Our researchers

Juan Luis Alcázar Zambrano

Most recent scientific publications (since 2010)

Authors: Coelho Neto, M. A.; Ludwin, A. ; Borrell, A.; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 51  Nº 1  2018  pp. 10 - 20
This Consensus Opinion summarizes the main aspects of several techniques for performing ovarian antral follicle count (AFC), proposes a standardized report and provides recommendations for future research. AFC should be performed using a transvaginal ultrasound (US) probe with frequency >= 7 MHz. For training, we suggest a minimum of 20-40 supervised examinations. The operator should be able to adjust the machine settings in order to achieve the best contrast between follicular fluid and ovarian stroma. AFC may be evaluated using real-time two-dimensional (2D) US, stored 2D-US cine-loops and stored three-dimensional (3D) US datasets. Real-time 2D-US has the advantage of permitting additional maneuvers to determine whether an anechoic structure is a follicle, but may require a longer scanning time, particularly when there is a large number of follicles, resulting in more discomfort to the patient. 2D-US cine-loops have the advantages of reduced scanning time and the possibility for other observers to perform the count. The 3D-US technique requires US machines with 3D capability and the operators to receive additional training for acquisition/analysis, but has the same advantages as cine-loop and also allows application of different imaging techniques, such as volume contrast imaging, inversion mode and semi-automated techniques such as sonography-based automated volume calculation. In this Consensus Opinion, we make certain recommendations based on the available evidence. However, there is no strong evidence that any one method is better than another; the operator should choose the best method for counting ovarian follicles based on availability of resources and on their own preference and skill. More studies evaluating how to improve the reliability of AFC should be encouraged. Copyright (c) 2017 ISUOG. Published by John Wiley & Sons Ltd.
Authors: Ludwin, A. ; Martins, W. P., (Autor de correspondencia); Nastri, C. O.; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 51  Nº 1  2018  pp. 101 - 109
Objectives To assess the level of agreement between experts in distinguishing between septate and normal/arcuate uterus using their subjective judgment when reviewing the coronal view of the uterus from three-dimensional ultrasound. Another aim was to determine the interobserver reliability and diagnostic test accuracy of threemeasurements suggested by recent guidelines, using as reference standard the decision made most often by experts (Congenital Uterine Malformation by Experts (CUME)). Methods Images of the coronal plane of the uterus from 100 women with suspected fundal internal indentation were anonymized and provided to 15 experts (five clinicians, five surgeons and five sonologists). They were instructed to indicate whether they believed the uterus to be normal/arcuate (defined as normal uterine morphology or not clinically relevant degree of distortion caused by internal indentation) or septate (clinically relevant degree of distortion caused by internal indentation). Two other observers independently measured indentation depth, indentation angle and indentation-to-wall-thickness (I: WT) ratio. The agreement between experts was assessed using kappa, the interobserver reliability was assessed using the concordance correlation coefficient (CCC), the diagnostic test accuracy was assessed using the area under the receiver-operating characteristics curve (AUC) and the best cut-off value was assessed using Youden's index, considering as the reference standard the choice made most often by the experts (CUME). Results There was good agreement between all experts (kappa, 0.62). There were 18 septate and 82 normal/arcuate uteri according to CUME; European Society of Human Reproduction and Embryology (ESHRE)-European Society for Gynaecological Endoscopy (ESGE) criteria (I: WT ratio> 50%) defined 80 septate and 20 normal/arcuate uteri, while American Society for Reproductive Medicine (ASRM) criteria defined five septate (depth> 15mm and angle < 90 degrees), 82 normal/arcuate (depth< 10mm and angle > 90 degrees) and 13 uteri that could not be classified (referred to as the gray-zone). The agreement between ESHRE-ESGE and ASRM criteria and CUME for septate was 87% (kappa, 0.39), and considering both septate and gray-zone as septate, the agreement was 98% (kappa, 0.93). Among the three measurements, the interobserver reproducibility of indentation depth (CCC, 0.99; 95% CI, 0.98-0.99) was better than both indentation angle (CCC, 0.96; 95% CI, 0.94-0.97) and I: WT ratio (CCC, 0.92; 95% CI, 0.90-0.94). The diagnostic test accuracy of these three measurements using CUME as reference standard was very good, with AUC between 0.96 and 1.00. The best cut-off values for these measurements to define septate uterus were: indentation depth >= 10 mm, indentation angle < 140 degrees and I: WT ratio > 110%. Conclusions The suggested ESHRE-ESGE cut-off value overestimates the prevalence of septate uterus while that of ASRM underestimates this prevalence, leaving in the gray-zone most of the uteri that experts considered as septate. We recommend considering indentation depth >= 10mmas septate, since the measurement is simple and reliable and this criterion is in agreement with expert opinion. Copyright (C) 2017 ISUOG. Published by John Wiley & Sons Ltd.
