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Sisli Etfal Hastanesi Tip Bulteni 2020Discrimination of benign and malignant adnexal masses is crucial for the follow-up and prognosis of the patient. Since each modality alone does not have enough...
OBJECTIVES
Discrimination of benign and malignant adnexal masses is crucial for the follow-up and prognosis of the patient. Since each modality alone does not have enough sensitivity, the combination of all methods called multimodal screening is currently being used. In this study, we aimed to compare pelvic mass score (PMS) and the risk of malignancy index (RMI-3) scoring systems in determining the malignant potential of adnexal masses.
METHODS
In this prospective observational study, 40 patients between the age of 15-79 who were diagnosed as an adnexal mass were included between March and October 2016. Patients were classified as benign (n=20) and malignant (n=20). The age, gravida, parity, findings of a pelvic examination, medical and family history, laboratory parameters, sonographic findings, histopathological results, PMS and RMI-3 scores of the patients were recorded.
RESULTS
The mean age, CA-125 levels, Sassone scores and ultrasonography scores of patients were higher in malignant cases, whereas the resistance index was lower. Both RMI-3 and PMS scores were higher in the malignant group (1728.14±325.3 vs. 36.27±31.01, p<0.001 and 55.31±40.96 vs. 9.91±5.29, p<0.001, respectively). Receiver operating curve for the predictive value of PMS to diagnose malignancy was performed and a cut-off value of 14 was determined with the area under the curve (AUC) 0.955 (p<0.001). The sensitivity was 95%, specificity was 80%, positive and negative predictive values were 82.6% and 94.1%. Likewise, the discriminative value of RMI-3 to diagnose malignancy was evaluated by the ROC curve. AUC for RMI-3 was 0.930 with a sensitivity of 95%, the specificity of 75%, the positive predictive value of 79.1% and negative predictive value of 93.7% with a cut-off value of >53.2 (p<0.001).
CONCLUSION
Age, menopause status, tumor markers and sonographic parameters may be beneficial alone for determining malignancy, whereas the scoring systems integrating all the parameters are more powerful. According to our findings, PMS is more sensitive and more practical than the RMI-3 scoring system.
PubMed: 33364892
DOI: 10.14744/SEMB.2019.67299 -
Frontiers in Medicine 2023Conservative management of adnexal mass is warranted when there is imaging-based and clinical evidence of benign characteristics. Malignancy risk is, however, a concern...
BACKGROUND
Conservative management of adnexal mass is warranted when there is imaging-based and clinical evidence of benign characteristics. Malignancy risk is, however, a concern due to the mortality rate of ovarian cancer. Malignancy occurs in 10-15% of adnexal masses that go to surgery, whereas the rate of malignancy is much lower in masses clinically characterized as benign or indeterminate. Additional diagnostic tests could assist conservative management of these patients. Here we report the clinical validation of OvaWatch, a multivariate index assay, with real-world evidence of performance that supports conservative management of adnexal masses.
METHODS
OvaWatch utilizes a previously characterized neural network-based algorithm combining serum biomarkers and clinical covariates and was used to examine malignancy risk in prospective and retrospective samples of patients with an adnexal mass. Retrospective data sets were assembled from previous studies using patients who had adnexal mass and were scheduled for surgery. The prospective study was a multi-center trial of women with adnexal mass as identified on clinical examination and indeterminate or asymptomatic by imaging. The performance to detect ovarian malignancy was evaluated at a previously validated score threshold.
RESULTS
In retrospective, low prevalence ( = 1,453, 1.5% malignancy rate) data from patients that received an independent physician assessment of benign, OvaWatch has a sensitivity of 81.8% [95% confidence interval (CI) 65.1-92.7] for identifying a histologically confirmed malignancy, and a negative predictive value (NPV) of 99.7%. OvaWatch identified 18/22 malignancies missed by physician assessment. A prospective data set had 501 patients where 106 patients with adnexal mass went for surgery. The prevalence was 2% (10 malignancies). The sensitivity of OvaWatch for malignancy was 40% (95% CI: 16.8-68.7%), and the specificity was 87% (95% CI: 83.7-89.7) when patients were included in the analysis who did not go to surgery and were evaluated as benign. The NPV remained 98.6% (95% CI: 97.0-99.4%). An independent analysis set with a high prevalence (45.8%) the NPV value was 87.8% (95% CI: 95% CI: 75.8-94.3%).
