Grupo de Investigación en Fertilidad

Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Carriles Rivero, Isabel María; Cajas, M. B.; et al.

Título: Diagnostic performance of two-dimensional ultrasound, two-dimensional sonohysterography and three-dimensional ultrasound in the diagnosis of septate uterus-a systematic review and meta-analysis

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 4 2023 págs. 807

Resumen

Background: The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. Methods: Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. Results: The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. Conclusion: Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.
Autores: Dominguez, J. A.; Alonso-Pacheco, L. ; Moratalla, E.; et al.

Título: Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.62 N° 3 2023 págs. 336 - 344

Resumen

The purpose of this State-of-the-Art Review was to provide a strategic analysis, in terms of strengths, weaknesses, opportunities and threats (SWOT analysis), of the current evidence regarding the management of uterine isthmocele (Cesarean scar defect). Strengths include the fact that isthmocele can be diagnosed on two-dimensional transvaginal ultrasound, and that surgical repair may restore natural fertility potential and prevent secondary infertility, as well as reduce the risk of miscarriage and other obstetric complications. However, there is a lack of high-quality evidence regarding the best diagnostic method and criteria, as well as the potential benefits of surgical repair with respect to fertility. There is a need for experienced surgeons skilled in the various isthmocele repair techniques. Isthmocele repair does not prevent the need for Cesarean delivery in subsequent pregnancies. There is increasing awareness regarding the accuracy of transvaginal ultrasound in diagnosing isthmocele. This may lead to surgical correction and prevention of obstetric and perinatal complications in subsequent pregnancies, including Cesarean scar pregnancy. Regarding threats, the existence of different surgical techniques means that there is a risk of selecting an inadequate approach if the type of isthmocele and the patient's characteristics are not considered. There is a risk of overtreatment when asymptomatic defects are repaired surgically. Finally, there is an absence of cost-effectiveness analyses to justify routine repair. Thus, while there are many data suggesting that isthmocele has an adverse effect on both natural fertility and the outcome of assisted reproduction techniques, high-quality evidence to support surgical isthmocele repair in all asymptomatic patients desiring future fertility are lacking. There is increasing agreement to recommend hysteroscopic repair of isthmocele as a first-line approach as long as the residual myometrial thickness is at least 2.5- 3.0 mm.
Autores: Rábade, P.; Vara García, Julio; Alcázar Zambrano, Juan Luis (Autor de correspondencia)

Título: Correlation between the ultrasound and laparoscopic findings in deep endometriosis staging: A narrative review

Revista: CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA

ISSN: 0210-573X Vol.50 N° 4 2023 págs. 100885

Resumen

Many women across the world suffer from endometriosis. This disease should be staged by laparoscopy in order to know the extent of disease. Ultrasound may be a reliable diagnostic tool that could complement laparoscopy for endometriosis staging. The aim of this study is to perform a narrative review of the current status of studies comparing ultrasound findings and laparoscopic staging according to American Society Reproductive Medicine (ASRM) and ENZIAN classifications. A search in PubMed and Web of Science databases from 2004 to 2022 was performed using the following terms endometriosis, ultrasound, laparoscopy, ENZIAN and ASRM. We focused on the accuracy of sonography using laparoscopy as gold standard. Seven studies were ultimately included. We observed that ultrasound is accurate and correlates well with advanced stages in the case of ASRM classification, and correlates well with ENZIAN classification. However, some limitations came up. There is little scientific information out there regarding this specific topic. Some of the studies have a retrospective design and one of them has a small sample size. In addition to this, even if ultrasound could have a relevant role in staging deep endometriosis, this method is highly dependent on the operator's experience. We conclude that diagnostic performance of transvaginal ultrasound (TVS) for evaluating the extent of disease in women with pelvic endometriosis is high. However, evidence is still limited and further studies are needed.
Autores: Canete, M. L.; Hernández, A.; Romero, V.; et al.

Título: Nuevo paradigma en la cirugía del mioma: reparación uterina

Revista: CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA

ISSN: 0210-573X Vol.50 N° 3 2023 págs. 100859

Resumen

Uterine fibroids are a frequent pathology that mainly affects women in their third and fourth decade of life. Most are asymptomatic. However, some may have a significant clinical impact or on the fertility of the patient. Recently there have been relevant changes in the diagnosis and management of this entity. This paper aims to summarize these changes discussed at the 1 st National Congress of the Spanish Society for the Study of Fibroids and Endometriosis.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Rodríguez-Guzmán, L.; Vara García, Julio; et al.

Título: Gynecologic imaging and reporting data system for classifying adnexal masses

Revista: MINERVA OBSTETRICS AND GYNECOLOGY

ISSN: 2724-606X Vol.75 N° 1 2023 págs. 69 - 79

Resumen

INTRODUCTION: To perform a systematic review and meta-analysis of the diagnostic performance of the so-called Gynecologic Imaging and Report Data System (GI-RADS) for classifying adnexal masses. EVIDENCE ACQUISITION: A search for studies reporting about the use of GI-RADS system for classifying adnexal masses from January 2009 to December 2021 was performed in Medline (Pubmed), Google Scholar, Scopus, Cochrane, and Web of Science databases. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odd ratio (DOR) were calculated. Studies' quality was evaluated using QUADAS-2. EVIDENCE SYNTHESIS: We identified 510 citations. Ultimately, 26 studies comprising 7350 masses were included. Mean prevalence of ovarian malignancy was 26%. The risk of bias was high in eight studies for domain patient selec-tion and low for index test, reference test domains for all studies. Overall, pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio and DOR of GI-RADS system for classifying adnexal masses were 94% (95% confidence interval [CI]=91-96%), 90% (95% CI=87-92%), 9.1 (95% CI=7.0-11.9), and 0.07 (95% CI=0.05-0.11), and 132 (95% CI=78-221), respectively. Heterogeneity was high for both sensitivity and specificity. Meta -regression showed that multiple observers and study's design explained this heterogeneity among studies. CONCLUSIONS: GI-RADS system has a good diagnostic performance for classifying adnexal masses.
Autores: Garde, I.; Paredes, C.; Ventura, L.; et al.

Título: Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.61 N° 3 2023 págs. 310 - 324

Resumen

ObjectiveTo evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. MethodsThis 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, 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. ResultsThe 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, quality was considered to be moderate or good for most of the studies. 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. ConclusionsThe 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. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Autores: Delgado-Morell, A.; Nieto-Tous, M.; Andrada-Ripolles, C.; et al.

Título: Transvaginal ultrasound accuracy in the hydrosalpinx diagnosis: a systematic review and meta-analysis

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 5 2023 págs. 948

Resumen

Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an adequate reproductive assessment while avoiding unnecessary laparoscopies. The aim of the present systematic review and meta-analysis is to synthetize and report the current evidence on transvaginal sonography (TVS) accuracy to diagnose hydrosalpinx. Articles on the topic published between January 1990 and December 2022 were searched in five electronic databases. Data from the six selected studies, comprising 4144 adnexal masses in 3974 women, 118 of which were hydrosalpinxes, were analyzed as follows: overall, TVS had a pooled estimated sensitivity for hydrosalpinx of 84% (95% confidence interval (CI) = 76-89%), specificity of 99% (95% CI = 98-100%), positive likelihood ratio of 80.7 (95% CI = 33.7-193.0), and negative likelihood ratio of 0.16 (95% CI = 0.11-0.25) and DOR of 496 (95% CI = 178-1381). The mean prevalence of hydrosalpinx was 4%. The quality of the studies and their risk of bias were assessed using QUADAS-2, evidencing an overall acceptable quality of the selected articles. We concluded that TVS has a good specificity and sensitivity for diagnosing hydrosalpinx.
Autores: Tameish, S.; Florez, N.; Pérez Vidal, J. R.; et al.

Título: Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with low-grade endometrioid endometrial cancer: a systematic review and head-to-head meta-analysis

Revista: JOURNAL OF CLINICAL ULTRASOUND

ISSN: 0091-2751 Vol.51 N° 7 2023 págs. 1188 - 1197

Resumen

PurposeWe aimed to compare the diagnostic performance of magnetic resonance imaging (MRI) and transvaginal ultrasound (TVS) for detecting myometrial invasion (MI) in patients with low-grade endometrioid endometrial carcinoma. MethodsA comprehensive search of MEDLINE (Pubmed), Web of Science, Embase and Scopus (from January 1990 to December 2022) was performed for articles comparing TVS and MRI in the evaluation of myometrial infiltration in low-grade (grade 1 or 2) endometrioid endometrial carcinoma in the same group of patients. We used QUADAS-2 tool for assessing the risk of bias of studies. ResultsWe found 104 citations in our extensive research. Four articles were ultimately included in the meta-analysis, after excluding 100 reports. All articles were considered low risk of bias in most of the domains assessed in QUADAS-2. We observed that pooled sensitivity and specificity for detecting deep MI were 65% (95% confidence interval [CI] = 54%-75%) and 85% (95% CI = 79%-89%) for MRI, and 71% (95% CI = 63%-78%) and 76% (95% CI = 67%-83%) for TVS, respectively. No statistical differences were found between both imaging techniques (p > 0.05). We observed low heterogeneity for sensitivity and high for specificity regarding TVS; and moderate for both sensitivity and specificity in case of MRI. ConclusionsThe diagnostic performance of TVS and MRI for the evaluation of deep MI in women with low-grade endometrioid endometrial cancer is similar. However, further research is needed as the number of studies is scanty.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Vara García, Julio; Usandizaga, C.; et al.

Título: Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: a systematic review and head-to-head meta-analysis

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGY AND OBSTETRICS

ISSN: 0020-7292 Vol.161 N° 2 2023 págs. 397 - 405

Resumen

BackgroundTransvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are used for the clinical diagnosis of adenomyosis. ObjectivesTo compare the diagnostic accuracy of TVS and MRI for the diagnosis of adenomyosis. Search StrategyA search of studies was performed in five databases comparing TVS and MRI for the diagnosis of adenomyosis from January 1990 to May 2022. Selection CriteriaStudies were eligible if they reported on the use of TVS and MRI in the same set of patients. The reference standard must be pathology (hysterectomy). Data Collection and AnalysisThe quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity of both techniques were estimated and compared. Main ResultsSix studies comprising 595 women were included. The risk of bias of patient selection was high in three studies. The risk of bias for index tests and reference test was low. Pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for TVS were 75%, 81%, 3.9, and 0.31, respectively. These figures for MRI were 69%, 80%, 3.5, and 0.39, respectively. No statistically significant differences were found (p = 0.7509). Heterogeneity was high. ConclusionsMRI and TVS have similar performances for the diagnosis of adenomyosis.
Autores: Carrera, M. (Autor de correspondencia); Alonso, L.; Domínguez, J. A.; et al.

Título: Hysteroscopic metroplasty for the treatment of the dysmorphic uterus: a SWOT analysis

Revista: FRONTIERS IN SURGERY

ISSN: 2296-875X Vol.9 2023 págs. 1097248

Resumen

IntroductionDysmorphic uterus or T-shaped uterus is an increasingly frequent diagnosis among the infertile population that has been associated to worse reproductive results. Hysteroscopic metroplasty is a safe and simple procedure that can improve the reproductive outcomes in this group of patients, although the benefits of this procedure remains controversial due to the lack of adequate scientific evidence. ObjectiveTo analyze the hysteroscopic metroplasty using the SWOT (Strengths, Weaknesses, Opportunities and Threats) methodology. Data sourcesAn electronic search from inception each database up to December 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Methods of study selectionStudies reporting outcomes of patients undergoing hysteroscopic metroplasty were included. TabulationNot applicable Integration and ResultsClinical evidence from the included studies suggests an improvement in reproductive results after performing hysteroscopic metroplasty especially in women with recurrent pregnancy loss and previous infertility, but all of them have relevant methodological limitations. For this reason, benefits, risks and alternatives of this intervention should be considered with caution. ConclusionsEvidence from published data shows a probable association between dysmorphic uterus and poor reproductive outcomes. Hysteroscopic metroplasty in patients with dysmorphic uterus could improve pregnancy outcomes, but there is need of properly designed prospective controlled studies to determine the benefits of this technique.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Carazo, P.; Pegenaute, L.; et al.

