Our researchers

María Auba Guedea

Most recent scientific publications (since 2010)

Authors: Hidalgo, J. J.; Ros, F.; Aubá, María; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 53  Nº 5  2019  pp. 693 - 700
Objectives To perform an external validation of the diagnostic performance of the three-step strategy proposed by the International Ovarian Tumor Analysis (IOTA) group for classifying adnexal masses as benign or malignant, when ultrasound is performed by non-expert sonographers in the first two steps. The second objective was to assess the diagnostic performance of an alternative strategy using simple-rules risk (SRR), instead of simple rules (SR), in the second step. Methods This was a prospective observational study conducted at two university hospitals, from September 2015 to August 2017, of consecutive patients diagnosed with an adnexal mass. All women were evaluated by ultrasound using the IOTA three-step strategy. Non-expert sonographers performed the first step (use of simple descriptors to classify the masses) and the second step (use of SR if the mass could not be classified in the first step); masses that could not be classified in the first two steps were categorized by an expert sonographer based on their subjective assessment (third step). The reference standard was histological diagnosis in patients who underwent surgery or at least 12 months of follow-up in cases managed expectantly. The sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios and overall accuracy of the IOTA three-step strategy were estimated. Furthermore, we evaluated retrospectively an alternative two-step strategy using SRR in the second step to categorize the masses not classifiable with simple descriptors, classifying the lesions as being of low, intermediate or high risk for malignancy. The diagnostic performance of this strategy was estimated by calculating its sensitivity and specificity, assuming surgical intervention for intermediate-or high-risk lesions. Results The study included 283 patients (median age, 48 (range, 18-90) years), of whom 165 (58.3%) were premenopausal and 118 (41.7%) postmenopausal. Two hundred and sixteen (76.3%) women underwent surgery (154 benign and 62 malignant masses) and 67 (23.7%) were managed expectantly with serial ultrasound follow-up for at least 12 months. All expectantly managed masses were considered benign because no sonographic changes suggestive of malignancy were observed during follow-up. Simple descriptors could be applied in 126 (44.5%) masses. Of the remaining 157 lesions, 112 (39.6%) could be characterized using SR. Therefore, 238 (84.1%) masses could be classified by non-expert sonographers in the first two steps. Of the remaining 45 (15.9%) masses, all could be classified by an expert sonographer. Overall sensitivity, specificity, LR+ and LR- of the IOTA three-step strategy were 95.2%, 97.7%, 42.1 and 0.05, respectively. The diagnostic accuracy was 97.2%. Following the two-step strategy using SRR in the second step, of the 157 lesions not classified with simple descriptors, 42, 38 and 77 presented low, intermediate or high risk for malignancy, respectively. Based on this method, 210 women would have undergone surgical treatment. The sensitivity and specificity of this two-step strategy were 98.4% and 63.8%, respectively. Conclusions The IOTA three-step strategy shows high accuracy for discriminating between benign and malignant adnexal lesions when used by non-expert sonographers. An alternative strategy using the SRR calculator in the second step might improve on this diagnostic performance by decreasing the number of surgical interventions and increasing sensitivity.
Authors: Alcázar, Juan Luis; Pascual, M. A.; Graupera, B.; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 48  Nº 3  2016  pp. 397 - 402
Objective To assess the diagnostic performance of a three-step strategy proposed by the International Ovarian Tumor Analysis (IOTA) Group for discriminating between benign and malignant adnexal masses. Methods This was a prospective observational study, performed at two tertiary-care university hospitals, of women diagnosed with an adnexal mass on transvaginal or transabdominal ultrasound between December 2012 and December 2014. Women were scheduled for an ultrasound evaluation, which was initially performed by non-expert examiners. The examiner had to classify the mass using `simple descriptors¿ (first step) and, if not possible, using `simple rules¿ (second step). For inconclusive masses, an expert examiner classified the mass according to their subjective impression (third step). Masses were managed expectantly, with serial follow-up examinations, or surgically, according to ultrasound findings and clinical