Authors: Pascual, M. A. , (Autor de correspondencia); Graupera, B. ; Pedrero, C.; et al.
Journal: OBSTETRICS AND GYNECOLOGY
ISSN 0029-7844  Vol. 130  Nº 6  2017  pp. 1244 - 1250
OBJECTIVE: To assess the natural history of ultrasonographically diagnosed benign ovarian teratomas in asymptomatic women. METHODS: We conducted a retrospective observational cohort study of 408 women (mean age 36.6 years, range 14-81 years) diagnosed as having an ovarian teratoma by transvaginal ultrasonography (except eight who only had a transabdominal study done) between January 2003 and December 2013 at a single tertiary care institution. Six hundred thirteen women were diagnosed with ovarian teratoma of whom 205 were promptly treated surgically, leaving 408 patients followed conservatively with follow-up scans at 3 and 6 months from diagnosis and then yearly. The ultrasonographic diagnosis of a benign ovarian teratoma required at least one of the following features: a cystic mass with mixed echogenicity, thick band-like echoes, a fat-fluid level, or echogenic tubercle with posterior shadowing. Clinical, ultrasonographic, and histologic data (in case of surgery) were retrieved for analysis. RESULTS: During follow-up, 130 of 408 (31.8%) women underwent surgery. The main reason for surgery was the physician's recommendation according to our protocol (n=115). One patient had adnexal torsion. Most surgeries (112/130 [86.2%]) were performed within the first 5 years after diagnosis. The remainder (278/408) is still being followed (median time 45.6 months, range 6-147 months). The vast majority of these lesions had no change and women remain asymptomatic. Histologic diagnosis of tumors removed surgically revealed a benign ovarian teratoma in 103 of 130 (79.2%) of the women. There were two borderline tumors, four endometriomas, three fibromas, seven serous cysts, two mucinous cysts, two stroma ovarii, seven other benign, and no case of malignant tumor. CONCLUSION: Our results demonstrate that expectant management might be a reasonable option for managing asymptomatic women who receive a ultrasonographic diagnosis of a benign ovarian teratoma. The risk of undergoing surgery for this lesion decreases significantly after 5 years to follow-up. With careful observation, the risk of missing a diagnosis of malignancy is low.
Authors: Alcázar, Juan Luis, (Autor de correspondencia); Pascual, M. A.; Ajossa, S.; et al.
Journal: JOURNAL OF ULTRASOUND IN MEDICINE
ISSN 0278-4297  Vol. 36  Nº 7  2017  pp. 1347 - 1354
ObjectivesTo estimate intraobserver and interobserver reproducibility for assigning an International Endometrial Tumor Analysis (IETA) group color score for endometrial vascularization on color Doppler imaging. MethodsSixty-eight endometrial 3-dimensional volumes from endometrial color Doppler assessments of women with different endometrial disorders were evaluated by 8 different examiners (4 skilled examiners and 4 obstetric and gynecologic trainees). One skilled examiner who did not participate in the assessments selected the 68 volumes from a database to select a balanced number of each IETA score. Each examiner evaluated the 68 endometrial volumes to assign the IETA color score (1, absence of vascularization; 2, low vascularization; 3, moderate vascularization; or 4, abundant vascularization) using tomographic ultrasound imaging. The analysis was repeated 4 weeks later, and interobserver and intraobserver reproducibility was analyzed by calculating the weighted index. The second of the measurements made by each observer was used to estimate interobserver reproducibility. ResultsThe intraobserver reproducibility was very good for all examiners, with a weighted index ranging from 0.84 to 0.91. The interobserver reproducibility was good or very good for all estimated comparisons, with a weighted index ranging from 0.77 to 0.96, regardless of experience level. ConclusionsThe reproducibility of assigning the IETA color score for assessing endometrial vascularization using 3-dimensional volumes is good or very good regardless of the experience of the examiner.
Authors: Pascual, A.; Guerriero, S.; Rams, N.; et al.
