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Cureus Sep 2021Background One of the limiting factors for early diagnosis of ovarian neoplasms is the lack of standardized terminology for ultrasound. The Ovarian-Adnexal Reporting and...
Background One of the limiting factors for early diagnosis of ovarian neoplasms is the lack of standardized terminology for ultrasound. The Ovarian-Adnexal Reporting and Data System (O-RADS) classification aimed to reduce variability between observers and facilitate communication with attending physicians. Recent studies show that O-RADS has higher sensitivity (96.8%) and specificity (92.8%) compared to other classifications. However, to date, there are no reports on O-RADS correlation with pathology findings. Objectives To determine sensitivity and specificity of ultrasound, as a tool for detecting malignant ovarian neoplasms, using the O-RADS compared to pathology reports. Materials and methods We evaluated 73 transvaginal ultrasound records with adnexal masses and applied the O-RADS system. Then, we compared against definitive histopathology diagnosis. We calculated sensitivity and specificity using SPSS. Results O-RADS sensitivity for detection of ovarian cancer was 52%, with a specificity of 84%, negative predictive value of 79%, and positive predictive value of 60%, with an accuracy of 73%. Conclusions In our study, O-RADS classification yielded a higher specificity than sensitivity for malignant vs. benign findings. Hence, we propose that this classification could be useful for tailoring treatment appropriately. O-RADS 0 to 2 may benefit from conservative treatment while O-RADS 3 to 5 may require surgical treatment.
PubMed: 34650841
DOI: 10.7759/cureus.17646 -
Ultraschall in Der Medizin (Stuttgart,... Dec 2022Ovarian lesions have a wide range of sonomorphological features with numerous different underlying benign and malignant histologies. Based on the studies conducted by...
Ovarian lesions have a wide range of sonomorphological features with numerous different underlying benign and malignant histologies. Based on the studies conducted by the International Ovarian Tumor Analysis (IOTA) group, ovarian masses can currently be reliably characterized by ultrasound. In the following article, we explain how to use the IOTA terms and definitions and we provide insight into how to safely triage patients with an ovarian mass.
Topics: Female; Humans; Ovarian Neoplasms; Ovarian Cysts; Sensitivity and Specificity; Adnexal Diseases; Ultrasonography; Diagnosis, Differential
PubMed: 36220077
DOI: 10.1055/a-1912-5361 -
Diagnostics (Basel, Switzerland) Mar 2023Subjective ultrasound assessment by an expert examiner is meant to be the best option for the differentiation between benign and malignant adnexal masses. Different...
Subjective ultrasound assessment by an expert examiner is meant to be the best option for the differentiation between benign and malignant adnexal masses. Different ultrasound scores can help in the classification, but whether one of them is significantly better than others is still a matter of debate. The main aim of this work is to compare the diagnostic performance of some of these scores in the evaluation of adnexal masses in the same set of patients. This is a retrospective study of a consecutive series of women diagnosed as having a persistent adnexal mass and managed surgically. Ultrasound characteristics were analyzed according to IOTA criteria. Masses were classified according to the subjective impression of the sonographer and other ultrasound scores (IOTA simple rules -SR-, IOTA simple rules risk assessment -SRRA-, O-RADS classification, and ADNEX model -with and without CA125 value-). A total of 122 women were included. Sixty-two women were postmenopausal (50.8%). Eighty-one women had a benign mass (66.4%), and 41 (33.6%) had a malignant tumor. The sensitivity of subjective assessment, IOTA SR, IOTA SRRA, and ADNEX model with or without CA125 and O-RADS was 87.8%, 66.7%, 78.1%, 95.1%, 87.8%, and 90.2%, respectively. The specificity for these approaches was 69.1%, 89.2%, 72.8%, 74.1%, 67.9%, and 60.5%, respectively. All methods with similar AUC (0.81, 0.78, 0.80, 0.88, 0.84, and 0.75, respectively). We concluded that IOTA SR, IOTA SRRA, and ADNEX models with or without CA125 and O-RADS can help in the differentiation of benign and malignant masses, and their performance is similar to the subjective assessment of an experienced sonographer.
