal mass is one of the most common complications during pregnancy and clinicians are sometimes caught in a dilemma concerning the decision to be made regarding clinical management.
OBJECTIVES
The objective of this study was to outline and discuss the clinical features, management and outcomes of adnexal masses that were encountered during a cesarean section (CS) at a university affiliated hospital in China.
MATERIAL AND METHODS
The medical records of the patients with an adnexal mass observed during a CS were retrospectively collected at Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China, from January 1991 to December 2011.
RESULTS
The incidence of adnexal masses was 16.40 per 1000 CSs. The most common pathologic diagnosis was benign ovarian tumor, the 2nd was ovarian endometrioma and the 3rd was theca lutein cyst. Thirteen cases of ovarian malignancies were diagnosed during a CS. Only 388 cases (29.78%) were detected by an ultrasonography (USG) examination before a CS. Eight cases required emergency CS due to abdominal pain; all other patients were clinically asymptomatic. The reasons for abdominal pain included torsion (n = 5), rupture (n = 2) and ovarian enlargement (n = 1). In 13 cases with ovarian endometrioma, cysts ruptured during a CS without any clinical manifestation. No maternal and fetal complications related to surgery were observed.
CONCLUSIONS
Preconception care and routine prenatal care, including USG examination, may optimize the detection and management of an adnexal mass. The presumptive ovarian endometrioma detected before pregnancy could be the indication for surgery due to the possibility of spontaneous hemoperitoneum. Theca lutein cysts might be huge and exist throughout the whole pregnancy period. Expectant management is reasonable for an adnexal mass that emerged during pregnancy without suspicion of malignancy. Abdominal pain might be a clue for cyst torsion or rupture.
Topics: Adnexa Uteri; Adnexal Diseases; Adult; Cesarean Section; China; Female; Humans; Incidence; Incidental Findings; Ovarian Cysts; Ovarian Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Retrospective Studies
PubMed: 30085429
DOI: 10.17219/acem/77099 -
Sexually Transmitted Diseases Jul 2017Mycoplasma genitalium is a common, predominately asymptomatic, and often undiagnosed sexually transmitted infection that is associated with inflammatory urogenital and... (Review)
Review
Mycoplasma genitalium is a common, predominately asymptomatic, and often undiagnosed sexually transmitted infection that is associated with inflammatory urogenital and reproductive tract disease syndromes of men and women. Without programmatic screening in the United States, and with increasing resistance to antibiotics used in empiric sexually transmitted infection management, undiagnosed M. genitalium infections put many women at risk for cervicitis and pelvic inflammatory disease. Chronic infection may also lead to tubal-factor infertility, adverse pregnancy outcomes in expectant mothers, and is a risk factor for acquisition and transmission of human immunodeficiency virus. This review details the dynamics of M. genitalium infection, and then examines the potentially deleterious role of host immunity in reproductive tract disease pathogenesis and enhanced human immunodeficiency virus acquisition/transmission.
Topics: Anti-Bacterial Agents; Communicable Diseases, Emerging; Evidence-Based Medicine; Female; HIV Infections; Humans; Infertility, Female; Mass Screening; Mycoplasma Infections; Mycoplasma genitalium; Pregnancy; Pregnancy Complications, Infectious; Prevalence; Reproductive Health; Risk Factors; United States
PubMed: 28608793
DOI: 10.1097/OLQ.0000000000000621 -
Obstetrics and Gynecology International 2023Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is...
AIMS
Adnexal torsion commonly affects reproductive age group females. Prompt diagnosis and early management help in the preservation of fertility. However, its diagnosis is challenging. Preoperative diagnosis can be suspected in only 23-66% of the cases and half of the patients operated for adnexal torsion have different diagnosis. This article thus aims to identify the diagnostic value of preoperative neutrophil lymphocyte ratio in adnexal torsion in comparison with other untwisted unruptured ovarian cysts.
METHODS
This was a retrospective study conducted in the duration of five years from 1st January 2016 to 1st January 2020. The data about demographic parameters, hematological parameters, operative approach, operative technique, and histopathological reports were derived from an electronic database and documented on proforma. SPSS was used for statistical analysis. Logistic regression analysis and influence of each factor on preoperative diagnosis of Adnexal torsion was evaluated.