CONCLUSION
OvaWatch demonstrated high NPV across diverse data sets and promises utility as an effective diagnostic test supporting management of suspected benign or indeterminate mass to safely decrease or delay unnecessary surgeries.
PubMed: 36756174
DOI: 10.3389/fmed.2023.1102437 -
Cancers Jun 2022Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. In...
Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. In this retrospective study, we aimed to compare albumin as a single parameter to calculate models by analyzing laboratory parameters of 1552 patients with an adnexal mass (epithelial ovarian cancer (EOC): = 294; borderline tumor of the ovary (BTO): = 66; benign adnexal mass: = 1192) undergoing surgery. Models comprising classical laboratory parameters show better accuracies (AUCs 0.92-0.93; 95% CI 0.90-0.95) compared to the use of single markers, and could easily be implemented in clinical practice by containing only readily available markers. This has been incorporated into a nomogram.
PubMed: 35804981
DOI: 10.3390/cancers14133210 -
Medicine Jan 2021Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal... (Review)
Review
RATIONALE
Torsion is the most common gynecologic emergency of the adnexal mass occurring during pregnancy. We report the clinical data of a case of twin pregnancy with adnexal torsion after in vitro fertilization (IVF) and embryo transfer, in which the patient underwent surgery for adnexal detorsion and experienced preterm delivery. One child died as a neonate, and the other child was diagnosed with hematological disease, which, to our knowledge, has not been reported previously. We also performed a systematic literature review to increase knowledge of the need for prompt surgical intervention.
PATIENT CONCERNS
The patient was a 32-year-old pregnant woman, who presented to our center with acute onset of stabbing and non-radiating continuous lower left abdominal pain after urination, of 6 hours duration.
DIAGNOSIS
Physical examination revealed that the lower abdominal tenderness was worse on the left side, and there were no signs of peritonitis. Transvaginal ultrasonographic examination indicated a multiloculated left ovary measuring 12.1 × 7.1 cm with sparse blood flow. The size of the largest cyst was 7.2 × 6.6 cm, the right ovary appeared normal, and two live fetuses were seen.
INTERVENTIONS
laparoscopy was performed 1.5 hours later, which revealed a cystic and multilocular left ovary with a black purplish surface and thin wall. The left ovary and left fallopian tube had undergone 720° torsion (3 rotations), and detorsion was performed laparoscopy.
OUTCOMES
The left adnexa recovered to near normal appearance 20 minutes postoperatively. The patient was discharged from hospital 5 days postsurgery, without complications. Unfortunately, the patient delivered two preterm babies at 30 weeks of gestation.
CONCLUSIONS
We should be alert to the possible risk of adnexal torsion in pregnant women after IVF. Adnexal torsion necessitates prompt surgical intervention, detorsion and preserving ovarian function are the main treatment methods. Furthermore, the possibility of recurrence, and pregnancy outcomes for the patient, as well as newborn health, should be considered.
Topics: Adult; Female; Fertilization in Vitro; Humans; Ovarian Torsion; Pregnancy; Pregnancy Complications; Pregnancy, Twin; Premature Birth
PubMed: 33545996
DOI: 10.1097/MD.0000000000024009 -
European Journal of Radiology Open 2015To evaluate the CT features of pathologically proven low grade serous carcinoma (LGSC) of the ovary.
OBJECTIVE
To evaluate the CT features of pathologically proven low grade serous carcinoma (LGSC) of the ovary.