Journal: EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY
ISSN 0392-2936  Vol. 38  Nº 3  2017  pp. 382 - 386
Objective: To compare clinical and sonographic features of benign, borderline, and malignant invasive mucinous ovarian tumors (MOTs). Materials and Methods: Retrospective observational multicenter study comprising 365 women (mean age: 46.1 years) with a histologically confirmed benign, borderline or malignant invasive MOT. Clinical data (patient's age, patient's complaints), tumor markers (CA-125 and CA-19.9), and sonographic data (tumor size, bilaterality, morphology unilocular, multilocular, unilocular-solid, multilocular-solid and solid-, and IOTA color score) were reviewed and compared among these three groups. Women with ultrasound evidence on intra-abdominal disease spread were excluded. Results: Three hundred seventy-eight MOTs (14 women had bilateral lesions) were analyzed. Histologically, 287 tumors were benign, 51 were borderline, and 40 were malignant. No difference in patient's mean age was observed. Women with borderline or invasive tumors were less frequently asymptomatic. Tumors were larger in case of invasive lesions. Borderline and invasive tumors showed solid components and exhibited IOTA color score 3 or 4, more frequently than benign lesions (p < 0.001). However, the authors discovered that 16 out of 51 (31.4%) of borderline tumors and six out of 40 (15.0%) of invasive cancers had no solid components and a color score 1 or 2, and were considered as a benign lesion by the sonologist. On the other hand, 96 out of 287 (33.4%) benign mucinous cystadenoma exhibited solid components and/or a color score of 3 or 4. Conclusions: In spite of statistical differences, the authors observed significant overlapping in ultrasound features among benign, borderline, and invasive ovarian mucinous tumors that renders a difficult accurate preoperative discrimination among these lesions.
Authors: Alcázar, Juan Luis; Pascual, M. A. ; Marquez, R.; et al.
Journal: MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY
ISSN 1072-3714  Vol. 24  Nº 6  2017  pp. 613 - 616
Objective: To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women. Methods: Retrospective observational cohort study comprising 99 women (mean age, 58.2 years, ranging from 50 to 77 years) diagnosed as having a purely solid ovarian lesion at transvaginal ultrasound between April 2001 and October 2015. Inclusion criteria were as follows: asymptomatic postmenopausal women with a well-defined purely solid ovarian lesion with International Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and histologic data (in case of surgery) were retrieved for analysis. Patients who were managed conservatively were assessed by transvaginal sonography every 6 months for a minimum of a year. In case of bilateral lesions we used the largest one for analysis. Results: Five women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9cm (range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic shadowing was present in 59.6% of cases. International Ovarian Tumor Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases, respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL). Forty-two women underwent surgery after diagnosis (histologic diagnoses were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid (n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1), primary invasive cancer (n = 2). One case of invasive cancer CA-125 was 403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were stage 1. Fifty-seven women were managed with serial follow-up. With a median follow-up time of 36 months (range, 12-142 months) all these lesions had no change and women remain asymptomatic. Considering all 99 cases the risk of malignancy is 2% (95% CI, 0.1-7.5). Conclusions: The risk of malignancy of benign appearing purely solid adnexal masses in asymptomatic postmenopausal women is low. Conservative management of these lesions might be an option.
Authors: Ros, C.; Barnes, D.; Fervienza, A. ; et al.
Journal: BRITISH JOURNAL OF RADIOLOGY
ISSN 0007-1285  Vol. 90  Nº 1074  2017  pp. Article number 20160913
Objective: To evaluate the utility of transvaginal ultrasound-guided thrombin injection (UGTI) to treat uterine artery pseudoaneurysms (UAPs) as an alternative to emergency arterial embolization. Methods: Two females presenting with heavy vaginal bleeding were diagnosed with UAPs by pelvic CT scan. After UAP identification by transvaginal ultrasound, 2 cm3 of thrombin (Tissucol®; Baxter Healthcare Corporation, Munich, Germany) was slowly injected into the UAPs using a 30-cm long 22-gauge needle through a needle guide attached to the vaginal probe. The same procedure was performed in both cases, and the Doppler sign disappeared immediately and the bleeding stopped. Results: We describe two cases of UAPs treated with transvaginal UGTI: one after intrauterine tandem and vaginal colpostat insertion for brachytherapy after diagnosis of cervical cancer (Case 1) and the other after the insertion of a levonorgestrel-releasing intrauterine device (Case 2). Conclusion: Transvaginal UGTI could be a minimally invasive tool to treat selected cases of UAPs with severe vaginal bleeding. Advances in knowledge: Transvaginal UGTI could avoid the need for uterine embolization and emergency hysterectomy in selected cases of UAPs diagnosed by CT scan.
Authors: Pascual, M. A.; Alcázar, Juan Luis; Graupera, B.; et al.