PubMed: 37046525
DOI: 10.3390/diagnostics13071307 -
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 -
Health Technology Assessment... Mar 2016The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling... (Review)
Review
BACKGROUND AND OBJECTIVES
The evidence base supporting the National Chlamydia Screening Programme, initiated in 2003, has been questioned repeatedly, with little consensus on modelling assumptions, parameter values or evidence sources to be used in cost-effectiveness analyses. The purpose of this project was to assemble all available evidence on the prevalence and incidence of Chlamydia trachomatis (CT) in the UK and its sequelae, pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI) to review the evidence base in its entirety, assess its consistency and, if possible, arrive at a coherent set of estimates consistent with all the evidence.
METHODS
Evidence was identified using 'high-yield' strategies. Bayesian Multi-Parameter Evidence Synthesis models were constructed for separate subparts of the clinical and population epidemiology of CT. Where possible, different types of data sources were statistically combined to derive coherent estimates. Where evidence was inconsistent, evidence sources were re-interpreted and new estimates derived on a post-hoc basis.
RESULTS
An internally coherent set of estimates was generated, consistent with a multifaceted evidence base, fertility surveys and routine UK statistics on PID and EP. Among the key findings were that the risk of PID (symptomatic or asymptomatic) following an untreated CT infection is 17.1% [95% credible interval (CrI) 6% to 29%] and the risk of salpingitis is 7.3% (95% CrI 2.2% to 14.0%). In women aged 16-24 years, screened at annual intervals, at best, 61% (95% CrI 55% to 67%) of CT-related PID and 22% (95% CrI 7% to 43%) of all PID could be directly prevented. For women aged 16-44 years, the proportions of PID, EP and TFI that are attributable to CT are estimated to be 20% (95% CrI 6% to 38%), 4.9% (95% CrI 1.2% to 12%) and 29% (95% CrI 9% to 56%), respectively. The prevalence of TFI in the UK in women at the end of their reproductive lives is 1.1%: this is consistent with all PID carrying a relatively high risk of reproductive damage, whether diagnosed or not. Every 1000 CT infections in women aged 16-44 years, on average, gives rise to approximately 171 episodes of PID and 73 of salpingitis, 2.0 EPs and 5.1 women with TFI at age 44 years.
CONCLUSIONS AND RESEARCH RECOMMENDATIONS
The study establishes a set of interpretations of the major studies and study designs, under which a coherent set of estimates can be generated. CT is a significant cause of PID and TFI. CT screening is of benefit to the individual, but detection and treatment of incident infection may be more beneficial. Women with lower abdominal pain need better advice on when to seek early medical attention to avoid risk of reproductive damage. The study provides new insights into the reproductive risks of PID and the role of CT. Further research is required on the proportions of PID, EP and TFI attributable to CT to confirm predictions made in this report, and to improve the precision of key estimates. The cost-effectiveness of screening should be re-evaluated using the findings of this report.
FUNDING
The Medical Research Council grant G0801947.
Topics: Adolescent; Adult; Bayes Theorem; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Incidence; Mass Screening; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Prevalence; United Kingdom; Young Adult
PubMed: 27007215
DOI: 10.3310/hta20220 -
Facts, Views & Vision in ObGyn Mar 2018Obesity has an influence on the risk and prognosis of different types of cancers of the female reproductive tract. In the uterus, a common site for neoplasms is the... (Review)
Review
Obesity has an influence on the risk and prognosis of different types of cancers of the female reproductive tract. In the uterus, a common site for neoplasms is the endometrium, the inner lining tissue. Generally, obesity has been documented to be involved in endometrioid carcinoma of the endometrium. Obesity may influence the cancer risk by various mechanisms such as chronic inflammation, dysregulation of sex hormones and abnormal secretion of hormone-like cytokines or adipokines from adipose tissue. One of the important pro-inflammatory adipokines is leptin, which acts via its transmembrane receptors (Ob-R). In normal conditions, leptin functions in the hypothalamic anorexigenic pathway to maintain the energy homeostasis. Conversely, in obesity, leptin participates in the pro-inflammatory processes. Several clinical studies have suggested that leptin and Ob-R play a role in the pathological processes of endometrial cancer. In different endometrial cancer cell lines, laboratory findings also have demonstrated leptin's link to various neoplastic phenomena such as cellular proliferation, angiogenesis, and oestrogenic activity. Furthermore, endometrial cancer risk could be increased in ovarian pathology like polycystic ovary syndrome, which is commonly associated with obesity. It is noteworthy that leptin participates in both physiological and pathological conditions of the ovary. Leptin has shown pro-tumorigenic effects in both in-vitro and in-vivo studies. Generally, reduced serum leptin levels have been observed in ovarian cancer patients. However, overexpression of leptin and Ob-R in ovarian cancer tissue has indicated aggressive disease. Understanding the role of leptin-related intracellular signalling pathways in tumour development could be helpful in early cancer detection.