RESULTS
A total of 125 patients were included in the article (adnexal torsion group = 25, untwisted unruptured ovarian cyst group = 100). There was no statistically significant difference in comparison to age, parity, and abortion between both groups. Most patients had undergone laparoscopic surgery which was based on surgeon's skill and preference. Nineteen (78%) patients in the adnexal torsion group underwent oophorectomy while infarcted ovary was seen in only 4 cases. Among the blood parameters, only neutrophil-lymphocyte ratio (NLR) >3 was found to be statistically significant under logistic regression analysis. Most common adnexal pathology to undergo torsion was serous cyst.
CONCLUSION
Preoperative neutrophil-lymphocyte ratio can be a predictive marker for diagnosis of adnexal torsion and can differentiate it from untwisted unruptured ovarian cysts.
PubMed: 36880062
DOI: 10.1155/2023/3585189 -
Frontiers in Medicine 2021Single-port laparoscopy has become a feasible and safe approach for the management of benign adnexal masses during pregnancy. To our knowledge, there are few reports on...
OBJECTIVE
Single-port laparoscopy has become a feasible and safe approach for the management of benign adnexal masses during pregnancy. To our knowledge, there are few reports on the feasibility and safety of single-port laparoscopy for adnexal mass removal during pregnancy. Our study reports the use of single-port laparoscopy in adnexal mass removal during pregnancy in our hospital.
METHODS
We included 10 cases of single-port laparoscopic surgery for adnexal mass removal during pregnancy in the West China Second University Hospital between January 2017 and March 2020. Median values were found using SPSS20. When the -value was <0.05, the median and interquartile range were used. All patients provided informed consent.
RESULTS
The following median values were recorded: surgical time, 112.50 min; blood loss, 25 ml; postoperative hospital stay, 3 days; postoperative pain [visual analog scale (VAS)] at 6 h, 3; and postoperative pain (VAS) at 24 h, 2. Our study reported no postoperative spontaneous abortions. There was one preterm birth.
CONCLUSION
Single-port laparoscopy appears to be safe for both the mother and the fetus.
PubMed: 35242767
DOI: 10.3389/fmed.2021.800180 -
Frontiers in Medicine 2022Ovarian cancer is the most deadly gynecological cancer, so proper assessment of a pelvic mass is necessary in order to determine which are at high risk for malignancy...
Ovarian cancer is the most deadly gynecological cancer, so proper assessment of a pelvic mass is necessary in order to determine which are at high risk for malignancy and should be referred to a gynecologic oncologist. However, in a family medicine setting, evaluation and treatment of these masses can be challenging due to a lack of resources. A number of risk assessment tools are available to family medicine physicians, including imaging techniques, imaging systems, and blood-based biomarker assays each with their respective pros and cons, and varying ability to detect malignancy in pelvic masses. Effective utilization of these assessment tools can inform the care pathway for patients which present with an adnexal mass, such as expectant management for those with a low risk of malignancy, or referral to a gynecologic oncologist for surgery and staging, for those at high risk of malignancy. Triaging patients to the appropriate care pathway improves patient outcomes and satisfaction, and family medicine physicians can play a key role in this decision-making process.
PubMed: 35865172
DOI: 10.3389/fmed.2022.913549 -
Diagnostics (Basel, Switzerland) Jan 2023Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are...
Calcified subserous leiomyoma is a rare benign tumor commonly seen in the postmenopausal age group. Cases with severely calcified degeneration all over the mass are extremely rare. It causes diagnostic confusion with the solid calcified adnexal mass and the large bladder calculi in the pelvis. We hereby present a case of heavily calcified subserous uterine leiomyoma in a 66-year-old postmenopausal woman. An X-ray of the abdomen and pelvis and CT scan showed a pelvic mass with scattered popcorn appearance in the pelvis, representing severely calcified discrete spots all over the mass. Sonographically, different from typical uterine leiomyomas which exhibit recurrent refractory shadowing patterns, our case showed heavy homogeneous acoustic shadow obscuring all structures beneath the mass surface, resulting in a suboptimal ultrasound examination. Accordingly, CT scans, which are usually not a primary tool for the diagnosis of uterine leiomyomas, are helpful to characterize the mass and identify their organ of origin. The case presented here was treated with a hysterectomy with bilateral oophorectomy and was post-operatively confirmed for severely calcified subserous leiomyomas.
PubMed: 36611445
DOI: 10.3390/diagnostics13010154