Título: Preoperative assessment of cervical involvement in endometrial cancer by transvaginal ultrasound and magnetic resonance imaging: a systematic review and meta-analysis

Revista: ULTRASCHALL IN DER MEDIZIN

ISSN: 0172-4614 Vol.44 N° 3 2023 págs. 280 -289
Autores: Chiva de Agustín, Luis (Autor de correspondencia); González Rodríguez, Marta; Tendobi, C.

Título: Elikia: a hope for cervical cancer in the Democratic Republic of Congo

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X 2023 págs. 004220
Autores: Berasaluce Gómez, A.; Martín Calvo, Nerea; Boria Alegre, Félix; et al.

Título: ASO visual abstract: SUCCOR nodes: may sentinel node biopsy determine the need for adjuvant treatment?

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.30 N° 8 2023 págs. 4986 - 4987
Autores: Boria Alegre, Félix (Autor de correspondencia); Riesco López, José María; Vázquez Vicente, Daniel; et al.

Título: Conservative endoscopic management of colorectal anastomotic leak in advanced ovarian cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.33 N° 7 2023 págs. 1154 - 1155
Autores: Pelayo, M.; Sancho-Sauco, J.; Sanchez-Zurdo, J.; et al.

Título: Application of ultrasound scores (subjective assessment, simple rules risk assessment, ADNEX model, O-RADS) to adnexal masses of difficult classification

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 17 2023 págs. 2785

Resumen

Featured Application Ultrasound scores should consider that some frequent masses such as fibromas, cystoadenofibromas, some mucinous cystadenomas and Brenner tumors may present some characteristics that induce confusion with malignant lesions. Some malignant lesions are not always identified as malignant.Abstract Background: Ultrasound features help to differentiate benign from malignant masses, and some of them are included in the ultrasound (US) scores. The main aim of this work is to describe the ultrasound features of certain adnexal masses of difficult classification and to analyse them according to the most frequently used US scores. Methods: Retrospective studies of adnexal lesions are difficult to classify by US scores in women undergoing surgery. Ultrasound characteristics were analysed, and masses were classified according to the Subjective Assessment of the ultrasonographer (SA) and other US scores (IOTA Simple Rules Risk Assessment-SRRA, ADNEX model with and without CA125 and O-RADS). Results: A total of 133 adnexal masses were studied (benign: 66.2%, n:88; malignant: 33.8%, n:45) in a sample of women with mean age 56.5 & PLUSMN; 7.8 years. Malignant lesions were identified by SA in all cases. Borderline ovarian tumors (n:13) were not always detected by some US scores (SRRA: 76.9%, ADNEX model without and with CA125: 76.9% and 84.6%) nor were serous carcinoma (n:19) (SRRA: 89.5%), clear cell carcinoma (n:9) (SRRA: 66.7%) or endometrioid carcinoma (n:4) (ADNEX model without CA125: 75.0%). While most teratomas and serous cystadenomas have been correctly differentiated, other benign lesions were misclassified because of the presence of solid areas or papillae. Fibromas (n:13) were better identified by SA (23.1% malignancy), but worse with the other US scores (SRRA: 69.2%, ADNEX model without and with CA125: 84.6% and 69.2%, O-RADS: 53.8%). Cystoadenofibromas (n:10) were difficult to distinguish from malignant masses via all scores except SRRA (SA: 70.0%, SRRA: 20.0%, ADNEX model without and with CA125: 60.0% and 50.0%, O-RADS: 90.0%). Mucinous cystadenomas (n:12) were misdiagnosed as malignant in more than 15% of the cases in all US scores (SA: 33.3%, SRRA: 16.7%, ADNEX model without and with CA125: 16.7% and 16.7%, O-RADS:41.7%). Brenner tumors are also difficult to classify using all scores. Conclusion: Some malignant masses (borderline ovarian tumors, serous carcinoma, clear cell carcinoma, endometrioid carcinomas) are not always detected by US scores. Fibromas, cystoadenofibromas, some mucinous cystadenomas and Brenner tumors may present solid components/papillae that may induce confusion with malignant lesions. Most teratomas and serous cystadenomas are usually correctly classified.
Autores: Costas, T. (Autor de correspondencia); Rodríguez, M. de la O.; Sanchez-Barba, M.; et al.

Título: Predictive value of cervical shear wave elastography in the induction of labor in late-term pregnancy nulliparous women: preliminary results

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 10 2023 págs. 1782

Resumen

The prediction of induction of labor continues to be a paradigm nowadays. Bishop Score is the traditional widely spread method but with a low reliability. Ultrasound cervical assessment has been proposed as an instrument of measurement. Shear wave elastography (SWE) should be a promising tool in the prediction of the success of labor induction in nulliparous late-term pregnancies. Ninety-two women with nulliparous late-term pregnancies who were going to be induced were included in the study. A shear wave measurement of the cervix divided into six regions (inner, middle and outer in both cervical lips), cervical length and fetal biometry was performed by blinded investigators prior to routine hand cervical assessment (Bishop Score (BS)) and induction of labor. The primary outcome was success of induction. Sixty-three women achieved labor. Nine women did not, and they underwent a cesarean section due to failure to induce labor. SWE was significantly higher in the inner part of the posterior cervix (p < 0.0001). SWE showed an area under the curve (AUC): 0.809 (0.677-0.941) in the inner posterior part. For CL, AUC was 0.816 (0.692-0.984). BS AUC was 0.467 (0.283-0.651). The ICC of inter-observer reproducibility was =0.83 in each region of interest (ROI). The cervix elastic gradient seems to be confirmed. The inner part of the posterior cervical lip is the most reliable region to predict induction of labor results in SWE terms. In addition, cervical length seems to be one of the most important procedures in the prediction of induction. Both methods combined could replace the Bishop Score.
Autores: Landolfo, C.; Bourne, T.; Froyman, W.; et al.

Título: Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.61 N° 2 2023 págs. 231 - 242

Resumen

ObjectivePrevious work has suggested that the ultrasound-based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two-step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. MethodsThis was a retrospective analysis using data from the 2-year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase-5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. ResultsA total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow-up at recruitment and all patients from 19 centers that did not fulfil our criteria for good-quality surgical and follow-up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver-operating-characteristics curve (AUC) of 0.94 (95% CI, 0.92-0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). ConclusionA large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Autores: Chacon Cruz, Enrique Maria (Autor de correspondencia); Gómez-Hidalgo, N. R.; Lago, V.; et al.

Título: Principles of urinary reconstruction in gynecologic oncology

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.33 N° 4 2023 págs. 638 - 639
Autores: Delgado, I. P.; Sancho, J.; Pelayo, M.; et al.

Título: Contribution of outpatient ultrasound transvaginal biopsy and puncture in the diagnosis and treatment of pelvic lesions: a bicenter study

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 3 2023 págs. 380

Resumen

Background: The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. Methods: This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20-25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. Results: A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant-ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium-and 23 benign). The tolerance was excellent and no complications were detected. Conclusion: The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.
Autores: Vara García, Julio; Pagliuca, M.; González de Canales Díaz, Juan; et al.

Título: O-RADS classification for ultrasound assessment of adnexal masses: agreement between IOTA lexicon and ADNEX model for assigning risk group

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 4 2023 págs. 673

Resumen

Background: The O-RADS system is a new proposal for establishing the risk of malignancy of adnexal masses using ultrasound. The objective of this study is to assess the agreement and diagnostic performance of O-RADS when using the IOTA lexicon or ADNEX model for assigning the O-RADS risk group. Methods: Retrospective analysis of prospectively collected data. All women diagnosed as having an adnexal mass underwent transvaginal/transabdominal ultrasound. Adnexal masses were classified according to the O-RADS classification, using the criterion of the IOTA lexicon and according to the risk of malignancy determined by the ADNEX model. The agreement between both methods for assigning the O-RADS group was estimated using weighted Kappa and the percentage of agreement. The sensitivity and specificity of both approaches were calculated. Results: 454 adnexal masses in 412 women were evaluated during the study period. There were 64 malignant masses. The agreement between the two approaches was moderate (Kappa: 0.47), and the percentage of agreement was 46%. Most disagreements occurred for the groups O-RADS 2 and 3 and for groups O-RADS 3 and 4. The sensitivity and specificity for O-RADS using the IOTA lexicon and O-RADS using the ADNEX model were 92.2% and 86.1%, and 85.9% and 87.4%, respectively. Conclusion: The diagnostic performance of O-RADS classification using the IOTA lexicon as opposed to the IOTA ADNEX model is similar. However, O-RADS group assignment varies significantly, depending on the use of the IOTA lexicon or the risk estimation using the ADNEX model. This fact might be clinically relevant and deserves further research.
Autores: Pelayo, M.; Sancho-Sauco, J.; Sanchez-Zurdo, J.; et al.

Título: Ultrasound features and ultrasound scores in the differentiation between benign and malignant adnexal masses

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 13 2023 págs. 2152

Resumen

Background: Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. Methods: This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). Results: Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, & GE;1 papillae, vascularized septum, and moderate-severe ascites. Conclusion: IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy.
Autores: Berasaluce Gómez, A.; Martín Calvo, Nerea; Boria Alegre, Félix; et al.

Título: SUCCOR Nodes: may sentinel node biopsy determine the need for adjuvant treatment?

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.30 N° 8 2023 págs. 4975 - 4985

Resumen

Background The SUCCOR cohort was developed to analyse the overall and disease-free survival at 5 years in women with FIGO 2009 stage IB1 cervical cancer. The aim of this study was to compare the use of adjuvant therapy in these women, depending on the method used to diagnose lymphatic node metastasis.Patients and Methods We used data from the SUCCOR cohort, which collected information from 1049 women with FIGO 2009 stage IB1 cervical cancer who were operated on between January 2013 and December 2014 in Europe. We calculated the adjusted proportion of women who received adjuvant therapy depending on the lymph node diagnosis method and compared disease free and overall survival using Cox proportional-hazards regression models. Inverse probability weighting was used to adjust for baseline potential confounders.Results The adjusted proportion of women who received adjuvant therapy was 33.8% in the sentinel node biopsy + lymphadenectomy (SNB+LA) group and 44.7% in the LA group (p = 0.02), although the proportion of positive nodal status was similar (p = 0.30). That difference was greater in women with negative nodal status and positive Sedlis criteria (difference 31.2%, p = 0.01). Here, those who underwent a SNB+LA had an increased risk of relapse [hazard ratio (HR) 2.49, 95% confidence interval (CI) 0.98-6.33, p = 0.056] and risk of death (HR 3.49, 95% CI 1.04-11.7, p = 0.042) compared with those who underwent LA.Conclusions Women in this study were less likely to receive adjuvant therapy if their nodal invasion was determined using SNB+LA compared with LA. These results suggest a lack of therapeutic measures available when a negative result is obtained by SNB+LA, which may have an impact on the risk of recurrence and survival.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Para, E.; Tomaizhe, A,; et al.

Título: Vaginal wall thickness as potential biomarker of vaginal health. A proposal for standardized ultrasound measurement using three-dimensional transvaginal ultrasound

Revista: JOURNAL OF CLINICAL ULTRASOUND

ISSN: 0091-2751 Vol.51 N° 8 2023 págs. 1366 - 1369

Resumen

Vaginal wall thickness could be used as a biomarker of vaginal health. We propose a standardized method using three-dimensional (3D) ultrasound for measuring vaginal wall thickness. Fill the vagina with gel. Insert the endovaginal transducer into the vagina up to the middle third. In the sagittal plane, visualizing the cervix and vaginal fornices, capture a 3D volume of the upper third of the vagina. Using tomographic ultrasound imaging function in the sagittal plane and the posterior vaginal fornix as the reference obtain at least three axial planes of the vagina, separated by 1 cm. Measure the vaginal wall thickness at a distance of 2 cm from the posterior vaginal fornix at 12, 3, 6, and 9 o'clock. The reproducibility of measurements was high. Measurements of vaginal wall thickness can be reliably performed. Vaginal wall thickness could be used as a biomarker of vaginal health. We propose a standardized method using three-dimensional ultrasound for measuring vaginal wall thickness. Measurements of vaginal wall thickness can be reliably performed.
Autores: Chacon Cruz, Enrique Maria; Arraiza Sarasa, María; Manzour Sifontes, Nabil; et al.