METHODS
Patients with a pathologic diagnosis of LGSC and CT prior to oophorectomy were retrospectively identified. The CT scans in 14 patients were available and were analyzed for an adnexal mass, peritoneal mass and ascites. The adnexal mass was characterized as complex primarily cystic, mixed cystic solid, or primarily solid. Calcification in the adnexal and peritoneal masses and nodes was noted.
RESULTS
Pathology revealed 6 patients had LGSC and 8 patients had a combined diagnosis of LGSC and serous borderline tumor (SBT) of the ovary. Of the 6 patients with only LGSC, 4 had primarily solid or mixed solid cystic adnexal masses and 5 had peritoneal masses. Calcification was present in the adnexal and peritoneal masses in 4 patients, and in nodes in 2 patients. Of the 8 patients with co-existing LGSC and SBT, 7 had complex primarily cystic adnexal masses and 6 had peritoneal masses. Calcification was present in the adnexal and peritoneal masses in 5 patients and in nodes in 2 patients.
CONCLUSION
LGSC can appear as a solid, mixed solid cystic, or complex primarily cystic ovarian mass, and the appearance may be due to a co-existing SBT. Calcification of the adnexal and peritoneal masses appears to be common. LGSC is a diagnostic consideration in patients with a calcified adnexal mass and concurrent peritoneal masses or calcified nodes on CT.
PubMed: 26937434
DOI: 10.1016/j.ejro.2015.01.001 -
Journal of Ovarian Research Feb 2018Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these... (Review)
Review
BACKGROUND
Pelvic masses are a common gynecologic problem, and majority of them are diagnosed as ovarian tumors finally. Sometimes, it is hard to distinguish the origin of these pelvic masses. The following case is a solitary neurofibroma arising from the right-side obturator nerve, which was impressed as a right-side ovarian tumor initially. We reported this case, and also performed a PRISMA-driven systematic review to summary the similar cases in the literature. This review includes image, molecular and pathological findings and outcome of neurofibroma.
CASE PRESENTATION
A 33-year-old woman with a regular menstrual period denied any symptoms or signs. During her physical check-up, image examination revealed a right-side heterogeneous pelvic mass; it was suggestive of a complex of right-side ovarian tumor. A provisional diagnosis of retroperitoneal pelvic mass, probably a benign ovarian tumor, was made. Excision of the right-side pelvic mass was performed. We sent the specimens for frozen pathology, which indicated neurofibroma and lipomatous tumor and that the possibility of liposarcoma cannot be excluded. A segment of the obturator nerve was attached to the tumor and was severed. A right-side obturator nerve tear during tumor excision was observed, and a neurosurgeon was consulted for obturator nerve grafting and repair. The patient complained of mild weakness and paresthesia affecting the right leg, and we consulted a rehabilitation doctor for neuron injury. The patient's recovery was uneventful, and she was discharged eight days after the drain was removed. Further rehabilitation treatment was arranged.
CONCLUSION
A neurofibroma is an uncommon pelvic retroperitoneal tumor, and it can be misdiagnosed as an adnexal mass. To our knowledge, this is a rare case of a solitary neurofibroma arising from the obturator nerve. It usually does not have any neurological deficit. We present this case to demonstrate that pelvic neurofibroma can be mistaken for an adnexal mass. This fact should be borne in mind during the diagnosis process.
Topics: Adnexal Diseases; Adult; Biopsy; Diagnosis, Differential; Disease Management; Female; Histocytochemistry; Humans; Neurofibroma; Obturator Nerve; Physical Examination; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Workflow
PubMed: 29426349
DOI: 10.1186/s13048-018-0386-z -
Journal of Dairy Science Dec 2023The objective was to unravel the peripartum immune and metabolic changes associated with metritis in Holstein cows. Holstein cows (n = 128) had blood collected at -14,...