symptoms. Histology was used as the reference standard. Masses that were managed expectantly with at least 1 year of follow-up were considered as benign for analytical purposes. Women with less than 1 year of follow-up were not included in the study. Results Six hundred and sixty-six women were included (median age, 41 (range, 18¿81)¿years) of whom 514 were premenopausal and 152 were postmenopausal. Based on the three-step strategy, 362 women had surgical removal of the mass (53 malignant and 309 benign), 71 masses resolved spontaneously and 233 persisted. Four hundred and forty-eight (67.3%) of 666 masses could be classified using simple descriptors and, of the 218 that could not, 147 (67.4%) were classified using simple rules. Of the remaining 71 masses, the expert examiner classified 45 as benign, 12 as malignant and 14 as uncertain. Overall sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the three-step strategy were 94.3%, 94.9%, 18.6 and 0.06, respectively. Conclusion The IOTA three-step strategy, based on the sequential use of simple descriptors, simple rules and expert evaluation, performs well for classifying adnexal masses as benign or malignant.
Authors: Alcázar, Juan Luis; Aubá, María; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 45  Nº 5  2015  pp. 613-17
The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.
Authors: Aubá, María; Alcázar, Juan Luis; Baixauli, J; et al.
Journal: INTERNATIONAL UROGYNECOLOGY JOURNAL
ISSN 0937-3462  Vol. 26  Nº 7  2015  pp. 985-990
Levator avulsion is associated with lower manometric squeeze pressure (p¿=¿0.032).
Authors: Pascual, Eider; Aubá, María; et al.
Journal: ENDOCRINOLOGIA Y NUTRICION
ISSN 1575-0922  Vol. 61  Nº 7  2014  pp.  377-381
The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ¿ 2.5 mU/mL.
Authors: Olartecoechea, Begoña; Aubá, María; et al.
Journal: DONALD SCHOOL JOURNAL OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0973-614X  Vol. 7  Nº 1  2013  pp. 80-85
Authors: Rodríguez, María Cristina; Díez, María de las Nieves; et al.
Journal: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 36  Nº 2  2013  pp. 275-280
To determine the degree of confidence of students regarding obstetric examination before and after training with simulators, and assess their satisfaction with the use of simulation as a tool for acquiring skills. METHODS:Training groups involved 10 students per lecturer. Students learned how to perform Leopold's manoeuvres and measure uterine height with a simulator. The instructor supervised each physical exam. Surveys by those students who had previously done an internship at the Department of Obstetric & Gynecology were not taken into account. RESULTS:Students' confidence in performing the procedures improved significantly (p¿0.001) after the intervention.
Authors: Alcázar, Juan Luis; Iturra, A.; Sedda, F.; et al.
Journal: European Journal of Obstetrics & Gynecology and Reproductive Biology
ISSN 0301-2115  Vol. 161  Nº 1  2012  pp. 92 - 95
Off-line 3D volume analysis may be a useful method for assessing adnexal masses, showing a good agreement with real-time ultrasound and having a similar diagnostic performance.
Authors: Alcázar, Juan Luis; Aubá, María; Olartecoechea, Begoña;
Journal: REPORTS IN MEDICAL IMAGING
ISSN 1179-1586  Vol. 5  2012  pp. 1 - 13
Three-dimensional ultrasound is an imaging technique that is being introduced into clinical practice in several medical specialties. Although this technique is unlikely to replace the two-dimensional ultrasound, its role as a diagnostic tool is being explored. In fact, in the field of gynecology there has been a steady increase in the number of papers published in the last few years. These applications include: imaging the uterus, uterine cavity, adnexa, and pelvic floor as well as reproductive medicine, such as the prediction of IVF success or ovarian hyperstimulation syndrome. The aim of this paper is to review the current status of three-dimensional ultrasound in clinical practice in gynecology.
Authors: Alcázar, Juan Luis; Aubá, María; Ruiz-Zambrana, A; et al.
Journal: EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY
ISSN 1747-4108  Vol. 7  Nº 5  2012  pp. 441-449
Authors: Mínguez, José Ángel; Alcázar, Juan Luis; Aubá, María; et al.
Journal: JOURNAL OF MATERNAL-FETAL AND NEONATAL MEDICINE
ISSN 1476-7058  Vol. 24  Nº 10  2011  pp. 1235 - 1238
The mode of delivery does not affect survival. Cesarean section provides lower morbidity and better prognosis for neurodevelopment long-term outcome in ELBW infants.
Authors: Mínguez, José Ángel; Aubá, María;
Journal: INTUROGYNECOLJPEL
ISSN 0937-3462  Vol. 22  Nº 12  2011  pp. 1597 - 1599
Authors: Aubá, María; Mínguez, José Ángel;
Book title:  La clínica y el laboratorio
2010  pp. 253-258