Título: Ultrasound examination, MRI, or ROMA for discriminating between inconclusive adnexal masses as determined by IOTA Simple Rules: a prospective study

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.33 N° 6 2023 págs. 951 - 956

Resumen

ObjectiveTo determine the best second-step approach for discriminating benign from malignant adnexal masses classified as inconclusive by International Ovarian Tumour Analysis Simple Rules (IOTA-SR). MethodsSingle-center prospective study comprising a consecutive series of patients diagnosed as having an adnexal mass classified as inconclusive according to IOTA-SR. All women underwent Risk of Ovarian Malignancy Algorithm (ROMA) analysis, MRI interpreted by a radiologist, and ultrasound examination by a gynecological sonologist. Cases were clinically managed according to the result of the ultrasound expert examination by either serial follow-up for at least 1 year or surgery. Reference standard was histology (patient was submitted to surgery if any of the tests was suspicious) or follow-up (masses with no signs of malignancy after 12 months were considered benign). Diagnostic performance of all three approaches was calculated and compared. Direct cost analysis of the test used was also performed. ResultsEighty-two adnexal masses in 80 women (median age 47.6 years, range 16 to 73 years) were included. Seventeen patients (17 masses) were managed expectantly (none had diagnosis of ovarian cancer after at least 12 months of follow-up) and 63 patients (65 masses) underwent surgery and tumor removal (40 benign and 25 malignant tumors). Sensitivity and specificity for ultrasound, MRI, and ROMA were 96% and 93%, 100% and 81%, and 24% and 93%, respectively. The specificity of ultrasound was better than that for MRI (p=0.021), and the sensitivity of ultrasound was better than that for ROMA (p<0.001), sensitivity was better for MRI than for ROMA (p<0.001) and the specificity of ROMA was better than that for MRI (p<0.001). Ultrasound evaluation was the most effective and least costly method as compared with MRI and ROMA. ConclusionIn this study, ultrasound examination was the best second-step approach in inconclusive adnexal masses as determined by IOTA-SR, but the findings require confirmation in multicenter prospective trials.
Autores: Zapardiel, I. (Autor de correspondencia); Gracia Segovia, M.; Macuks, R.; et al.

Título: Prognostic factors in patients with uterine sarcoma: the SARCUT study

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.33 N° 6 2023 págs. 897 - 904

Resumen

ObjectiveUterine sarcomas are a rare and heterogeneous group of malignancies that include different histological sub-types. The aim of this study was to identify and evaluate the impact of the different prognostic factors on overall survival and disease-free survival of patients with uterine sarcoma. MethodsThis international multicenter retrospective study included 683 patients diagnosed with uterine sarcoma at 46 different institutions between January 2001 and December 2007. ResultsThe 5-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma, and adenosarcoma was 65.3%, 78.3%, 52.4%, and 89.5%, respectively, and the 5-year disease-free survival was 54.3%, 68.1%, 40.3%, and 85.3%, respectively. The 10-year overall survival for leiomyosarcoma, endometrial stromal sarcoma, undifferentiated sarcoma and adenosarcoma was 52.6%, 64.8%, 52.4%, and 79.5%, respectively, and the 10-year disease-free survival was 44.7%, 53.3%, 40.3%, and 77.5%, respectively. The most significant factor associated with overall survival in all types of sarcoma except for adenosarcoma was the presence of residual disease after primary treatment. In adenosarcoma, disease stage at diagnosis was the most important factor (hazard ratio 17.7; 95% CI 2.86 to 109.93). ConclusionIncomplete cytoreduction, tumor persistence, advanced stage, extra-uterine and tumor margin involvement, and the presence of necrosis were relevant prognostic factors significantly affecting overall survival in uterine sarcoma. The presence of lymph vascular space involvement and administration of adjuvant chemotherapy were significantly associated with a higher risk of relapse.
Autores: Timmerman, S.; Valentin, L.; Ceusters, J.; et al.

Título: External validation of the ovarian-adnexal reporting and data system (O-RADS) lexicon and the international ovarian tumor analysis 2-step strategy to stratify ovarian tumors into O-RADS risk groups

Revista: JAMA ONCOLOGY

ISSN: 2374-2437 Vol.9 N° 2 2023 págs. 225 - 233

Resumen

IMPORTANCE Correct diagnosis of ovarian cancer results in better prognosis. Adnexal lesions can be stratified into the Ovarian-Adnexal Reporting and Data System (O-RADS) risk of malignancy categories with either the O-RADS lexicon, proposed by the American College of Radiology, or the International Ovarian Tumor Analysis (IOTA) 2-step strategy. OBJECTIVE To investigate the diagnostic performance of the O-RADS lexicon and the IOTA 2-step strategy. DESIGN, SETTING, AND PARTICIPANTS Retrospective external diagnostic validation study based on interim data of IOTA5, a prospective international multicenter cohort study, in 36 oncology referral centers or other types of centers. A total of 8519 consecutive adult patients presenting with an adnexal mass between January 1, 2012, and March 1, 2015, and treated either with surgery or conservatively were included in this diagnostic study. Twenty-five patients were excluded for withdrawal of consent, 2777 were excluded from 19 centers that did not meet predefined data quality criteria, and 812 were excluded because they were already in follow-up at recruitment. The analysis included 4905 patients with a newly detected adnexal mass in 17 centers that met predefined data quality criteria. Data were analyzed from January 31 to March 1, 2022. EXPOSURES Stratification into O-RADS categories (malignancy risk < 1%, 1% to < 10%, 10% to < 50%, and-50%). For the IOTA 2-step strategy, the stratification is based on the individual risk of malignancy calculated with the IOTA 2-step strategy. MAIN OUTCOMES AND MEASURES Observed prevalence of malignancy in each O-RADS risk category, as well as sensitivity and specificity. The reference standard was the status of the tumor at inclusion, determined by histology or clinical and ultrasonographic follow-up for 1 year. Multiple imputation was used for uncertain outcomes owing to inconclusive follow-up information. RESULTS Median age of the 4905 patients was 48 years (IQR, 36-62 years). Data on race and ethnicity were not collected. A total of 3441 tumors (70%) were benign, 978 (20%) were malignant, and 486 (10%) had uncertain classification. Using the O-RADS lexicon resulted in 1.1% (24 of 2196) observed prevalence of malignancy in O-RADS 2, 4% (34 of 857) in O-RADS 3, 27% (246 of 904) in O-RADS 4, and 78% (732 of 939) in O-RADS 5; the corresponding results for the IOTA 2-step strategy were 0.9% (18 of 1984), 4% (58 of 1304), 30% (206 of 690), and 82% (756 of 927). At the 10% risk threshold (O-RADS 4-5), the O-RADS lexicon had 92% sensitivity (95% CI, 87%-96%) and 80% specificity (95% CI, 74%-85%), and the IOTA 2-step strategy had 91% sensitivity (95% CI, 84%-95%) and 85% specificity (95% CI, 80%-88%). CONCLUSIONS AND RELEVANCE The findings of this external diagnostic validation study suggest that both the O-RADS lexicon and the IOTA 2-step strategy can be used to stratify patients into risk groups. However, the observed malignancy rate in O-RADS 2 was not clearly below 1%.
Autores: Orozco, R. (Autor de correspondencia); Vilches, J. C.; Brunel, I.; et al.

Título: Adenomyosis in pregnancy-should it be managed in high-risk obstetric units?

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 6 2023 págs. 1184

Resumen

Background: Uterine adenomyosis is an increasingly frequent disorder. Our study aimed to demonstrate the presence of obstetric complications in the population affected by this condition to demonstrate the need for follow-up in high-risk obstetric units. Material and Methods: The data for the study were obtained from TriNetX, LLC, between 2010 and 2020. The outcomes analyzed were intrauterine growth restriction (IUGR), preterm delivery, cesarean delivery, hypertension, abruption placentae, and spontaneous abortion. Seven thousand six hundred and eight patients were included in the cohort of pregnant patients with adenomyosis, and 566,153 women in the cohort of pregnant patients without any history of endometriosis. Results: Upon calculating the total risk of presenting any of these problems during pregnancy, we obtained an OR = 1.521, implying that a pregnancy with adenomyosis was 52.1% more likely to present some complication. We found: IUGR OR = 1.257 (95% CI: 1.064-1.485) (p = 0.007); preterm delivery OR = 1.422 (95% CI: 1.264-1.600) (p = 0.0001); cesarean delivery OR = 1.099 (95% CI: 1.002-1.205) (p = 0.046); hypertensive disorders OR = 1.177 (95% CI: 1.076-1.288) (p = 0.0001); abruption placentae OR = 1.197 (95% CI: 1.008-1.422) (p = 0.040), and spontaneous abortion OR = 1.529 (95% CI: 1.360-1.718) (p = 0.0001). Conclusion: We conclude that the review carried out and the data we obtained on increased risk provide sufficient evidence to recommend that patients with adenomyosis should be managed in obstetric high-risk units.
Autores: Pedrassani, M.; Guerriero, S.; Pascual, M. A.; et al.

Título: Superficial endometriosis at ultrasound examination - a diagnostic criteria proposal

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 11 2023 págs. 1876

Resumen

The actual prevalence of superficial endometriosis is not known. However, it is considered the most common subtype of endometriosis. The diagnosis of superficial endometriosis remains difficult. In fact, little is known about the ultrasound features of superficial endometriotic lesions. In this study, we aimed to describe the appearance of superficial endometriosis lesions at ultrasound examination, with laparoscopic and/or histologic correlation. This is a prospective study on a series of 52 women with clinical suspicion of pelvic endometriosis who underwent preoperative transvaginal ultrasound and received a confirmed diagnosis of superficial endometriosis via laparoscopy. Women with ultrasound or laparoscopic findings of deep endometriosis were not included. We observed that superficial endometriotic lesions may appear as a solitary lesions, multiple separate lesions, and cluster lesions. The lesions may exhibit the presence of hypoechogenic associated tissue, hyperechoic foci, and/or velamentous (filmy) adhesions. The lesion may be convex, protruding from the peritoneal surface, or it may appear as a concave defect in the peritoneum. Most lesions exhibited several features. We conclude that transvaginal ultrasound may be useful for diagnosing superficial endometriosis, as these lesions may exhibit different ultrasound features.
Autores: Browne, J. L.; Pascual, M. A. (Autor de correspondencia); Pérez, J.; et al.

Título: AI: can it make a difference to the predictive value of ultrasound breast biopsy?

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 4 2023 págs. 811

Resumen

(1) Background: This study aims to compare the ground truth (pathology results) against the BI-RADS classification of images acquired while performing breast ultrasound diagnostic examinations that led to a biopsy and against the result of processing the same images through the AI algorithm KOIOS DS (TM) (KOIOS). (2) Methods: All results of biopsies performed with ultrasound guidance during 2019 were recovered from the pathology department. Readers selected the image which better represented the BI-RADS classification, confirmed correlation to the biopsied image, and submitted it to the KOIOS AI software. The results of the BI-RADS classification of the diagnostic study performed at our institution were set against the KOIOS classification and both were compared to the pathology reports. (3) Results: 403 cases were included in this study. Pathology rendered 197 malignant and 206 benign reports. Four biopsies on BI-RADS 0 and two images are included. Of fifty BI-RADS 3 cases biopsied, only seven rendered cancers. All but one had a positive or suspicious cytology; all were classified as suspicious by KOIOS. Using KOIOS, 17 B3 biopsies could have been avoided. Of 347 BI-RADS 4, 5, and 6 cases, 190 were malignant (54.7%). Because only KOIOS suspicious and probably malignant categories should be biopsied, 312 biopsies would have resulted in 187 malignant lesions (60%), but 10 cancers would have been missed. (4) Conclusions: KOIOS had a higher ratio of positive biopsies in this selected case study vis-a-vis the BI-RADS 4, 5 and 6 categories. A large number of biopsies in the BI-RADS 3 category could have been avoided.
Autores: Cabezas, N.; López-Picazo Moreno, Ana; Díaz, P.; et al.

Título: How frequently benign uterine myomas appear suspicious for sarcoma as assessed by transvaginal ultrasound?

