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BMJ Medicine 2024To conduct a systematic review of studies externally validating the ADNEX (Assessment of Different Neoplasias in the adnexa) model for diagnosis of ovarian cancer and to...
OBJECTIVES
To conduct a systematic review of studies externally validating the ADNEX (Assessment of Different Neoplasias in the adnexa) model for diagnosis of ovarian cancer and to present a meta-analysis of its performance.
DESIGN
Systematic review and meta-analysis of external validation studies.
DATA SOURCES
Medline, Embase, Web of Science, Scopus, and Europe PMC, from 15 October 2014 to 15 May 2023.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
All external validation studies of the performance of ADNEX, with any study design and any study population of patients with an adnexal mass. Two independent reviewers extracted the data. Disagreements were resolved by discussion. Reporting quality of the studies was scored with the TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) reporting guideline, and methodological conduct and risk of bias with PROBAST (Prediction model Risk Of Bias Assessment Tool). Random effects meta-analysis of the area under the receiver operating characteristic curve (AUC), sensitivity and specificity at the 10% risk of malignancy threshold, and net benefit and relative utility at the 10% risk of malignancy threshold were performed.
RESULTS
47 studies (17 007 tumours) were included, with a median study sample size of 261 (range 24-4905). On average, 61% of TRIPOD items were reported. Handling of missing data, justification of sample size, and model calibration were rarely described. 91% of validations were at high risk of bias, mainly because of the unexplained exclusion of incomplete cases, small sample size, or no assessment of calibration. The summary AUC to distinguish benign from malignant tumours in patients who underwent surgery was 0.93 (95% confidence interval 0.92 to 0.94, 95% prediction interval 0.85 to 0.98) for ADNEX with the serum biomarker, cancer antigen 125 (CA125), as a predictor (9202 tumours, 43 centres, 18 countries, and 21 studies) and 0.93 (95% confidence interval 0.91 to 0.94, 95% prediction interval 0.85 to 0.98) for ADNEX without CA125 (6309 tumours, 31 centres, 13 countries, and 12 studies). The estimated probability that the model has use clinically in a new centre was 95% (with CA125) and 91% (without CA125). When restricting analysis to studies with a low risk of bias, summary AUC values were 0.93 (with CA125) and 0.91 (without CA125), and estimated probabilities that the model has use clinically were 89% (with CA125) and 87% (without CA125).
CONCLUSIONS
The results of the meta-analysis indicated that ADNEX performed well in distinguishing between benign and malignant tumours in populations from different countries and settings, regardless of whether the serum biomarker, CA125, was used as a predictor. A key limitation was that calibration was rarely assessed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42022373182.
PubMed: 38375077
DOI: 10.1136/bmjmed-2023-000817 -
Archives of Gynecology and Obstetrics Oct 2023After performing laparoscopic unilateral adnexectomy in a 53-year-old woman for a rapidly grown unilateral adnexal mass, pathologists reported a primary ovarian...
After performing laparoscopic unilateral adnexectomy in a 53-year-old woman for a rapidly grown unilateral adnexal mass, pathologists reported a primary ovarian leiomyoma with no genuine ovarian tissue. This rare diagnosis is found in less than 100 reports after systematic literature review, a greater number of asymptomatic ovarian leiomyomas can be expected. Thorough preoperative diagnostic measures are essential as rare cases of malignancy have been described.
Topics: Female; Humans; Middle Aged; Leiomyoma; Ovarian Neoplasms; Adnexal Diseases; Laparoscopy
PubMed: 36539622
DOI: 10.1007/s00404-022-06842-4 -
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 -
The Cochrane Database of Systematic... Jul 2022Ovarian cancer (OC) has the highest case fatality rate of all gynaecological cancers. Diagnostic delays are caused by non-specific symptoms. Existing systematic reviews... (Review)
Review
BACKGROUND
Ovarian cancer (OC) has the highest case fatality rate of all gynaecological cancers. Diagnostic delays are caused by non-specific symptoms. Existing systematic reviews have not comprehensively covered tests in current practice, not estimated accuracy separately in pre- and postmenopausal women, or used inappropriate meta-analytic methods.