Journal: JOURNAL OF REPRODUCTIVE MEDICINE
ISSN 0024-7758  Vol. 62  Nº 2  2017  pp. 133 - 137
OBJECTIVE: To compare the uterine transverse diameter (UTD) in women with normal uteri and women with uterine canalization defects as well as to assess its performance for ruling out such defects. STUDY DESIGN: Retrospective analysis of prospectively collected data in a series of selected women with primary or secondary infertility. Measurement of UTD and 3D volume acquisition subsequent off-line analysis was performed in order to identify possible canalization defects. UTD of the normal uterus, measured by 2D ultrasound, was compared to that of arcuate, subseptate, and septate uteri. ROC curve was plotted to determine the best UTD cutoff for differentiating normal from abnormal uteri. RESULTS: A total of 421 women were ultimately evaluated. UTD was significantly larger in women with (53.3 mm, SD 6.3, p <0.05), subseptate (55.0 mm, SD 6.7, p <0.05), and septate (56.0 mm, SD 4.8, <0.05) uterus as compared with the normal uterus (45.9 mm, SD 7.1). ROC curve showed that the best UTD cutoff for ruling out the presence of a uterine canalization defect was 45 mm (AUC 0.809, 95% CI 0;768-0.849). CONCLUSION: Measurement of UTD may be a simple and practical method for ruling out a uterine canalization defect in infertile women.
Authors: Alcázar, Juan Luis; Martinez-Astorquiza Corral T; Orozco R; et al.
Journal: GYNECOLOGIC AND OBSTETRIC INVESTIGATION
ISSN 0378-7346  Vol. 81  Nº 4  2016  pp. 289-95
A total number of 88 papers were identified. After exclusions, nine studies were ultimately included. Pooled estimated sensitivity was 98% (95% CI 91-100) with a moderate heterogeneity (I2: 64.8%, 95% CI 39.6-89.9; and Cochran Q 22.7, p < 0.001). Pooled estimated specificity was 90% (95% CI 83-95) with significant heterogeneity (I2: 80.3%, 95% CI 68.1-92.5; and Cochran Q 40.6, p < 0.001). Positive likelihood ratio was 10.3 (95% CI 5.6-18.7) and negative likelihood ratio was 0.02 (95% CI 0.00-0.21). CONCLUSION: 3D-HyCoSy is an accurate test for diagnosing tubal occlusion in women with infertility.
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; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 47  Nº 3  2015  pp. 369-73
Objective To compare diagnostic performance of TVS and intraoperative macroscopic examination for determining myometrial infiltration in low risk endometrial cancer and to estimate the agreement between both methods. Methods One single center observational study comprising women with preoperative diagnosis of well or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative transvaginal ultrasound (TVS) by a single examiner. According to subjective examiner's impression myometrial infiltration was stated as¿¿¿or¿<¿50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was done by pathologists unaware of ultrasound findings and myometrial infiltration was stated as¿¿¿or¿<¿50%. Definitive histological diagnosis of myometrial infiltration was done by frozen section analysis and used as gold standard. Sensitivity and specificity with 95% confidence intervals for TVS and intraoperative macroscopic inspection were calculated and compared using McNemar test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's Kappa index (¿) and percentage of agreement. Results 152 out of 209 eligible women were ultimately included. Patients¿ mean age was 60.9¿years old (SD: 10.2, range: 32 to 91 years). Definitive histological diagnosis revealed that myometrial infiltration was¿<¿50% in 114 women and¿¿¿50% in 38 women, respectively. Sensitivity and specificity for TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively. Whereas these figures for intraoperative macroscopic examination were and 78.9% and 90.4%, respectively (McNemar test p¿>¿0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between both methods was moderate (¿¿=¿0.54, 95%CI: 0.39 to 0.69. Percentage of agreement 82%) Conclusions Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration is only moderate; both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might be reasonably proposed as a method for assessing myometrial infiltration instead of intraoperative macroscopic examination, at least when performed by an experienced examiner and image quality is not poor. Future research is needed to confirm this proposal.
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: Ruiz-Zambrana, A; et al.
Journal: ANALES DEL SISTEMA SANITARIO DE NAVARRA
ISSN 1137-6627  Vol. 38  Nº 3  2015  pp. 387-396
Fundamento. La validación externa de un modelo predictivo de predicción de preeclampsia tardía en un centro de bajo volumen obstétrico en gestantes de bajo riesgo obstétrico. Métodos. Estudio prospectivo de 174 gestaciones únicas de 11+0 a 13+6 semanas de gestación en la Clínica Universidad de Navarra desde septiembre 2011 a marzo de 2013, que fue considerado como una cohorte de validación de un modelo descrito anteriormente para preeclampsia tardía en el hospital Clínic de Barcelona). Resultados: Un total de 7 (4%) mujeres desarrollaron PE tardía. En la cohorte de validación el área bajo la curva del modelo fue de 0,69 (IC del 95% 0,45 a 0,93). Las tasas de detección para un 5, 10 y 15% de tasas de falsos positivos fueron 21,9, 31,4 y 38,6%. Al comparar las áreas bajo la curva de la cohorte de validación con la cohorte de la construcción, no se encontraron diferencias estadísticamente significativas (p = 0,68). Conclusión. La combinación de la historia clínica materna, la proteína placentaria A-asociada al embarazo y presión arterial media es moderadamente útil para predecir preeclampsia tardía en gestantes de bajo riesgo y en un centro de bajo volumen obstétrico. El modelo predictivo del hospital Clinic de Barcelona es una herramienta válida para predecir preeclampsia tardía en este entorno.