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 3 2023 págs. 501

Resumen

Background: Uterine myomas may resemble uterine sarcomas in some cases. However, the rate of benign myomas appearing as sarcomas at an ultrasound examination is not known. The objective of this study is to determine the percentage of benign myomas that appear suspicious for uterine sarcoma on ultrasound examination. This is a prospective observational multicenter study (June 2019-December 2021) comprising a consecutive series of patients with histologically proven uterine myoma after hysterectomy or myomectomy who underwent transvaginal and/or transabdominal ultrasound prior to surgery. All ultrasound examinations were performed by expert examiners. MUSA criteria were used to describe the lesions (1). Suspicion of sarcoma was established when three or more sonographic features, described by Ludovisi et al. as frequently seen in uterine sarcoma, were present (2). These features are no visible myometrium, irregular cystic areas, non-uniform echogenicity, irregular contour, cooked appearance, and a Doppler color score of 3-4. In addition, the examiners had to classify the lesion as suspicious based on her/his impression, independent of the number of features present. Eight hundred and ten women were included. The median maximum diameter of the myomas was 58.7 mm (range: 10.0-263.0 mm). Three hundred and forty-nine (43.1%) of the patients had more than one myoma. Using the criterion of >3 suspicious features, 40 (4.9%) of the myomas had suspicious appearance. By subjective impression, the examiners considered 40 (4.9%) cases suspicious. The cases were not exactly the same. We conclude that approximately 5% of benign uterine myomas may exhibit sonographic suspicion of sarcoma. Although it is a small percentage, it is not negligible.
Autores: Engels, V.; Medina, M.; Antolin, E.; et al.

Título: Factors associated with a post-procedure spontaneous pregnancy after a hysterosapingo-foam-sonography (HyFoSy): results from a multicenter observational study

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.13 N° 3 2023 págs. 504

Resumen

Background: Tubal patency testing constitutes an essential part of infertility work-up. Hysterosalpingo-foam-sonography (HyFoSy) is currently one of the best tests for assessing tubal patency. The objective of our study was to evaluate the post-procedure rate of spontaneous pregnancy among infertile women submitted for an HyFoSy exam with ExEm((R)) foam and the factors associated with this. Methods: Multicenter, prospective, observational study performed at six Spanish centers for gynecologic sonography and human reproduction. From December 2015 to June 2021, 799 infertile women underwent HyFoSy registration consecutively. The patients' information was collected from their medical records. Multivariable regression analyses were performed, controlling for age, etiology, and time of sterility. The main outcome was to measure post-procedure spontaneous pregnancy rates and the factors associated with the achievement of pregnancy. Results: 201 (26.5%) women got spontaneous conception (SC group), whereas 557 (73.5%) women did not get pregnant (non-spontaneous conception group, NSC). The median time for reaching SC after HyFoSy was 4 months (CI 95% 3.1-4.9), 18.9% of them occurring the same month of the procedure. Couples with less than 18 months of infertility were 93% more likely to get pregnant after HyFoSy (OR 1.93, 95% CI 1.34-2.81; p < 0.001); SC were two times more frequent in women under 35 years with unexplained infertility (OR 2.22, 95% CI 1.07-4.65; P0.033). Conclusion: After HyFoSy, one in four patients got pregnant within the next twelve months. Couples with shorter infertility time, unexplained infertility, and women under 35 years are more likely to achieve SC after HyFoSy.
Autores: Murcia Lora, J. M. (Autor de correspondencia); Esparza Encina, M. L.; Reig, C.; et al.

Título: L-type (loaf) cervical secretion crystallization directionality biomarker study

Revista: CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY

ISSN: 0390-6663 Vol.50 N° 6 2023 págs. 127

Resumen

Background: Cervical discharge is considered a hydrogel, which is part liquid and part solid. Under physiological conditions, the characteristic fern-leaf arborization is proportional to the circulating estradiol concentration and maximal in the preovulatory phase. Crystallization of the cervical secretion is a process of dehydration with the arrangement of sodium and potassium chloride crystals around a main axis composed of mucin. L-type (Loaf) (L) is proportional to the circulating estradiol concentration and is higher in the Fertile Window (FW). Currently, most studies comparing the FW with cervical discharge include the biophysical fertile window (BFW) which is 6 days before the estimated day of ovulation (EDO). Methods: Samples were taken from the vulvovaginal region within the FW using the Creighton Model System for Fertility Care (CrMS). Optical images of the samples were digitized to perform a binarization, skeletonization, and crystallization directionality study of the scanned branches. These samples taken from the vulvovaginal secretion were not collected from the endocervix. They were recorded by the Vaginal Secretion Recording System (VDRS) using CrMS. The FW was taken into account from 6 days before the peak (P) day according to CrMS. A statistical study was performed by comparing vulvovaginal crystallization samples including -6 day EDO in FW. Results: Out of 29 samples, 58.6% deemed true positives, 34% were true negatives, 6.8% represented 2 false positives, and no cases were false negatives (p < 0.001). Conclusions: Our analysis of the statistical distribution of the branching angles of the crystallization of cervical secretions allowed us to detect a significant contribution of 90-degree frecuencies, indicating, the existence of an L-type pattern in the FW samples that we studied. The skeletonization of the studied images together with a FW indicator allowed us to identify this crystallization pattern. We therefore propose this feature detection mechanism as a novel biomarker of fertility.
Autores: Chargari, C. (Autor de correspondencia); Tanderup, K.; Planchamp, F.; et al.

Título: ESGO/ESTRO quality indicators for radiation therapy of cervical cancer

Revista: RADIOTHERAPY AND ONCOLOGY

ISSN: 0167-8140 Vol.183 2023 págs. 109589

Resumen

Background: The European Society of Gynaecological Oncology (ESGO) has previously defined and estab-lished a list of quality indicators for the surgical treatment of cervical cancer. As a continuation of this effort to improve overall quality of care for cervical cancer patients across all aspects, ESGO and the European SocieTy for Radiotherapy and Oncology (ESTRO) initiated the development of quality indicators for radiation therapy of cervical cancer.Objective: To develop a list of quality indicators for radiation therapy of cervical cancer that can be used to audit and improve clinical practice by giving to practitioners and administrators a quantitative basis to improve care and organizational processes, notably for recognition of the increased complexity of mod-ern external radiotherapy and brachytherapy techniques.Methods: Quality indicators were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for identification of potential quality indicators and doc-umentation of scientific evidence, consensus meetings of a group of international experts, an internal val-idation process, and external review by a large international panel of clinicians (n = 99). Results: Using a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are detailed to define how the quality indicators will be mea-sured in practice. Targets were also defined for specifying the level which each unit or center should be aiming to achieve. Nineteen structural, process, and outcome indicators were defined. Quality indicators 1-6 are general requirements related to pretreatment workup, time to treatment, upfront radiation ther-apy, and overall management, including active participation in clinical research and the decision making process within a structured multidisciplinary team. Quality indicators 7-17 are related to treatment indi-cators. Quality indicators 18 and 19 are related to patient outcomes.Discussion: This set of quality indicators is a major instrument to standardize the quality of radiation therapy in cervical cancer. A scoring system combining surgical and radiotherapeutic quality indicators will be developed within an envisaged future ESGO accreditation process for the overall management of cervical cancer, in an effort to support institutional and governmental quality assurance programs.& COPY; 2022 The Author(s). Published by Elsevier B.V and BMJ. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Radiotherapy and Oncology 183 (2023) 109589 This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Autores: Shazly, S. A. A. (Autor de correspondencia); Coronado, P. J. J.; Yilmaz, E.; et al.

Título: Endometrial Cancer Individualized Scoring System (ECISS): a machine learning-based prediction model of endometrial cancer prognosis

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGY AND OBSTETRICS

ISSN: 0020-7292 Vol.161 N° 3 2023 págs. 760 - 768

Resumen

ObjectiveTo establish a prognostic model for endometrial cancer (EC) that individualizes a risk and management plan per patient and disease characteristics. MethodsA multicenter retrospective study conducted in nine European gynecologic cancer centers. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pretreatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). ResultsOf 1150 women, 1144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88%, and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracies of models I, II, and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. ConclusionThe Endometrial Cancer Individualized Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy.
Autores: Chargari, C. (Autor de correspondencia); Tanderup, K.; Planchamp, F.; et al.

Título: ESGO/ESTRO quality indicators for radiation therapy of cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.33 N° 6 2023 págs. 862 - 875

Resumen

BackgroundThe European Society of Gynaecological Oncology (ESGO) has previously defined and established a list of quality indicators for the surgical treatment of cervical cancer. As a continuation of this effort to improve overall quality of care for cervical cancer patients across all aspects, ESGO and the European SocieTy for Radiotherapy and Oncology (ESTRO) initiated the development of quality indicators for radiation therapy of cervical cancer. ObjectiveTo develop a list of quality indicators for radiation therapy of cervical cancer that can be used to audit and improve clinical practice by giving to practitioners and administrators a quantitative basis to improve care and organizational processes, notably for recognition of the increased complexity of modern external radiotherapy and brachytherapy techniques. MethodsQuality indicators were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for identification of potential quality indicators and documentation of scientific evidence, consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians (n=99). ResultsUsing a structured format, each quality indicator has a description specifying what the indicator is measuring. Measurability specifications are detailed to define how the quality indicators will be measured in practice. Targets were also defined for specifying the level which each unit or center should be aiming to achieve. Nineteen structural, process, and outcome indicators were defined. Quality indicators 1-6 are general requirements related to pretreatment workup, time to treatment, upfront radiation therapy, and overall management, including active participation in clinical research and the decision making process within a structured multidisciplinary team. Quality indicators 7-17 are related to treatment indicators. Quality indicators 18 and 19 are related to patient outcomes. DiscussionThis set of quality indicators is a major instrument to standardize the quality of radiation therapy in cervical cancer. A scoring system combining surgical and radiotherapeutic quality indicators will be developed within an envisaged future ESGO accreditation process for the overall management of cervical cancer, in an effort to support institutional and governmental quality assurance programs.
Autores: Jurado Chacón, Matías (Autor de correspondencia); Chiva de Agustín, Luis; Tinelli, G.; et al.

Título: The role of oncovascular surgery in gynecologic oncology surgery

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 4 2022 págs. 553 - 559

Resumen

Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.
Autores: García-García, I.; Alcázar Zambrano, Juan Luis (Autor de correspondencia); Rodríguez, I.; et al.

Título: 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

Revista: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY

ISSN: 1553-4650 Vol.29 N° 2 2022 págs. 204 - 212

Resumen

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.
Autores: Vara García, Julio; Manzour Sifontes, Nabil; Chacon Cruz, Enrique Maria; et al.

Título: Ovarian Adnexal Reporting Data System (O-RADS) for classifying adnexal masses: a systematic review and meta-analysis

Revista: CANCERS

ISSN: 2072-6694 Vol.14 N° 13 2022 págs. 3151

Resumen

Simple Summary We performed a systematic review and meta-analysis aiming to assess the diagnostic performance of the Ovarian Adnexal Report Data System (O-RADS) using transvaginal ultrasound for classifying adnexal masses. Data from 11 studies comprising 4634 masses showed that the pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of O-RADS system for classifying adnexal masses were 97% (95% confidence interval (CI) = 94%-98%), 77% (95% CI = 68%-84%), 4.2 (95% CI= 2.9-6.0), 0.04 (95% CI = 0.03-0.07), and 96 (95% CI = 50-185), respectively. We concluded that the O-RADS system has good sensitivity and moderate specificity for classifying adnexal masses. In this systematic review and meta-analysis, we aimed to assess the pooled diagnostic performance of the so-called Ovarian Adnexal Report Data System (O-RADS) for classifying adnexal masses using transvaginal ultrasound, a classification system that was introduced in 2020. We performed a search for studies reporting the use of the O-RADS system for classifying adnexal masses from January 2020 to April 2022 in several databases (Medline (PubMed), Google Scholar, Scopus, Cochrane, and Web of Science). We selected prospective and retrospective cohort studies using the O-RADS system for classifying adnexal masses with histologic diagnosis or conservative management demonstrating spontaneous resolution or persistence in cases of benign appearing masses after follow-up scan as the reference standard. We excluded studies not related to the topic under review, studies not addressing O-RADS classification, studies addressing MRI O-RADS classification, letters to the editor, commentaries, narrative reviews, consensus documents, and studies where data were not available for constructing a 2 x 2 table. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated. The quality of the studies was evaluated using QUADAS-2. A total of 502 citations were identified. Ultimately, 11 studies comprising 4634 masses were included. The mean prevalence of ovarian malignancy was 32%. The risk of bias was high in eight studies for the patient selection domain. The risk of bias was low for the index test and reference test domains for all studies. Overall, the pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of the O-RADS system for classifying adnexal masses were 97% (95% confidence interval (CI) = 94%-98%), 77% (95% CI = 68%-84%), 4.2 (95% CI = 2.9-6.0), 0.04 (95% CI = 0.03-0.07), and 96 (95% CI = 50-185), respectively. Heterogeneity was moderate for sensitivity and high for specificity. In conclusion, the O-RADS system has good sensitivity and moderate specificity for classifying adnexal masses.
Autores: Graupera, B.; Pascual, M. A.; Guerriero, S. (Autor de correspondencia); et al.