PubMed: 30510663
DOI: No ID Found -
European Journal of Case Reports in... 2022Ovarian vein thrombosis (OVT) is a relatively rare, but serious disease more commonly seen in puerperal patients. In the postpartum period, there is an unequal incidence...
UNLABELLED
Ovarian vein thrombosis (OVT) is a relatively rare, but serious disease more commonly seen in puerperal patients. In the postpartum period, there is an unequal incidence of OVT in women with vaginal delivery (0.18%) and caesarean section (2.0%). OVT is usually associated with other conditions like pelvic inflammatory disease, malignant tumours, sepsis, enteritis, and recent pelvic or abdominal surgery. The incidence of idiopathic OVT is extremely rare and only a few cases have been reported to date in healthy patients with unknown aetiology. Patients with OVT present with abdominal pain, nausea, vomiting, fever or abdominal mass. Complications of OVT include pulmonary embolism, ovarian infarction, sepsis and death. CT scanning of the abdomen provides reliable evidence for the diagnosis of idiopathic OVT. Thrombus in most patients with idiopathic OVT is located in the right ovarian vein. This may be due to the longer length of the right ovarian vein, right shift of the uterus and relative insufficiency of the right ovarian vein valve. Treatment of OVT includes systemic anticoagulation which will achieve resolution of symptoms and prevent life-threatening complications. Our case report documents a non-puerperal patient who underwent hysterectomy a year before presenting to the ED with complaints of diarrhoea and found to have OVT on a CT scan. Our case brings attention to the fact that OVT can occur outside the puerperium and might present as a rare complication of minimally invasive surgeries for endometrial cancer. Furthermore, we posit that OVT in the non-puerperal patient may be a separate clinical entity.
LEARNING POINTS
Ovarian vein thrombosis (OVT) can occur outside the puerperium and might present as a rare complication of minimally invasive surgeries.OVT should be included in the differential diagnosis of a non-puerperal postoperative woman presenting with vague abdominal symptoms.Duration of anti-coagulation varies from case to case. More research is needed to determine its exact duration.
PubMed: 35774727
DOI: 10.12890/2022_003351 -
International Journal of Surgery Case... Jul 2022Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and...
INTRODUCTION AND IMPORTANCE
Ovarian small cell carcinomas are a rare type of ovarian cancer that is highly aggressive and consists of two distinct types the hypercalcemic type (SCCOHT) and pulmonary type (SCCOPT).
CASE PRESENTATION
A 23 years old girl was admitted to the emergency room with the presentation of acute abdomen. The ultrasound and Magnetic resonance imaging revealed a right adnexal huge mass with adnexal torsion. In laparotomy, she underwent unilateral salpingo-oophorectomy due to ovarian torsion and possible malignancy. The histopathological evaluation was challenging and was finalized by a team of pathologists as hypercalcemic small cell carcinoma. She refused reoperation and unfortunately relapsed during chemotherapy and died 6 months after the initial diagnosis.
CLINICAL DISCUSSION
Conclusion: We do not yet have comprehensive information on small cell ovarian cancer. Cytopathology diagnosis is still challenging and the treatments are not usually effective. Further clinical trials and studies are recommended to find appropriate treatments for these patients.
PubMed: 35797874
DOI: 10.1016/j.ijscr.2022.107337 -
Pakistan Journal of Medical Sciences 2022To investigate the effect of Fu Yan Qing prescription on sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type.