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: Díez, María de las Nieves; Guillén, S.; Rodríguez, María Cristina; et al.
Journal: SIMULATION IN HEALTHCARE
ISSN 1559-2332  Vol. 10  Nº 5  2015  pp. 277 - 282
Introduction: Simulation enables medical students to practice clinical skills in a safe environment. Graduates in medicine must be able to correctly perform an examination on a pregnant woman using Leopold maneuvers. Learning curves-cumulative summation (LC-CUSUM) may help determine when the student has achieved a specific skill. Our objective was to perform the LC-CUSUM test regarding the ability of students to correctly carry out Leopold maneuvers; a pregnancy simulator was used, transferring the results to a clinical setting. Methods: Five medical students were trained to carry out Leopold maneuvers using the simulator. Each student performed maneuvers for 50 cases of different fetus positions; a LC-CUSUM was plotted for each student. Afterward, the students performed the Leopold maneuvers on 5 pregnant women. Results: Of the 5 students, 3 achieved a level of proficiency; the attempts needed for reaching this level were 13, 13, and 37, respectively. The other 2 students did not reach proficiency level. Of the students who became successfully proficient with the simulator, one of them attained a 100% success rate in pregnant patients, whereas the other two had success rates of 80%. The students who did not achieve a level of competency with the simulator had only a 60% success rate with patients. Conclusions: Because of the differences observed between students in the number of attempts needed for achieving proficiency in Leopold maneuvers, we believe that each student should build his/her own learning curve. Achieving competency in carrying out Leopold maneuvers using the simulator could be transferable to patients. Copyright © 2015 by the Society for Simulation in Healthcare.
Authors: Reynoso, C.; Crespo-Eguílaz, Nerea; Alcázar, Juan Luis; et al.
Journal: ANALES DE PEDIATRIA
ISSN 1695-4033  Vol. 82  Nº 3  2015  pp. 183-191
Authors: Prieto, Elena; Marti-Climent, JM; Marisol Gómez Fernández; et al.
Journal: INTERNATIONAL JOURNAL OF OPHTHALMOLOGY
ISSN 2222-3959  Vol. 33  Nº 2  2014  pp. 79 - 86
Objetivo Diseñar una técnica novedosa de adquisición ex-vivo para establecer un marco común de validación de diferentes técnicas de segmentación para imágenes PET oncológicas. Evaluar sobre estas imágenes el funcionamiento de varios algoritmos de segmentación automática. Material y métodos En 15 pacientes oncológicos se realizaron estudios PET ex-vivo de las piezas quirúrgicas extraídas durante la cirugía, previa inyección de 18F-FDG, adquiriéndose imágenes en 2 tomógrafos: un PET/CT clínico y un tomógrafo PET de alta resolución. Se determinó el volumen tumoral real en cada paciente, generándose una imagen de referencia para la segmentación de cada tumor. Las imágenes se segmentaron con 12 algoritmos automáticos y con un método estándar para PET (umbral relativo del 42%) y se evaluaron los resultados mediante parámetros cuantitativos. Resultados La segmentación de imágenes PET de piezas quirúrgicas ha demostrado que para imágenes PET de alta resolución 8 de las 12 técnicas de segmentación evaluadas superan al método estándar del 42%. Sin embargo, ninguno de los algoritmos superó al método estándar en las imágenes procedentes del PET/CT clínico. Debido al gran interés de este conjunto de imágenes PET, todos los estudios se han publicado a través de Internet con el fin de servir de marco común de validación y comparación de diferentes técnicas de segmentación. Conclusiones Se ha propuesto una técnica novedosa para validar técnicas de segmentación para imágenes PET oncológicas, adquiriéndose estudios ex-vivo de piezas quirúrgicas. Se ha demostrado la utilidad de este conjunto de imágenes PET mediante la evaluación de varios algoritmos automáticos.
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; 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: Jurado, Matías; Alcázar, Juan Luis; Baixauli, J; et al.
Journal: International Journal of Gynecolgical Cancer
ISSN 1048-891X  Vol. 21  Nº 2  2011  pp. 397 - 402
Authors: Alcázar, Juan Luis; Guerriero, Stefano; Pascual, M.A.; et al.