Título: Extra-gynecological pelvic pathology: a challenge in the differential diagnosis of the female pelvis

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.12 N° 7 2022 págs. 1693

Resumen

Ultrasound technology with or without color Doppler allows a real-time evaluation of the entire female pelvis including gynecologic and non-gynecological organs, as well as their pathology. As ultrasound is an accurate tool for gynecological diagnosis and is less invasive and less expensive than other techniques, it should be the first imaging modality used in the evaluation of the female pelvis. We present a miscellany of non-gynecological pelvic images observed during the realization of gynecological ultrasound. Transvaginal and transabdominal ultrasound is the first choice among diagnostic techniques for the study of the female pelvis, providing information about gynecological and extra-gynecological organs, allowing for an orientation toward the pathology of a specific organ or system as well as for additional tests to be performed that are necessary for definitive diagnosis.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Eguez, P. M.; Forcada, P.; et al.

Título: Diagnostic accuracy of sliding sign for detecting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis: systematic review and meta-analysis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.60 N° 4 2022 págs. 477 - 486

Resumen

Objective The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard. Methods A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA. Results A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high. Conclusion The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis.
Autores: Costas, T.; Belda, R.; Alcázar Zambrano, Juan Luis (Autor de correspondencia)

Título: Transvaginal three-dimensional ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis

Revista: MEDICAL ULTRASONOGRAPHY

ISSN: 1844-4172 Vol.24 N° 1 2022 págs. 77 - 84

Resumen

Aim: The aim of this meta-analysis is to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasound subjective assessment (3D-TVS) in the preoperative detection of deep myometrial invasion (MI) in patients with endometrial cancer, using definitive frozen section diagnosis after surgery as the reference standard. Material and methods: A search for studies evaluating the role of 3D-TVS for assessing myometrial invasion in endometrial cancer from January 1990 to November 2020 was performed in PubMed/MEDLINE and Web of Science. The Quality Assessment of Diagnostic Accuracy Studies 2 evaluated the quality of the studies (QUADAS-2). All analyses were performed using MIDAS and METANDI commands. Results: Nine studies comprising 581 women were included. The mean prevalence of deep MI was 39.8%. QUADAS assessment showed that most studies had a high risk for the patient selection domain. Overall, the pooled estimated sensitivity, specificity, positive likelihood and negative likelihood ratio of 3D-TVS for detecting deep MI were 84% (95% CI, 73-90%), 82% (95% CI, 75-88%), 5 (95% CI, 3.1-7.1) and 0.20 95% CI, 0.11-0.35). respectively. Conclusions: 3D-TVS has an acceptable diagnostic performance for detecting MI in women with endometrial cancer.
Autores: Guerriero, S. (Autor de correspondencia); Ajossa, S.; Pagliuca, M.; et al.

Título: Advances in imaging for assessing pelvic endometriosis

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.12 N° 12 2022 págs. 2960

Resumen

In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16 alpha-[18F]fluoro-17 beta-estradiol.
Autores: Carrera, M.; Pérez-Milán, F.; Alcázar Zambrano, Juan Luis; et al.

Título: Effect of hysteroscopic metroplasty on reproductive outcomes in women with septate uterus: systematic review and meta-analysis

Revista: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY

ISSN: 1553-4650 Vol.29 N° 4 2022 págs. 465 - 475

Resumen

Objective: The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes. Data sources: A systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, 'cesarean delivery, and fetal malpresentation. Methods of study selection: Studies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus. Tabulation, integration, and results: The systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22-0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03-0.78), OR = 0.36 (95% CI, 0.19-0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20-1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11-0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16-0.65). Conclusion: The results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.
Autores: Manzour Sifontes, Nabil (Autor de correspondencia); Núñez Córdoba, Jorge María; Chiva de Agustín, Luis; et al.

Título: Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis

Revista: GYNECOLOGIC ONCOLOGY

ISSN: 0090-8258 Vol.164 N° 2 2022 págs. 455 - 460

Resumen

Background. After the LACC trial, the SUCCOR study, and other studies, we know that patients who have undergone minimally invasive surgery for cervical cancer have worse outcomes, but today, we do not know if the surgical approach can be a reason to change the pattern of relapses on these patients. We evaluated the relapse pattern in patients with stage IB1 cervical cancer (FIGO, 2009) who underwent radical hysterectomy with different surgical approaches. Methods. A systematic review of literature was performed in PubMed, Cochrane Library, Clinicaltrials.gov, and Web of science. Inclusion criteria were prospective or retrospective comparative studies of different surgical approaches that described patterns or locations of relapse in patients with stage IB1 cervical cancer. Heterogeneity was assessed by calculating I2. Results. The research resulted in 782 eligible citations from January 2010 to October 2020. After filtering, nine articles that met all inclusion criteria were analyzed, comprising data from 1663 patients who underwent radical hysterectomy for IB1 cervical cancer, and the incidence of relapse was 10.6%. When we compared the pattern of relapse (local, distant, and both) of each group (open surgery and minimally invasive surgery), we did not see statistically significant differences, (OR 0.963; 95% CI, 0.602-1.541; p = 0.898), (OR 0.788; 95% CI, 0.467-1.330; p = 0.542), and (OR 0.683; 95% CI, 0.331-1.407; p = 0.630), respectively. Conclusion.There are no differences in patterns of relapse across surgical approaches in patients with stage IB1 cervical cancer undergoing radical hysterectomy as primary treatment.
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Harter, P.; Boria Alegre, Félix; et al.

Título: A comment on a recent failed HIPEC Trial

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.29 N° 5 2022 págs. 3359 - 3360
Autores: Chiva de Agustín, Luis (Autor de correspondencia); González Rodríguez, Marta; Tendobi, C.

Título: Locally advanced vulvar carcinoma diagnosed during cervical cancer screening

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 11 2022 págs. 1492
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Manzour Sifontes, Nabil

Título: ASO author reflections: will conization become a standard maneuver before radical hysterectomy?

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.29 N° 8 2022 págs. 4830 - 4831
Autores: Schwameis, R. (Autor de correspondencia); Chiva de Agustín, Luis; Harter, P.

Título: There is no role for hyperthermic intraperitoneal chemotherapy (HIPEC) in ovarian cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X 2022
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia)

Título: Transvaginal ultrasound versus magnetic resonance imaging in local staging of endometrial cancer

Revista: JOURNAL OF CLINICAL ULTRASOUND

ISSN: 0091-2751 Vol.50 N° 9 2022 págs. 1379 - 1380
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Márquez, R.; Castellanos Alarcón, Teresa

Título: Breast metastases from a serous ovarian carcinoma

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 8 2022 págs. 1086 - 1086
Autores: Murcia Lora, J. M. (Autor de correspondencia); Martínez Martínez, O.; Simoni, J.; et al.

Título: Fertile window and biophysical biomarkers of cervical secretion in subfertile cycles: a look at biotechnology applied to NaProTechnology

Revista: CLINICAL AND EXPERIMENTAL OBSTETRICS AND GYNECOLOGY

ISSN: 0390-6663 Vol.49 N° 1 2022 págs. 017

Resumen

Background: The principal objective of this study was to correlate biophysical properties of vaginal discharge present in the cervical mucus with the timing of the fertile window. In particular, we produce measures of the viscoelasticity of the cervical secretion using two methods. The first uses only the elasticity extracted from the Creighton Model Fertility Care System (CrMs) scale, calculated P-6 ovulation estimated day (OED) with respect to the peak day of the CrMs. The second uses a numerical method that takes into account the changes in viscoelasticity, but without reference to the peak day calculated using the CrMs model. Using both methods, twelve records were obtained from a single female subject. Methods: The methodology used to evaluate the viscoelasticity factor was by measuring the approximate length in centimeters (cm) of the vaginal discharge of cervical discharge. For this, the scale of the stretching graph established by observing the stretching of CrMS was used, taking into account the previous 6 days at peak day P-6. The first method, which we termed CFW (Clinical Fertile Window), uses a measure based on the approximate length (cm) of the maximal stretchiness of the vaginal discharge. The second method we termed SFW (Software-CrMS/strectching) (Software-based Fertile Window). Results: The fertile window was detected correctly in 100% of the cases using either method, and a correlation value of 0.71 was observed between the two methods. Conclusions: We conclude that the assessment of viscoelasticity using SFW algorithm allowed in this pilot study to detect the fertile window and to describe the evolution pattern of cervical discharge throughout the fertile window. Our study provides support for the use of computational methods in detecting the fertile window, taking only into account the time evolution of the cervical discharge throughout the menstrual cycle.
Autores: Chacon Cruz, Enrique Maria; Manzour Sifontes, Nabil; Zanagnolo, V.; et al.

Título: SUCCOR cone study: conization before radical hysterectomy

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 2 2022 págs. 117 - 124

Resumen

Objective To evaluate disease-free survival of cervical conization prior to radical hysterectomy in patients with stage IB1 cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009). Methods A multicenter retrospective observational cohort study was conducted including patients from the Surgery in Cervical Cancer Comparing Different Surgical Aproaches in Stage IB1 Cervical Cancer (SUCCOR) database with FIGO 2009 IB1 cervical carcinoma treated with radical hysterectomy between January 1, 2013, and December 31, 2014. We used propensity score matching to minimize the potential allocation biases arising from the retrospective design. Patients who underwent conization but were similar for other measured characteristics were matched 1:1 to patients from the non-cone group using a caliper width <= 0.2 standard deviations of the logit odds of the estimated propensity score. Results We obtained a weighted cohort of 374 patients (187 patients with prior conization and 187 non-conization patients). We found a 65% reduction in the risk of relapse for patients who had cervical conization prior to radical hysterectomy (hazard ratio (HR) 0.35, 95% confidence interval (CI) 0.16 to 0.75, p=0.007) and a 75% reduction in the risk of death for the same sample (HR 0.25, 95% CI 0.07 to 0.90, p=0.033). In addition, patients who underwent minimally invasive surgery without prior conization had a 5.63 times higher chance of relapse compared with those who had an open approach and previous conization (HR 5.63, 95% CI 1.64 to 19.3, p=0.006). Patients who underwent minimally invasive surgery with prior conization and those who underwent open surgery without prior conization showed no differences in relapse rates compared with those who underwent open surgery with prior cone biopsy (reference) (HR 1.94, 95% CI 0.49 to 7.76, p=0.349 and HR 2.94, 95% CI 0.80 to 10.86, p=0.106 respectively). Conclusions In this retrospective study, patients undergoing cervical conization before radical hysterectomy had a significantly lower risk of relapse and death.
Autores: Esquivel-Villabona, A. L. (Autor de correspondencia); Rodríguez, J. N.; Ayala, N. ; et al.

Título: Two-step strategy for optimizing the preoperative classification of adnexal masses in a university hospital, using international ovarian tumor analysis models: simple rules and assessment of different Neoplasias in the adneXa model

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.41 N° 2 2022 págs. 471 - 482

Resumen

Objectives To evaluate the performance of a two-step strategy compared with the International Ovarian Tumor Analysis (IOTA) - Assessment of Different NEoplasias in the adneXa (ADNEX) model for preoperative classification of adnexal masses. Methods An ambispective diagnostic accuracy study based on ultrasound data collected at one university hospital between 2012 and 2018. Two ultrasonographers classified the adnexal masses using IOTA Simple Rules (first step). Not classifiable masses were evaluated using the IOTA ADNEX model (second step). Also, all masses were classified using the IOTA ADNEX model. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-), and receiver operating characteristic (ROC) curve were estimated. A P value of <.05 was used to determine statistical significance. Results The study included 548 patients and 606 masses. Patients' median age was 41 years with an interquartile range between 32 and 51 years. In the first step, 89 (14%) masses were not classifiable. In the second step, 55 (61.8%) masses were classified as malignant. Furthermore, for the totality of 606 masses, the IOTA ADNEX model estimated the probability that 126 (20.8%) masses were malignant. The two-step strategy had a sensitivity, specificity, PPV, NPV, LR+, LR-, and ROC curve of 86.8%, 91.01%, 51.9%, 98.4%, 9.7, 0.1, and 0.889, respectively; compared to IOTA ADNEX model that had values of 91.8%, 87.16%, 44.4%, 99%, 7.1, 0.09, and 0.895, respectively. Conclusion The two-step strategy shows a similar diagnostic performance when compared to the IOTA ADNEX model. The IOTA ADNEX model involves only one step and can be more practical, and thus would be recommended to use.
Autores: Boria Alegre, Félix; Chiva de Agustín, Luis (Autor de correspondencia); Chacon Cruz, Enrique Maria; et al.