Effect of Fu Yan Qing prescription on pelvic effusion, mass absorption and microenvironment of pelvic blood stasis in patients with sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type.
OBJECTIVE
To investigate the effect of Fu Yan Qing prescription on sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type.
METHODS
Total 80 patients with sequelae of sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type were admitted to Baoding No.1 Central Hospital from December, 2018 to April, 2020 and divided into two groups according to the random number table, with 40 cases in each group. Patients in the control group were treated with conventional western medicine, while patients in the observation group were treated with Fu Yan Qing prescription orally. The clinical efficacy, the changes of traditional Chinese medicine (TCM) syndromes, local sign scores, visual analog scale (VAS) of pain, pelvic mass size, pelvic fluid volume and uterine blood flow parameters of the two groups before and after treatment were observed and compared, and the safety of the two groups was evaluated.
RESULTS
The total efficacy after treatment in the observation group was 87.5%, which was significantly higher than that of 67.5% in the control group (0.05). The TCM syndrome scores, local signs scores, pain scores, size of pelvic mass and pelvic effusion in both groups decreased significantly after treatment (0.05), PSV indexes of the two groups were significantly increased after treatment (0.05), and these changes were even more pronounced in the observation group (0.05). Compared with before treatment, PI and RI indexes of the observation group were significantly decreased after treatment (<0.05). The observation group experienced an adverse reaction in 7.5% cases considerably lower than the 27.5% of the control group (p<0.05).
CONCLUSION
Fu Yan Qing prescription is a safe and reliable treatment for patients with sequelae of pelvic inflammatory disease of accumulation of dampness heat and blood stasis type. It is worth promotion in clinical practice.
PubMed: 35799718
DOI: 10.12669/pjms.38.5.4641 -
The International Journal of Biological... Jul 2015The aim of this study was to estimate the diagnostic accuracy of serum marker CA 19-9 levels in the triage of adnexal masses. (Review)
Review
OBJECTIVE
The aim of this study was to estimate the diagnostic accuracy of serum marker CA 19-9 levels in the triage of adnexal masses.
METHODS
This retrospective cohort study was carried out in patients referred to the Gynecology Department at Carmel Medical Center due to adnexal masses. All patients underwent preoperative measurements of serum CA 125 and CA 19-9 and surgery with histopathologically confirmed diagnosis.
RESULTS
Between January 2005 and December 2012, 503 patients with adnexal masses were evaluated with serum tumor markers. Combination of CA 19-9 with CA 125, compared with CA 125 levels alone, suggested a nonsignificant effect on sensitivity (86.9% vs. 88.9%, respectively, p = 0.54) or specificity (79.5% vs. 73.5%, p = 0.1) in differentiating malignant from benign adnexal masses. CA 19-9 was not helpful in detecting mucinous histological types or borderline tumors. Mean CA 19-9 levels were higher in metastatic cases compared with primary ovarian malignancy (488.7 ± 1,457 vs. 46.3 ± 149.8 U/mL, respectively, p = 0.001). In mature cystic teratomas, mean CA 19-9 levels were higher and CA 125 levels were lower than in ovarian carcinoma (p = 0.049 and p = 0.0012, respectively).
CONCLUSIONS
The combination of the tumor markers CA 19-9 and CA 125 did not contribute significantly to the detection of malignant adnexal masses compared with CA 125 alone. As our results suggest that higher CA 19-9 levels could be helpful in differentiating metastatic tumors from primary ovarian malignancy; this issue should be investigated in large well-designed prospective cohort trials.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antigens, Neoplasm; Biomarkers, Tumor; CA-125 Antigen; CA-19-9 Antigen; Carcinoma; Cohort Studies; Diagnosis, Differential; Female; Granulosa Cell Tumor; Humans; Middle Aged; Neoplasms, Germ Cell and Embryonal; Ovarian Diseases; Ovarian Neoplasms; Postmenopause; Predictive Value of Tests; Premenopause; Retrospective Studies; Risk; Sensitivity and Specificity; Teratoma; Ultrasonography; Young Adult
PubMed: 25704505
DOI: 10.5301/jbm.5000139