The objective was to unravel the peripartum immune and metabolic changes associated with metritis in Holstein cows. Holstein cows (n = 128) had blood collected at -14, 0, 3, and 7 d relative to parturition (DRP). Flow cytometry was used to evaluate blood leukocyte counts, proportions, and activation. Total cells, live cells, single cells, monocytes (CD172α/CD14), polymorphonuclears (CD172α/CD14/SSC), B-cells (CD21/MHCII), CD4 T-cells (CD4), CD8 T-cells (CD8), and γδ T-cells (γδTCR) were evaluated. Both CD62L and CD11b were used as markers of cell activation. Major histocompatibility complex class II was used as a marker of antigen presentation in monocytes. A Milliplex Bovine Cytokine/Chemokine 08-plex kit was used to evaluate plasma concentrations of IFN-γ, IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor-α. The body weight (BW) change prepartum was calculated as the difference between calving BW and prepartum BW divided by the number of days between measurements. Plasma fatty acids (FA) were measured at -14 and 0 DRP using untargeted gas chromatography with time-of-flight mass spectrometry. Data were analyzed by ANOVA for repeated measures. Cows that developed metritis (n = 57) had greater prepartum BW, prepartum BW loss, and greater FA concentrations at calving. Plasma FA at calving was positively correlated with IL-1β. Cows that developed metritis had persistent systemic inflammation, which was demonstrated by greater B-cell activation, greater pro-inflammatory cytokine concentrations, and greater cell damage pre- and postpartum. Postpartum, we observed greater polymorphonuclear cell activation and extravasation but lesser monocytes and CD4 T-cells activation and extravasation, which suggests postpartum immune tolerance. Greater prepartum adiposity in cows that developed metritis may lead to systemic inflammation pre- and postpartum and immune tolerance postpartum, which may lead to failure to prevent bacterial infection, and development of puerperal metritis.
Topics: Female; Cattle; Animals; CD8-Positive T-Lymphocytes; Gas Chromatography-Mass Spectrometry; Postpartum Period; Cytokines; Inflammation; Pelvic Inflammatory Disease; Cattle Diseases; Lactation
PubMed: 37641354
DOI: 10.3168/jds.2023-23289 -
Journal of Dairy Science May 2023Objectives were to evaluate differences in the uterine and serum metabolomes associated with metritis in dairy cows. Vaginal discharge was evaluated using a Metricheck...
Objectives were to evaluate differences in the uterine and serum metabolomes associated with metritis in dairy cows. Vaginal discharge was evaluated using a Metricheck device (Simcro) at 5, 7, and 11 d in milk (DIM; herd 1) or 4, 6, 8, 10, and 12 DIM (herd 2). Cows with reddish or brownish, watery, and fetid discharge were diagnosed with metritis (n = 24). Cows with metritis were paired with herdmates without metritis (i.e., clear mucous vaginal discharge or clear lochia with ≤50% of pus) based on DIM and parity (n = 24). Day of metritis diagnosis was considered study d 0. All cows diagnosed with metritis received antimicrobial therapy. The metabolome of uterine lavage collected on d 0 and 5, and serum samples collected on d 0 were evaluated using untargeted gas chromatography time-of-flight mass spectrometry. Normalized data were subjected to multivariate canonical analysis of population using the MultBiplotR and MixOmics packages in R Studio. Univariate analyses including t-test, principal component analyses, partial least squares discriminant analyses, and pathway analyses were conducted using Metaboanalyst. The uterine metabolome differed between cows with and without metritis on d 0. Differences in the uterine metabolome associated with metritis on d 0 were related to the metabolism of butanoate, amino acids (i.e., glycine, serine, threonine, alanine, aspartate, and glutamate), glycolysis and gluconeogenesis, and the tricarboxylic acid cycle. No differences in the serum metabolome were observed between cows diagnosed with metritis and counterparts without metritis on d 0. Similarly, no differences in uterine metabolome were observed between cows with metritis and counterparts not diagnosed with metritis on d 5. These results indicate that the establishment of metritis in dairy cows is associated with local disturbances in amino acid, lipid, and carbohydrate metabolism in the uterus. The lack of differences in the uterine metabolome on d 5 indicates that processes implicated with the disease are reestablished by d 5 after diagnosis and treatment.