Título: SUCCOR quality: validation of ESGO quality indicators for surgical treatment of cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 10 2022 págs. 1236 - 1243

Resumen

Objective To evaluate whether compliance with European Society of Gynaecological Oncology (ESGO) surgery quality indicators impacts disease-free survival in patients undergoing radical hysterectomy for cervical cancer. Methods In this retrospective cohort study, 15 ESGO quality indicators were assessed in the SUCCOR database (patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 2009 IB1, FIGO 2018 IB1, and IB2 cervical cancer between January 2013 and December 2014), and the final score ranged between 0 and 16 points. Centers with more than 13 points were classified as high-quality indicator compliance centers. We constructed a weighted cohort using inverse probability weighting to adjust for the variables. We compared disease-free survival and overall survival using Cox proportional hazards regression analysis in the weighted cohort. Results A total of 838 patients were included in the study. The mean number of quality indicators compliance in this cohort was 13.6 (SD 1.45). A total of 479 (57.2%) patients were operated on at high compliance centers and 359 (42.8%) patients at low compliance centers. High compliance centers performed more open surgeries (58.4% vs 36.7%, p<0.01). Women who were operated on at centers with high compliance with quality indicators had a significantly lower risk of relapse (HR=0.39; 95% CI 0.25 to 0.61; p<0.001). The association was reduced, but remained significant, after further adjustment for conization, surgical approach, and use of manipulator surgery (HR=0.48; 95% CI 0.30 to 0.75; p=0.001) and adjustment for adjuvant therapy (HR=0.47; 95% CI 0.30 to 0.74; p=0.001). Risk of death from disease was significantly lower in women operated on at centers with high adherence to quality indicators (HR=0.43; 95% CI 0.19 to 0.97; p=0.041). However, the association was not significant after adjustment for conization, surgical approach, use of manipulator surgery, and adjuvant therapy. Conclusions Patients with early cervical cancer who underwent radical hysterectomy in centers with high compliance with ESGO quality indicators had a lower risk of recurrence and death.
Autores: Fotopoulou, C.; Khan, T.; Bracinik, J.; et al.

Título: Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

Revista: AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY

ISSN: 0002-9378 Vol.227 N° 5 2022 págs. 735.e1 - 735.e25

Resumen

BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P<1/4>.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.
Autores: Gastón, B. (Autor de correspondencia); Muruzabal, J. C.; Lapeña, S.; et al.

Título: Transvaginal ultrasound versus magnetic resonance imaging for assessing myometrial infiltration in endometrioid low grade endometrial cancer: a prospective study

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.41 N° 2 2022 págs. 335 - 342

Resumen

Objective To compare the diagnostic accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) for assessing myometrial infiltration (MI) in patients with low grade endometrioid endometrial cancer. Methods Observational prospective study performed at a single tertiary care center from 2016 to 2020, comprising 156 consecutive patients diagnosed by endometrial sampling as having an endometrioid grade 1/grade 2 endometrial cancer. TVS and MRI were performed prior to surgical staging for assessing MI, which was estimated using subjective examiner's impression and Karlsson's method for both TVS and MRI. During surgery, intraoperative assessment of MI was also performed. Definitive pathological study considered as reference standard. Diagnostic accuracy for ultrasound, MRI, and intraoperative biopsy was estimated and compared. Results Sensitivity and specificity of TVS for detecting deep MI were 75 and 73.5% for subjective impression and 65 and 70% for Karlsson method, respectively (P = .54). Sensitivity and specificity of MRI for detecting deep MI were 80 and 87% for subjective impression and 70 and 71.3% for Karlsson method. MRI subjective impression showed a significant better specificity than MRI Karlsson method (P = .03). MRI showed better specificity than TVS when subjective impression was considered (P <.05), but not for Karlsson method. Sensitivity and specificity of intraoperative were 75 and 97%, respectively. Intraoperative biopsy showed better specificity than ultrasound and MRI either using examiner's impression or Karlsson method (P <.05). Conclusions MRI revealed a significant higher specificity than TVS when assessing deep myometrial infiltration. However, the intraoperative biopsy offers a significant better diagnostic accuracy than preoperative imaging techniques.
Autores: Chiva de Agustín, Luis; Knapp, P.; Fotopoulou, C. (Autor de correspondencia)

Título: Perioperative ovarian cancer management: management of bowel related morbidity, prophylactic stoma formation, and stoma reversal

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 12 2022 págs. 1623 - 1625
Autores: Wynants, L. (Autor de correspondencia); Verbakel, J. Y. J.; Valentín, L.; et al.

Título: The risk of endometrial malignancy and other endometrial pathology in women with abnormal uterine bleeding: an ultrasound-based model development study by the IETA group

Revista: GYNECOLOGIC AND OBSTETRIC INVESTIGATION

ISSN: 0378-7346 Vol.87 N° 1 2022 págs. 54 - 61

Resumen

Objectives: The aim of this study was to develop a model that can discriminate between different etiologies of abnormal uterine bleeding. Design: The International Endometrial Tumor Analysis 1 study is a multicenter observational diagnostic study in 18 bleeding clinics in 9 countries. Consecutive women with abnormal vaginal bleeding presenting for ultrasound examination (n = 2,417) were recruited. The histology was obtained from endometrial sampling, D&C, hysteroscopic resection, hysterectomy, or ultrasound follow-up for >1 year. Methods: A model was developed using multinomial regression based on age, body mass index, and ultrasound predictors to distinguish between: (1) endometrial atrophy, (2) endometrial polyp or intracavitary myoma, (3) endometrial malignancy or atypical hyperplasia, (4) proliferative/secretory changes, endometritis, or hyperplasia without atypia and validated using leave-center-out cross-validation and bootstrapping. The main outcomes are the model's ability to discriminate between the four outcomes and the calibration of risk estimates. Results: The median age in 2,417 women was 50 (interquartile range 43-57). 414 (17%) women had endometrial atrophy; 996 (41%) had a polyp or myoma; 155 (6%) had an endometrial malignancy or atypical hyperplasia; and 852 (35%) had proliferative/secretory changes, endometritis, or hyperplasia without atypia. The model distinguished well between malignant and benign histology (c-statistic 0.88 95% CI: 0.85-0.91) and between all benign histologies. The probabilities for each of the four outcomes were over- or underestimated depending on the centers. Limitations: Not all patients had a diagnosis based on histology. The model over- or underestimated the risk for certain outcomes in some centers, indicating local recalibration is advisable. Conclusions: The proposed model reliably distinguishes between four histological outcomes. This is the first model to discriminate between several outcomes and is the only model applicable when menopausal status is uncertain. The model could be useful for patient management and counseling, and aid in the interpretation of ultrasound findings. Future research is needed to externally validate and locally recalibrate the model.
Autores: Verbakel, J. Y. (Autor de correspondencia); Heremans, R.; Wynants, L.; et al.

Título: Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: results from the prospective IETA-1 cohort study

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGY AND OBSTETRICS

ISSN: 0020-7292 Vol.159 N° 1 2022 págs. 103 - 110

Resumen

Objective To investigate the association between personal history, anthropometric features and lifestyle characteristics and endometrial malignancy in women with abnormal vaginal bleeding. Methods Prospective observational cohort assessed by descriptive and multivariable logistic regression analyses. Three features-age, body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters), and nulliparity-were defined a priori for baseline risk assessment of endometrial malignancy. The following variables were tested for added value: intrauterine contraceptive device, bleeding pattern, age at menopause, coexisting diabetes/hypertension, physical exercise, fat distribution, bra size, waist circumference, smoking/drinking habits, family history, use of hormonal/anticoagulant therapy, and sonographic endometrial thickness. We calculated adjusted odds ratio, optimism-corrected area under the receiver operating characteristic curve (AUC), R-2, and Akaike's information criterion. Results Of 2417 women, 155 (6%) had endometrial malignancy or endometrial intraepithelial neoplasia. In women with endometrial cancer median age was 67 years (interquartile range [IQR] 56-75 years), median parity was 2 (IQR 0-10), and median BMI was 28 (IQR 25-32). Age, BMI, and parity produced an AUC of 0.82. Other variables marginally affected the AUC, adding endometrial thickness substantially increased the AUC in postmenopausal women. Conclusion Age, parity, and BMI help in the assessment of endometrial cancer risk in women with abnormal uterine bleeding. Other patient information adds little, whereas sonographic endometrial thickness substantially improves assessment.
Autores: Guerriero, S. (Autor de correspondencia); Pascual, M. A.; Ajossa, S.; et al.

Título: The reproducibility of ultrasonographic findings of rectosigmoid endometriosis among examiners with different level of expertise

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.41 N° 2 2022 págs. 403 - 408

Resumen

Objective To analyze the reproducibility of ultrasonographic (US) findings of rectosigmoid endometriosis among examiners with different level of expertise using stored three-dimensional (3D) volumes of the posterior compartment of the pelvis as a part of SANABA (Sardinia-Navarra-Barcelona) collaborative study. Materials and methods Six examiners in 3 academic Department of Obstetrics and Gynecology, with different levels of experience and blinded to each other, evaluated 60 stored 3D volumes from the posterior compartment of the pelvis and looked for the presence or absence of features of rectosigmoid endometriotic lesions defined as an irregular hypoechoic nodule with or without hypoechoic foci at the level of the muscularis propria of the anterior wall rectum sigma. Multiplanar view and virtual navigation were used. All examiners had to assess the 3D volume of posterior compartment of the pelvis and classify it as present or absent disease. To analyze intra-observer and the inter-observer agreements, each examiner performed the assessment twice with a 2-week interval between the first and second assessments. Reproducibility was assessed by calculating the weighted Kappa index. Results Intra-observer reproducibility was moderate to very good for all observers (Kappa index ranging from 0.49 to 0.96) associated with a good diagnostic accuracy of each reader. Inter-observer reproducibility was fair to very good (Kappa index range: 0.21-0.87). Conclusions The typical US sign of rectosigmoid endometriosis is reasonably recognizable to observers with different level of expertise when assessed in stored 3D volumes.
Autores: García, D.; Iváñez, M.; Salazar, B.; et al.

Título: Myometrial wall thickness ratio-A nomogram reference for diagnosing myometrial wall asymmetry

Revista: JOURNAL OF CLINICAL ULTRASOUND

ISSN: 0091-2751 Vol.50 N° 5 2022 págs. 655 - 659

Resumen

Objective Defining the normal range for the anterior/posterior myometrial wall thickness ratio in a cohort of women without adenomyosis or any other uterine wall anomaly on ultrasound examination. Methods Anterior and posterior miometrial wall thickness was measured in 555 women (mean age 34.6 years old, range: 20-50 years) without any ultrasound findings of adenomiosis or other uterine pathology. Measurements were performed in the longitudinal plane of a stored 3D volume. Two observers made all measurements. The myometrial wall thickness ratio was estimated and distribution by centiles obtained. Correlation of myometrial thickness ratio with patient's age and parity was also estimated, using the Pearson's correlation coefficient. Intra- and inter-observer reproducibility were estimated using the intra-class correlation coefficient (ICC). Results The mean ratio of the myometrial walls thickness (understood as anterior thickness/posterior thickness ratio) was 0.99 (95% CI: 0.96-1.01). The distribution of the ratio by centiles were as follows: 5%: 0.64, 10%: 0.70, 25%: 0.82, 50%: 0.96, 75%: 1.12, 90%: 1.30 and 95%: 1.45). The myometrial wall thickness ratio was not related to patient's age (Pearson's coefficient: 0.039, p = 0.371), neither to patient's parity (Pearson's coefficient: 0.004, p = 0.923). The ICC was 0.94 and 0.88 for observers 1 and 2, respectively. Inter-observer reproducibility was high (ICC: 0.83). Conclusions Myometrial thickness ratio in women with normal uterus at ultrasound examination is about 1. However, centile distribution shows that values as low as 0.64 or as high as 1.45 could be considered as normal.
Autores: Castillo, A.; Huete, M. E.; Errasti Alcalá, Tania; et al.