Journal: J CLIN ULTRASOUND
ISSN 0091-2751  Vol. 40  Nº 6  2011  pp. 323 - 329
Authors: Alcázar, Juan Luis; Guerriero, S.; et al.
Journal: JOURNAL OF ULTRASOUND IN MEDICINE
ISSN 0278-4297  Vol. 30  Nº 10  2011  pp. 1381 - 1386
Cancer antigen 125 screening does not add useful information for specific diagnosis of benign adnexal tumors, except for endometrioma. An elevated CA-125 level significantly increases the probability of such a lesion..
Authors: Alcázar, Juan Luis; Guerriero, S.; et al.
Journal: Maturitas
ISSN 0378-5122  Vol. 68  Nº 2  2011  pp. 182 - 188
Authors: Amor, F.; Alcázar, Juan Luis; Vaccaro, H.; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 38  Nº 4  2011  pp. 450 - 455
To assess the clinical usefulness of a structured reporting system based on ultrasound findings for management of adnexal masses. Methods This was a prospective multicenter study comprising 432 adnexalmasses in 372 women (mean age, 44.0 (range, 13¿78) yea
Authors: Setién, Nagore; Monedero, Pablo; Alcázar, Juan Luis;
Journal: Revista Espanola de Anestesiologia y Reanimacion
ISSN 0034-9356  Vol. 58  Nº 2  2011  pp. 132 - 133
Authors: Alcázar, Juan Luis;
Journal: Progresos de Obstetricia y Ginecologia
ISSN 0304-5013  Vol. 54  Nº 9  2011  pp. 476 - 477
Authors: García, Manuel; Alcázar, Juan Luis;
Journal: Fertility and Sterility
ISSN 0015-0282  Vol. 94  Nº 2  2010  pp. 450 - 452
Objective: To determine whether interleukin-8 (IL-8) serum levels are correlated with pelvic pain in patients with ovarian endometriomas. Design: Prospective study. Setting: Tertiary-care university hospital. Patient(s): Interleukin-8 serum levels were prospectively analyzed in 51 patients (group A, asymptomatic patients or patients with mild dysmenorrhea; group B, severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists between IL-8 serum levels and pelvic pain. Intervention(s): Interleukin-8 serum levels determination. Main Outcome Measure(s): Interleukin-8 serum levels and pelvic pain. Result(s): From 56 patients, five cases were ultimateley excluded because the histologic diagnosis was not cystic ovarian endometriosis (2 teratomas and 3 haemorragic cysts). The mean (+/- SD) IL-8 serum levels in group A were 6.41 +/- 12.17 pg/mL and in group B were 6.52 +/- 8.73 pg/mL. Conclusion(s): Pain symptoms in ovarian endometriosis is not correlated with IL-8 serum levels.
Authors: Alcázar, Juan Luis; Jurado, Matías;
Journal: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
ISSN 1048-891X  Vol. 20  Nº 3  2010  pp. 393 - 397
Objective: To evaluate whether tumor vascularity as assessed by 3-dimensional power Doppler angiography (3D-PDA) correlates with some tumor features in cervical cancer. Methods: Clinical, sonographic, and histologic data on 56 women (mean age, 47.8 years; range, 27-81 years) with a diagnosis of carcinoma in the uterine cervix were analyzed. Tumor volume and 3D-PDA indexes (vascularization index, flow index, and vascularization flow index) were calculated in all cases. These data were correlated with some tumoral features such as histologic type, histologic grade, lymphovascular space involvement, lymph node metastases, and tumor stage. Results: Intratumoral blood flow was found in all cases. No correlation was found between tumor volume and 3D-PDA indexes with histologic type, lymphovascular space involvement, and lymph node metastases. Moderately and poorly differentiated tumors and advanced-stage tumors had larger volume and 3D-PDA indexes (P < 0.05). Conclusions: Our data indicate that tumor vascularization as assessed by 3D-PDA correlates with some tumor features in cervical cancer.