OBJECTIVES
To establish the accuracy of combinations of menopausal status, ultrasound scan (USS) and biomarkers for the diagnosis of ovarian cancer in pre- and postmenopausal women and compare the accuracy of different test combinations.
SEARCH METHODS
We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), five other databases and three trial registries from 1991 to 2015 and MEDLINE (Ovid) and Embase (Ovid) form June 2015 to June 2019. We also searched conference proceedings from the European Society of Gynaecological Oncology, International Gynecologic Cancer Society, American Society of Clinical Oncology and Society of Gynecologic Oncology, ZETOC and Conference Proceedings Citation Index (Web of Knowledge). We searched reference lists of included studies and published systematic reviews.
SELECTION CRITERIA
We included cross-sectional diagnostic test accuracy studies evaluating single tests or comparing two or more tests, randomised trials comparing two or more tests, and studies validating multivariable models for the diagnosis of OC investigating test combinations, compared with a reference standard of histological confirmation or clinical follow-up in women with a pelvic mass (detected clinically or through USS) suspicious for OC.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed quality using QUADAS-2. We used the bivariate hierarchical model to indirectly compare tests at commonly reported thresholds in pre- and postmenopausal women separately. We indirectly compared tests across all thresholds and estimated sensitivity at fixed specificities of 80% and 90% by fitting hierarchical summary receiver operating characteristic (HSROC) models in pre- and postmenopausal women separately.
MAIN RESULTS
We included 59 studies (32,059 women, 9545 cases of OC). Two tests evaluated the accuracy of a combination of menopausal status and USS findings (IOTA Logistic Regression Model 2 (LR2) and the Assessment of Different NEoplasias in the adneXa model (ADNEX)); one test evaluated the accuracy of a combination of menopausal status, USS findings and serum biomarker CA125 (Risk of Malignancy Index (RMI)); and one test evaluated the accuracy of a combination of menopausal status and two serum biomarkers (CA125 and HE4) (Risk of Ovarian Malignancy Algorithm (ROMA)). Most studies were at high or unclear risk of bias in participant, reference standard, and flow and timing domains. All studies were in hospital settings. Prevalence was 16% (RMI, ROMA), 22% (LR2) and 27% (ADNEX) in premenopausal women and 38% (RMI), 45% (ROMA), 52% (LR2) and 55% (ADNEX) in postmenopausal women. The prevalence of OC in the studies was considerably higher than would be expected in symptomatic women presenting in community-based settings, or in women referred from the community to hospital with a suspicion of OC. Studies were at high or unclear applicability because presenting features were not reported, or USS was performed by experienced ultrasonographers for RMI, LR2 and ADNEX. The higher sensitivity and lower specificity observed in postmenopausal compared to premenopausal women across all index tests and at all thresholds may reflect highly selected patient cohorts in the included studies. In premenopausal women, ROMA at a threshold of 13.1 (± 2), LR2 at a threshold to achieve a post-test probability of OC of 10% and ADNEX (post-test probability 10%) demonstrated a higher sensitivity (ROMA: 77.4%, 95% CI 72.7% to 81.5%; LR2: 83.3%, 95% CI 74.7% to 89.5%; ADNEX: 95.5%, 95% CI 91.0% to 97.8%) compared to RMI (57.2%, 95% CI 50.3% to 63.8%). The specificity of ROMA and ADNEX were lower in premenopausal women (ROMA: 84.3%, 95% CI 81.2% to 87.0%; ADNEX: 77.8%, 95% CI 67.4% to 85.5%) compared to RMI 92.5% (95% CI 90.3% to 94.2%). The specificity of LR2 was comparable to RMI (90.4%, 95% CI 84.6% to 94.1%). In postmenopausal women, ROMA at a threshold of 27.7 (± 2), LR2 (post-test probability 10%) and ADNEX (post-test probability 10%) demonstrated a higher sensitivity (ROMA: 90.3%, 95% CI 87.5% to 92.6%; LR2: 94.8%, 95% CI 92.3% to 96.6%; ADNEX: 97.6%, 95% CI 95.6% to 98.7%) compared to RMI (78.4%, 95% CI 74.6% to 81.7%). Specificity of ROMA at a threshold of 27.7 (± 2) (81.5, 95% CI 76.5% to 85.5%) was comparable to RMI (85.4%, 95% CI 82.0% to 88.2%), whereas for LR2 (post-test probability 10%) and ADNEX (post-test probability 10%) specificity was lower (LR2: 60.6%, 95% CI 50.5% to 69.9%; ADNEX: 55.0%, 95% CI 42.8% to 66.6%).