Título: Maternity after orthotopic liver transplantation: can the use of biological fertility indicators help? Our own experience and literature-based recommendations

Revista: LINACRE QUARTERLY

ISSN: 0024-3639 Vol.89 N° 2 2022 págs. 135 - 151

Resumen

Over the last 5 decades, the fulfillment of maternity wishes in solid organ transplanted women has become a reality. Despite pregnancy contraindication in transplanted women during the early post-transplant period, such a condition can be overcome after 12 months if patients show a good clinical evolution and do not present other general pre-conceptional findings. This article presents the case report of a young female liver transplanted patient that used symptothermal method as a reliable family planning method. After her gestational contraindication was lifted, observation of biological fertility indicators and fertility-guided sexual intercourse helped her fulfill her maternity wish and conceive and carry out a healthy offspring. Based on this case and on the available bibliographic evidence, this paper reviews the potential implications of the use of this kind of approach as a safe and effective alternative to assisted reproduction technology in the management of potential infertility problems in the young female transplanted population, a population which according to literature has higher rates of unsuccessful parenthood and might also be more vulnerable to iatrogenicity of ovarian hyperstimulation process and to multiple pregnancy.
Autores: Manzour Sifontes, Nabil; Chiva de Agustín, Luis (Autor de correspondencia); Chacon Cruz, Enrique Maria; et al.

Título: SUCCOR risk: design and validation of a recurrence prediction index for early-stage cervical cancer

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.29 N° 8 2022 págs. 4819 - 4829

Resumen

Objective Based on the SUCCOR study database, our primary objective was to identify the independent clinical pathological variables associated with the risk of relapse in patients with stage IB1 cervical cancer who underwent a radical hysterectomy. Our secondary goal was to design and validate a risk predictive index (RPI) for classifying patients depending on the risk of recurrence. Methods Overall, 1116 women were included from January 2013 to December 2014. We randomly divided our sample into two cohorts: discovery and validation cohorts. The test group was used to identify the independent variables associated with relapse, and with these variables, we designed our RPI. The index was applied to calculate a relapse risk score for each participant in the validation group. Results A previous cone biopsy was the most significant independent variable that lowered the rate of relapse (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.17-0.60). Additionally, patients with a tumor diameter >2 cm on preoperative imaging assessment (OR 2.15, 95% CI 1.33-3.5) and operated by the minimally invasive approach (OR 1.61, 95% CI 1.00-2.57) were more likely to have a recurrence. Based on these findings, patients in the validation cohort were classified according to the RPI of low, medium, or high risk of relapse, with rates of 3.4%, 9.8%, and 21.3% observed in each group, respectively. With a median follow-up of 58 months, the 5-year disease-free survival rates were 97.2% for the low-risk group, 88.0% for the medium-risk group, and 80.5% for the high-risk group (p < 0.001). Conclusion Previous conization to radical hysterectomy was the most powerful protective variable of relapse. Our risk predictor index was validated to identify patients at risk of recurrence.
Autores: Tendobi, C.; Fernández-Marques, M.; Carlos Chillerón, Silvia; et al.

Título: Validation of a sustainable internationally monitored cervical cancer screening system using a visual smartphone inspection in Kinshasa, Democratic Republic of Congo

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 10 2022 págs. 1244 - 1249

Resumen

Objective To determine the sensitivity, specificity, and positive and negative predictive values of a cervical cancer screening program based on visual inspection with acetic acid and Lugol's iodine using a smartphone in a sub-urban area of very low resources in Kinshasa (Democratic Republic of Congo). Methods This cross-sectional validation study was conducted at Monkole Hospital and it included women between the ages of 25-70 years after announcing a free cervical cancer screening campaign through posters placed in the region of our hospital. Questionnaires collected sociodemographic and behavioral patients characteristics. In the first consultation, we gathered liquid-based cytology samples from every woman. At that time, local health providers performed two combined visual inspection techniques (5% acetic acid and Lugol's iodine) while a photograph was taken with a smartphone. Two international specialists evaluated the results of the smartphone cervicography. When a visual inspection was considered suspicious, patients were offered immediate cryotherapy. Cytological samples were sent to the Pathology Department of the University of Navarra for cytological assessment and human papillomavirus (HPV) DNA genotyping. Results A total of 480 women participated in the study. The mean age was 44.6 years (range 25-65). Of all the patients, only 18.7% were infected with HPV (75% had high-risk genotypes). The most frequent high-risk genotype found was 16 (12.2%). The majority (88%) of women had normal cytology. After comparing combined visual inspection results with cytology, we found a sensitivity of 66.0%, a specificity of 87.8%, a positive predictive value of 40.7%, and a negative predictive value of 95.3% for any cytological lesion. The negative predictive value for high-grade lesions was 99.7%. Conclusions Cervical cancer screening through combined visual inspection, conducted by non-specialized personnel and monitored by experts through smartphones, shows encouraging results, ruling out high-grade cytological lesions in most cases. This combined visual inspection test is a valid and affordable method for screening programs in low-income areas.
Autores: Carrera, M.; Domínguez, J. A.; Pérez-Milán, F.; et al.

Título: Systematic review and meta-analysis of efficacy and safety of r-FSH biosimilars EMA-approved compared to reference r-FSH (follitropin alfa)

Revista: HUMAN REPRODUCTION

ISSN: 0268-1161 Vol.37 N° Supl. 1 2022 págs. I477 - I478
Autores: Vázquez Vicente, Daniel; Boria Alegre, Félix; Castellanos Alarcón, Teresa; et al.

Título: SUCCOR morbidity. Intraoperative and postoperative complications inminimally invasive versus open radical hysterectomy in early cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° Supl. 2 2022 págs. A46
Autores: Fotopoulou, C.; Khan, T.; Bracinik, J.; et al.

Título: OUTCOMES OF GYNAECOLOGICAL CANCER SURGERY DURING THE COVID-19 PANDEMIC: RESULTS FROM THE INTERNATIONAL, MULTICENTER, PROSPECTIVE COVIDSURGGYNAECOLOGICAL CANCER STUDY

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° SUPPL 3 2022 págs. A10

Resumen

Objectives The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. Our aim was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methods A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary outcome: 30-day postoperative SARS-CoV-2 infection rate. Secondary outcomes: 30-day perioperative mortality and morbidity, COVID-19-related treatment modifications. Results We included 3973 patients (52 countries; 7 world regions). Lower-than-reported rate (22/3778; 0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%; p<0.0001) and mortality (18.2% vs 0.7%; p<0.0001), compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/3784), particularly in those with ovarian cancer (213/1355; 15.7%). This delay was associated with a composite of adverse outcomes including disease progression and death (95/424; 22.4% versus 601/3360; 17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430; 7.9%), in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of decisions for surgery. Conclusions One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations- coordinated mitigating strategies are urgently needed.
Autores: Boria Alegre, Félix; Martín Calvo, Nerea; Chacon Cruz, Enrique Maria; et al.

Título: SUCCORr quality: validation of ESGO quality indicators for surgical treatment of cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° Supl. 2 2022 págs. A46
Autores: Berasaluce-Gómez, A.; Chiva de Agustín, Luis; Boria Alegre, Félix; et al.

Título: Sentinel node biopsy diminishes de use of adjuvant therapy in women with early cervical cancer in the SUCCOR cohort

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° Supl. 2 2022 págs. A29
Autores: Guerriero, S.; Martínez, L.; Gómez, I.; et al.

Título: Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.58 N° 5 2021 págs. 669 - 676

Resumen

Objective: To evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard. Methods: A search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. 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 for TVS in the detection of parametrial deep endometriosis were calculated, and the post-test probability of parametrial deep endometriosis following a positive or negative test was determined. Results: The search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10-64%), 98% (95% CI, 95-99%), 18.5 (95% CI, 8.8-38.9) and 0.70 (95% CI, 0.46-1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10-68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post-test probability of parametrial deep endometriosis. Conclusion: TVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis.
Autores: Boned-López, J.; Alcázar Zambrano, Juan Luis (Autor de correspondencia); Errasti Alcalá, Tania; et al.

Título: Severe pain during hysterosalpingo-contrast sonography (HyCoSy): a systematic review and meta-analysis

Revista: ARCHIVES OF GYNECOLOGY AND OBSTETRICS

ISSN: 0932-0067 Vol.304 N° 6 2021 págs. 1389 - 1398

Resumen

Purpose To assess the frequency of severe pain perception during hysterosalpingo-contrast sonography (HyCoSy) in infertile women and to assess whether there are differences in the frequency of associated pain according to the contrast used. Design Systematic review and meta-analysis. Patients Women undergoing HyCoSy due to infertility. Interventions Searches were carried out in two databases (Pubmed and Web of Science). We included prospective or retrospective cohort observational studies that specified the type of contrast used during HyCoSy and reported data regarding the number of patients who perceived severe pain during the procedure and the scale used for pain perception score. Main outcome measures Pooled frequency of severe pain perception during HyCoSy and the pooled frequency of severe pain perception based on the contrast used. Results Twenty-nine studies were included in this meta-analysis including a total of 7139 patients. In 10 studies, Saline solution with air was used as contrast EchoVist (TM) was used in ten studies, in five studies, SonoVue (TM) was used and in four studies, ExEm-Foam (TM) was used as contrast. Pooled estimated frequency of severe pain perception during HyCoSy was 6% (95% CI 4-9). No statistically significant differences have been described regarding frequency of severe pain perception in relation to the different contrasts used. Conclusions HyCoSy is a tolerable outpatient procedure. We did not find any evidence that one specific contrast was better tolerated than any other was.
Autores: Timmerman, D. (Autor de correspondencia); Planchamp, F.; Bourne, T.; et al.

Título: ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 7 2021 págs. 961 - 982

Resumen

The European Society of Gynaecological Oncology (ESGO), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), the International Ovarian Tumour Analysis (IOTA) group, and the European Society for Gynaecological Endoscopy (ESGE) jointly developed clinically relevant and evidence-based statements on the pre-operative diagnosis of ovarian tumors, including imaging techniques, biomarkers, and prediction models. ESGO/ISUOG/IOTA/ESGE nominated a multidisciplinary international group, including expert practising clinicians and researchers who have demonstrated leadership and expertise in the pre-operative diagnosis of ovarian tumors and management of patients with ovarian cancer (19 experts across Europe). A patient representative was also included in the group. To ensure that the statements were evidence-based, the current literature was reviewed and critically appraised. Preliminary statements were drafted based on the review of the relevant literature. During a conference call, the whole group discussed each preliminary statement and a first round of voting was carried out. Statements were removed when a consensus among group members was not obtained. The voters had the opportunity to provide comments/suggestions with their votes. The statements were then revised accordingly. Another round of voting was carried out according to the same rules to allow the whole group to evaluate the revised version of the statements. The group achieved consensus on 18 statements. This Consensus Statement presents these ESGO/ISUOG/IOTA/ESGE statements on the pre-operative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
Autores: Van-den-Bosch, T. (Autor de correspondencia); Van-Schoubroeck, D.; Alcázar Zambrano, Juan Luis; et al.

Título: Importance of transient myometrial contractions in diagnosis of adenomyosis and congenital uterine anomalies

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.57 N° 4 2021 págs. 651 - 653
Autores: Timmerman, D. (Autor de correspondencia); Cibula, D.; Planchamp, F.; et al.

Título: Response to: Correspondence on "ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors" by Thomassin-Nagarra et al

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 10 2021 págs. 1396 - 1397
Autores: Chiva de Agustín, Luis (Autor de correspondencia); González Martín, Antonio

Título: Giant port-site recurrence after laparoscopic-staging for endometrial cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 4 2021 págs. 641 - 641
Autores: Manzour Sifontes, Nabil (Autor de correspondencia); Vázquez Vicente, Daniel; Carriles Rivero, Isabel María; et al.

Título: Intra-operative radiation therapy after a total lateral extended infralevator exenteration for recurrent cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 8 2021 págs. 1188 - 1189
Autores: Boria Alegre, Félix (Autor de correspondencia); Chiva de Agustín, Luis

Título: Three-dimensional computed tomography reconstruction of the para-aortic area in a patient with infrarenal vena cava agenesis

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 12 2021 págs. 1614 - 1614
Autores: Boria Alegre, Félix; Chiva de Agustín, Luis

Título: Role of cardiophrenic lymph node removal in advanced ovarian cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 2 2021 págs. 307 - 307
Autores: Manzour Sifontes, Nabil (Autor de correspondencia); Boria Alegre, Félix; Chiva de Agustín, Luis

Título: Empty pelvis syndrome: is there an easy way?