Topics: Pregnancy; Female; Cattle; Animals; Lactation; Endometritis; Uterus; Pelvic Inflammatory Disease; Vaginal Discharge; Metabolome; Cattle Diseases; Postpartum Period
PubMed: 36894419
DOI: 10.3168/jds.2022-22552 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Aug 2022International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and...
OBJECTIVES
International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and malignant adnexal tumors. This study aims to compare the diagnostic efficiency between the IOTA LR2 model and doctors' subjective assessment on diagnosing benign and malignant adnexal mass.
METHODS
The ultrasonographic images of 616 adnexal masses were retrospectively analyzed by the senior doctors' group and the junior doctors' group using the IOTA LR2 model and subjective assessment. The postoperative pathological diagnosis was used as the gold standard to compare the diagnostic efficiency of the 2 methods.
RESULTS
The area under the curves of subjective assessment and IOTA LR2 model for diagnosing malignant adnexal masses were 0.86 and 0.90 for the senior doctors' group and 0.79 and 0.88 for the junior doctors' group, respectively. The sensitivity and specificity of subjective assessment for diagnosing the malignant adnexal masses were 81.0% and 91.3% for the senior doctors' group and 70.1% and 88.7% for the junior doctors' group, respectively. The sensitivity and specificity of the IOTA LR2 model for diagnosing the malignant adnexal masses were 79.6% and 88.1% for the senior doctors' group, and 79.6% and 81.7% for the junior doctors' group, respectively.There were no significant difference in the sensitivities between the senior doctors' group and junior doctors' group using the IOTA LR2 model and the senior doctors' group using subjective assessment (both >0.05).
CONCLUSIONS
The diagnostic efficiency of the IOTA LR2 model is equal to the senior doctors' experiences. This model can help junior doctors to reduce the missed diagnosis of malignant adnexal masses.
Topics: Adnexal Diseases; Diagnosis, Differential; Female; Humans; Ovarian Neoplasms; Retrospective Studies
PubMed: 36097776
DOI: 10.11817/j.issn.1672-7347.2022.220051 -
Journal of the Turkish German... Dec 2022The occurrence of adnexal masses in patients with a history of non-gynaecological malignancy (NGM) raises concerns for malignancy, either primary or metastasis....
OBJECTIVE
The occurrence of adnexal masses in patients with a history of non-gynaecological malignancy (NGM) raises concerns for malignancy, either primary or metastasis. Subsequent treatment and prognosis depends on the etiology. Our aim was to investigate the characteristics and results of the patients with suspicious adnexal masses, who had a history of NGM.
MATERIAL AND METHODS
The records of 61 patients with a history of NGM were analyzed, who were operated for an adnexal mass. Complex adnexal masses were included in the analysis while simple cysts were excluded.
RESULTS
The most common NGM origins were gastrointestinal (gastric and colorectal) tract and breast. Of all adnexal masses, four were benign (6.5%), 22 were primary ovarian malignancy (36.1%) and 35 were metastasis (57.4%). Two of the 22 primary cases were borderline ovarian tumor. Among the characteristics of primary and metastatic groups, laterality in pathology results and serum CA125 levels were statistically different (p<0.05). Among the patients with history of gastrointestinal cancers, the percentage of ovarian metastasis was 81%. Primary ovarian malignancy was most frequently (64%) observed among the patients with history of breast cancers.
CONCLUSION
For patients with a history of gastrointestinal cancer, recurrence of the cancer in the form of ovarian metastasis was more likely, rather than a second primary cancer. The risk of primary ovarian cancer (POC) was remarkable in those with history of a breast cancer. A multidisciplinary strategy, including a gynaecological oncologist, plays an important role in managing these cases, regardless of whether or not it is a POC.
PubMed: 35266379
DOI: 10.4274/jtgga.galenos.2021.2021-0031