Authors: Jurado, Matías; Alcázar, Juan Luis; Martínez-Monge, Rafael;
Journal: GYNECOLOGIC ONCOLOGY
ISSN 0090-8258  Vol. 116  Nº 1  2010  pp. 38 - 43
Objective (1) To determine the accuracy of a standard clinical and radiological assessment of resectability in patients with previously irradiated recurrent cervical cancer (PIRCC), and (2) to report the outcome and prognostic factors in this high-risk population treated with an exenterative procedure. Methods Forty-eight patients with centrally located (n=20, 41.7%) or lateralized (n=28, 58.3%) PIRCC treated with exenterative procedures were analyzed. All patients underwent standard assessment of resectability with pelvic exam and radiological studies. Patients with centrally located tumors were considered as resectable and lateralized tumors were deemed unresectable. Results Complete surgical resection with negative margins (R0) was achieved in 28.6% of the patients with lateral recurrences and in 65.0% of the patients with central recurrences (p<0.019). After a median follow-up of 114.6 months (3.0¿244.9 months), the 10-year local control rate for the whole group was 36.3%, 43.1% in the central PIRCC group and 31.5% in the lateral PIRCC group, respectively (p=0.290). Multivariate analysis showed that improved local control was significantly associated with the presence of negative margins (p=0.004). The 10-year distant failure rate was 69%, 56.6% in the central PIRCC group and 83.2% in the lateral PIRCC group (p=0.178), respectively. Multivariate analysis showed that the development of distant metastases was significantly correlated with the absence of local control (p=0.01). The 10-year disease-specific survival (DSS) for central and lateral PIRCC was 27.2% and 14.9%, respectively (p=0.239). Multivariate analysis showed that negative margins (p=0.001), local control (p=0.001) and distant control (p=0.006) were all significantly associated with improved DSS. Location of PIRCC (central vs. lateral) was irrelevant for DSS in completely resected (R0) patients. Overall morbidity rate was 65.0% and 73.3% for central and lateral PIRCC patients, respectively (p=0.528). Conclusion About one-third of the patients with lateral PIRCC classified as unresectable with non-surgical means may ultimately undergo complete (R0) resections and about one-third of the patients with centrally located PIRCC and judged as resectable will undergo non-curative (R1) resections. A curative (R0) resection significantly impacts local control rates, distant metastases-free rates and DSS.
Authors: Guerriero, Stefano; Alcázar, Juan Luis; Ajossa, Silvia; et al.
Journal: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER
ISSN 1048-891X  Vol. 20  Nº 5  2010  pp. 781 - 786
Introduction: The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group. Methods: The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral. Results: Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P - 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status. Conclusions: The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.
Authors: Alcázar, Juan Luis; León, M.; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 35  Nº 2  2010  pp. 228 - 232
To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women.
Authors: Mercé, Luis Tadeo; Jurado, Matías; et al.
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 35  Nº 6  2010  pp. 723 - 729
Objective To assess the correlation between intratumoral vascularization using three-dimensional power Doppler angiography (3D-PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma. Methods Ninety-nine women (mean age, 61.7 (range, 31-84) years) diagnosed as having endometrial cancer were assessed by transvaginal 3D-PDA before surgical staging. Endometrial volume (E V,) and 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL (TM)) method. All patients were surgically staged. Individual tumor features such as histological type, tumor grade, myometrial infiltration depth, lymph-vascular space involvement, cervical involvement, lymph node metastases and tumor stage were considered for analysis. Multivariate logistic regression (MLR) analysis was used to determine which 3D-PDA parameters were independently associated with each histological characteristic. Results MLR analysis showed that only EV and VI were independently associated with myometrial infiltration (EV: odds ratio (OR), 1.119 (95% CI, 1.025-1.221), P = 0.012; VI: OR, 1.127 (95% CI, 1.063-1.195), P = 0.001) and tumor stage (EV: OR, 1.103 (95% CI, 1.012-1.202), P = 0.025; VI: OR, 1.120 (95% CI, 1.057-1.187), P = 0.001), only VI was independently associated with tumor grade (OR, 1.056 (95% CI, 1.023-1.091), P = 0.001) and only EV was independently associated with lymph node metastases (OR, 1.086 (95% CI, 1.017-1.161), P = 0.001). Conclusion 3D-PDA analysis of tumor vascularization in endometrial cancer correlates with some prognostic histological characteristics.
Authors: Kudla, J.M.; Alcázar, Juan Luis;
Journal: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY
ISSN 0960-7692  Vol. 35  Nº 5  2010  pp. 602 - 608
Objective: To assess whether, when using spherical sampling with Virtual Organ Computer-Aided Analysis (VOCAL) for calculating three-dimensional (3D) power Doppler angiography (PDA) indices, the sphere volume affects performance in the prediction of malignancy in vascularized cystic-solid or solid adnexal masses. Methods: One hundred and thirty-eight women (mean +/- SD age, 51.8 +/- 14.1 years) diagnosed as having vascularized cystic-solid or solid adnexal masses on B-mode and two-dimensional (2D) power Doppler ultrasound were evaluated by 3D-PDA prior to surgery. Five women had bilateral masses, giving a total number of 143 masses analyzed. Vascularization was assessed using VOCAL software. 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) from the most vascularized area within papillary projections and solid areas were calculated automatically using spherical sampling. Five different volumes of sphere were used (1 cm(3), 2 cm(3), 3 cm(3), 4 cm(3) and 5 cm(3)) in each case. A definitive histological diagnosis was obtained in each case after surgical tumor removal. Results: One hundred and seventeen (82%) masses were malignant and 26 (18%) were benign. Morphological evaluation revealed 34 (24%) unilocular solid masses, 49 (34%) multilocular solid masses and 60 (42%) mostly solid masses. The 1-cm(3) sphere could be used in 100% of the cases, the 2-cm(3) sphere could be used in 98.2% of the cases and the 3-5-cm(3) spheres could be used in 97.2% of the cases. The median VI, FI and VFI for all sphere volumes were significantly higher in malignant compared with non-malignant tumors. Receiver-operating characteristics curve analysis showed that VI and VFI, independently of sphere volume, were better predictors of malignancy than was FI. The best cut-off values for the 3D-PDA indices differed depending on sphere volume. VI was significantly more specific than were VFI and FI. Conclusions: Sphere volume does not affect the performance of 3D-PDA. We recommend the use of different cut-off values for 3D-PDA indices for discriminating between benign and malignant adnexal masses, depending on the sphere volume used. Use of VI is preferable due to its higher specificity.