AUTHORS' CONCLUSIONS
In specialist healthcare settings in both premenopausal and postmenopausal women, RMI has poor sensitivity. In premenopausal women, ROMA, LR2 and ADNEX offer better sensitivity (fewer missed cancers), but for ROMA and ADNEX this is off-set by a decrease in specificity and increase in false positives. In postmenopausal women, ROMA demonstrates a higher sensitivity and comparable specificity to RMI. ADNEX has the highest sensitivity in postmenopausal women, but reduced specificity. The prevalence of OC in included studies is representative of a highly selected referred population, rather than a population in whom referral is being considered. The comparative accuracy of tests observed here may not be transferable to non-specialist settings. Ultimately health systems need to balance accuracy and resource implications to identify the most suitable test.
Topics: Biomarkers; Carcinoma, Ovarian Epithelial; Cross-Sectional Studies; Female; Humans; Menopause; Ovarian Neoplasms; Sensitivity and Specificity
PubMed: 35879201
DOI: 10.1002/14651858.CD011964.pub2 -
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 -
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 -
Annals of Surgery Jul 2023To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy.
SUMMARY BACKGROUND DATA
Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking.
METHODS
We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link.
RESULTS
We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%).
CONCLUSIONS
Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Maternal Mortality; Fetus; Abdomen
PubMed: 34966066
DOI: 10.1097/SLA.0000000000005362 -
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 -
The American Journal of Dermatopathology Dec 2021Malignant proliferating trichilemmal tumors of the scalp can exhibit aggressive presentation and recurrences. Our objective was to perform an evidence-based systematic...
OBJECTIVES
Malignant proliferating trichilemmal tumors of the scalp can exhibit aggressive presentation and recurrences. Our objective was to perform an evidence-based systematic review evaluating clinical presentation, tumor characteristics, and treatment modalities used to determine which treatment strategies had the best outcomes.
METHODS
The databases PubMed, Embase, and Cochrane Library were searched for relevant literature by the authors. Patient demographics, imaging, treatments, and other clinical characteristics were obtained. The results were reported using the Preferred Reporting Systems for Systematic Reviews and Meta-Analysis guidelines.
RESULTS
Thirty-nine studies with a total of 65 patients were identified. The most common presentation was a history of slow-growing, painless swollen mass on the scalp. In total, 10 patients (15.4%) presented with spread to the regional lymph nodes and 6 (9.2%) additional patients presented with metastasis to distant locations. In total, 61 patients (93.8%) underwent surgery. Various chemotherapy and radiation therapy regimens were used. Of the 45 cases with documented follow-up, 11 (24.4%) patients had one or multiple instances of local, lymph node or metastatic tumor recurrence.
CONCLUSIONS
Surgery is favored, and the exact approach should be based on clinical judgment. However, Mohs micrographic surgery should strongly be considered because of its superior margin control against such an invasive tumor. Radiotherapy and chemotherapy have been used as adjuvant therapy in aggressive cases or recurrence. Patients should be followed closely and examined often to frequently assess recurrence or metastasis. Randomized controlled trials are needed to further clarify these findings.
Topics: Humans; Neoplasms, Adnexal and Skin Appendage; Scalp; Skin Neoplasms
PubMed: 34797787
DOI: 10.1097/DAD.0000000000001991 -
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