Authors: Alcázar, Juan Luis; Kudla, Marek J.;
Journal: JOURNAL OF ULTRASOUND IN MEDICINE
ISSN 0278-4297  Vol. 29  Nº 5  2010  pp. 761 - 766
Objective: The purpose of this study was to determine whether there are differences in 3-dimensional (3D) vascular indices when calculated using high-definition flow imaging (HDF) and power Doppler imaging (PD). Methods: Twenty-five consecutive asymptomatic premenopausal women (mean age, 31 years; range, 28-33 years) without a history of gynecologic disease who attended routine gynecologic checkups were included in the study. All women had regular menstrual cycles, and none had uterine or myometrial disease detected on basal transvaginal sonography. All women underwent 3D transvaginal sonography. In each patient, a first volume using conventional PD was obtained, immediately followed by a second volume using HDF. Volumes were stored and subsequently analyzed for calculating 3D vascular indices (vascularization index [VI], flow index [FI], and vascularization-flow index [VFI]) from the endometrium. Results: The median VI, FI, and VFI were significantly higher when calculated using HDF compared with conventional PD (P < .05). Conclusions: Three-dimensional vascular indices calculated using HDF are higher than those calculated using conventional PD.
Authors: Guerriero, Stefano; Ajossa, Silvia; Garau, N; et al.
Journal: Fertility and Sterility
ISSN 0015-0282  Vol. 94  Nº 2  2010  pp. 742 - 746
Objective: To estimate the diagnostic value of transvaginal ultrasonography in the detection of pelvic adhesions in women suspected of having endometriomas at ultrasonography. Design: Prospective observational study. Setting: Academic Department of Obstetrics and Gynecology. Patient(s): One hundred thirteen women who underwent surgery for an endometrioma. Intervention(s): All patients underwent transvaginal ultrasonography before surgery, and at ultrasonography the presence of fixation of the ovary to the uterus was considered characteristic of the presence of pelvic adhesions. Main Outcome Measure(s): Sensitivity, specificity, and likelihood ratios were calculated with 95% confidence intervals (CIs). Result(s): The sensitivity and specificity of the fixation to the uterus of at least one ovary were respectively 89% (95% CI 84%-92%) and 90% (95% CI 76%-97%). The likelihood ratio for fixation of at least one ovary to the uterus was 8.92 (95% CI 3.04-26) and for a "normal" ultrasound examination 0.12 (95% CI 0.06-0.23). The pretest probability of pelvic adhesions was 74%, and this probability increased to 96% when fixation of at least one ovary to the uterus was present and fell to 27% when this ultrasonographic finding was absent. Conclusion(s): Transvaginal ultrasonography seems to be able to detect or exclude the presence of adhesions in women with ultrasonographic suspicion of endometrioma.
Authors: Alcázar, Juan Luis; Ruiz-Zambrana, A;
Book title:  Obstetricia y ginecología. En la formación de Grado
2016  pp. 47 - 52
Authors: Alcázar, Juan Luis; Jurado, Matías;
Book title:  Textbook of gynaecological oncology
2012  pp.  -
Authors: Alcázar, Juan Luis;
Book title:  Donald School Textbook of Ultrasound in Obstetrics and Gynecology
2011  pp. 803-817
Authors: Alcázar, Juan Luis;
Book title:  Methods of Cancer Diagnosis, Therapy and Prognosis
Vol. 6  Nº 3  2010  pp. 23 - 33
Differentiating benign from malignant adnexal masses represents one of the most challenging problems in gynecological practice. It has been estimated that 5-10% of US women with a suspected adnexal mass will undergo surgery, but only 13-21% of these patie