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.32 N° 1 2021 págs. 114
Autores: Jurado Chacón, Matías (Autor de correspondencia); Chiva de Agustín, Luis

Título: Oncovascular surgery: is it time for a step forward in gynecologic oncology surgery?

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 9 2021 págs. 1315 - 1315
Autores: Vázquez Vicente, Daniel (Autor de correspondencia); Campillo Sánchez, Francisco de Asis; Boria Alegre, Félix; et al.

Título: Double identification of sentinel lymph node with indocyanine green and 99m-technetium in vulvar cancer and V-Y flap for vulvar reconstruction

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 2 2021 págs. 300 - 301
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Chacon Cruz, Enrique Maria

Título: Is Conization a Protective Surgical Maneuver in Early Cervical Cancer?

Revista: ANNALS OF SURGICAL ONCOLOGY

ISSN: 1068-9265 Vol.28 N° 7 2021 págs. 3463-3464
Autores: Guerriero, S. (Autor de correspondencia); Pascual, M. A.; Ajossa, S.; et al.

Título: Artificial intelligence (AI) in the detection of rectosigmoid deep endometriosis

Revista: EUROPEAN JOURNAL OF OBSTETRICS AND GYNECOLOGY AND REPRODUCTIVE BIOLOGY

ISSN: 0301-2115 Vol.261 2021 págs. 29 - 33

Resumen

Objectives: The aim of this study was to compare the accuracy of seven classical Machine Learning (ML) models trained with ultrasound (US) soft markers to raise suspicion of endometriotic bowel involvement. Materials and Methods: Input data to the models was retrieved from a database of a previously published study on bowel endometriosis performed on 333 patients. The following models have been tested: k-nearest neighbors algorithm (k-NN), Naive Bayes, Neural Networks (NNET-neuralnet), Support Vector Machine (SVM), Decision Tree, Random Forest, and Logistic Regression. The data driven strategy has been to split randomly the complete dataset in two different datasets. The training dataset and the test dataset with a 67 % and 33 % of the original cases respectively. All models were trained on the training dataset and the predictions have been evaluated using the test dataset. The best model was chosen based on the accuracy demonstrated on the test dataset. The information used in all the models were: age; presence of US signs of uterine adenomyosis; presence of an endometrioma; adhesions of the ovary to the uterus; presence of "kissing ovaries"; absence of sliding sign. All models have been trained using CARET package in R with ten repeated 10-fold cross-validation. Accuracy, Sensitivity, Specificity, positive (PPV) and negative (NPV) predictive value were calculated using a 50 % threshold. Presence of intestinal involvement was defined in all cases in the test dataset with an estimated probability greater than 0.5. Results: In our previous study from where the inputs were retrieved, 106 women had a final expert US diagnosis of rectosigmoid endometriosis. In term of diagnostic accuracy the best model was the Neural Net (Accuracy, 0.73; sensitivity, 0.72; specificity 0.73; PPV 0.52; and NPV 0.86) but without significant difference with the others. Conclusions: The accuracy of ultrasound soft markers in raising suspicion of rectosigmoid endometriosis using Artificial Intelligence (AI) models showed similar results to the logistic model. (C) 2021 Elsevier B.V. All rights reserved.
Autores: Boria Alegre, Félix (Autor de correspondencia); Rodríguez-Pérez, M.; Vázquez Vicente, Daniel; et al.

Título: Thoracic anatomical landmarks and uniportal VATS cardiophrenic lymph node resection in advanced ovarian cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 5 2021 págs. 793 - 794
Autores: Peixoto, C. (Autor de correspondencia); Castro, M.; Carriles Rivero, Isabel María; et al.

Título: Diagnosing septate uterus using three-dimensional ultrasound using three different classifications: an interobserver and intraobserver agreement study

Revista: REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA

ISSN: 0100-7203 Vol.43 N° 12 2021 págs. 911 - 918

Resumen

Objective Currently, there are up to three different classifications for diagnosing septate uterus. The interobserver agreement among them has been poorly assessed. Objective To assess the interobserver agreement of nonexpert sonographers for classifying septate uterus using the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), American Society for Reproductive Medicine (ASRM), and Congenital Uterine Malformations by Experts (CUME) classifications. Methods A total of 50 three-dimensional (3D) volumes of a nonconsecutive series of women with suspected uterine malformation were used. Two nonexpert examiners evaluated a single 3D volume of the uterus of each woman, blinded to each other. The following measurements were performed: indentation depth, indentation angle, uterine fundal wall thickness, external fundal indentation, and indentation-to-wall-thickness (I:WT) ratio. Each observer had to assign a diagnosis in each case, according to the three classification systems (ESHRE/ESGE, ASRM, and CUME). The interobserver agreement regarding the ESHRE/ESGE, ASRM, and CUME classifications was assessed using the Cohen weighted kappa index (k). Agreement regarding the three classifications (ASRM versus ESHRE/ESGE, ASRM versus CUME, ESHRE/ESGE versus CUME) was also assessed. Results The interobserver agreement between the 2 nonexpert examiners was good for the ESHRE/ESGE (k = 0.74; 95% confidence interval [CI]: 0.55-0.92) and very good for the ASRM and CUME classification systems (k = 0.95; 95%CI: 0.86-1.00; and k = 0.91; 95%CI: 0.79-1.00, respectively). Agreement between the ESHRE/ESGE and ASRM classifications was moderate for both examiners. Agreement between the ESHRE/ESGE and CUME classifications was moderate for examiner 1 and good for examiner 2. Agreement between the ASRM and CUME classifications was good for both examiners. Conclusion The three classifications have good (ESHRE/ESGE) or very good (ASRM and CUME) interobserver agreement. Agreement between the ASRM and CUME classifications was higher than that for the ESHRE/ESGE and ASRM and ESHRE/ESGE and CUME classifications.
Autores: Salas de Sa Fialho, Aina; Gastón, B.; Barrenetxea, J.; et al.

Título: Predictive value of hyperglycosylated human chorionic gonadotropin for pregnancy outcomes in threatened abortion in first-trimester viable pregnancies

Revista: ANALES DEL SISTEMA SANITARIO DE NAVARRA

ISSN: 1137-6627 Vol.44 N° 1 2021 págs. 23 - 31

Resumen

Background. To investigate the value of a single determination of hyperglycosylated hCG (hCG-H) for predicting the clinical outcome of patients with threatened abortion in the first trimester of pregnancy. Methods. Prospective study performed on 86 consecutively selected women with a diagnosis of threatened abortion and viable intrauterine pregnancy in the first trimester of pregnancy, conducted in two tertiary care hospitals. All patients underwent a single blood sample to determine hCG-H and total hCG serum levels and a transvaginal ultrasound 12-24 hours after diagnosis. Patients were monitored to determine whether the outcome was a miscarriage before the 20th week of pregnancy. Results. Forty-three women (50%) had a miscarriage during the follow-up. We observed a very high correlation between hCG-H and total hCG (r = 0.91, p < 0.001). Median hCG-H and total hCG from pregnancies with normal outcome was significantly higher than those ending in abortion. hCG-H and total hCG were very similar predictors of pregnancy outcomes (AUC: 0.90 and 0.89, respectively). The ratio hCG-H / total hCG was a poor predictor (AUC: 0.64). Conclusion. A single hCG-H assay is helpful for predicting pregnancy outcomes in women with first trimester threatened abortion and viable or potentially viable pregnancy at the time of presentation. However, hCG-H is not a better predictor than total hCG.
Autores: Fotopoulou, C. (Autor de correspondencia); Planchamp, F.; Aytulu, T.; et al.

Título: European Society of Gynaecological Oncology guidelines for the peri-operative management of advanced ovarian cancer patients undergoing debulking surgery

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 9 2021 págs. 1199 - 1206

Resumen

The European Society of Gynaecological Oncology (ESGO) developed and established for the first time in 2016, and updated in 2020, quality indicators for advanced ovarian cancer surgery to audit and improve clinical practice in Europe and beyond. As a sequela of the continuous effort to improve oncologic care in patients with ovarian cancer, ESGO issued in 2018 a consensus guidance jointly with the European Society of Medical Oncology addressing in a multidisciplinary fashion 20 selected key questions in the management of ovarian cancer, ranging from molecular pathology to palliation in primary and relapse disease. In order to complement the above achievements and consolidate the promoted systemic advances and surgical expertise with adequate peri-operative management, ESGO developed, as the next step, clinically relevant and evidence-based guidelines focusing on key aspects of peri-operative care and management of complications as part of its mission to improve the quality of care for women with advanced ovarian cancer and reduce iatrogenic morbidity. To do so, ESGO nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of ovarian cancer (18 experts across Europe). To ensure that the guidelines are evidence based, the literature published since 2015, identified from a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 117 independent international practitioners in cancer care delivery and patient representatives.
Autores: Boria Alegre, Félix; Chiva de Agustín, Luis (Autor de correspondencia); Zanagnolo, V.; et al.

Título: Radical hysterectomy in early cervical cancer in Europe: characteristics, outcomes and evaluation of ESGO quality indicators

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 9 2021 págs. 1212 - 1219

Resumen

Introduction Comprehensive updated information on cervical cancer surgical treatment in Europe is scarce. Objective To evaluate baseline characteristics of women with early cervical cancer and to analyze the outcomes of the ESGO quality indicators after radical hysterectomy in the SUCCOR database. Methods The SUCCOR database consisted of 1272 patients who underwent radical hysterectomy for stage IB1 cervical cancer (FIGO 2009) between January 2013 and December 2014. After exclusion criteria, the final sample included 1156 patients. This study first described the clinical, surgical, pathological, and follow-up variables of this population and then analyzed the outcomes (disease-free survival and overall survival) after radical hysterectomy. Surgical-related ESGO quality indicators were assessed and the accomplishment of the stated recommendations was verified. Results The mean age of the patients was 47.1 years (SD 10.8), with a mean body mass index of 25.4 kg/m(2) (SD 4.9). A total of 423 (36.6%) patients had a previous cone biopsy. Tumor size (clinical examination) <2 cm was observed in 667 (57.7%) patients. The most frequent histology type was squamous carcinoma (794 (68.7%) patients), and positive lymph nodes were found in 143 (12.4%) patients. A total of 633 (54.8%) patients were operated by open abdominal surgery. Intra-operative complications occurred in 108 (9.3%) patients, and post-operative complications during the first month occurred in 249 (21.5%) patients, with bladder dysfunction as the most frequent event (119 (10.3%) patients). Clavien-Dindo grade III or higher complication occurred in 56 (4.8%) patients. A total of 510 (44.1%) patients received adjuvant therapy. After a median follow-up of 58 months (range 0-84), the 5-year disease-free survival was 88.3%, and the overall survival was 94.9%. In our population, 10 of the 11 surgical-related quality indicators currently recommended by ESGO were fully fulfilled 5 years before its implementation. Conclusions In this European cohort, the rate of adjuvant therapy after radical hysterectomy is higher than for most similar patients reported in the literature. The majority of centers were already following the European recommendations even 5 years prior to the ESGO quality indicator implementations.
Autores: Kudla, M. J. (Autor de correspondencia); Zikan, M.; Fischerova, D.; et al.

Título: 4D Doppler ultrasound in high grade serous ovarian cancer vascularity evaluation-preliminary study

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.11 N° 4 2021 págs. 582

Resumen

The aim of the study was to evaluate the usefulness of 4D Power Doppler tissue evaluation to discriminate between normal ovaries and ovarian cancer tumors. This was a prospective observational study. Twenty-three cases of surgically confirmed ovarian High Grade Serous Carcinoma (HGSC) were analyzed. The control group consisted of 23 healthy patients, each matching their study-group counterpart age wise (+/- 3 years) and according to their menopausal status. Transvaginal Doppler 4D ultrasound scans were done on every patient and analyzed with 3D/4D software. Two 4D indices-volumetric Systolic/Diastolic Index (vS/D) and volumetric Pulsatility Index (vPI)-were calculated. To keep results standardized and due to technical limitations, virtual 1cc spherical tissue samples taken from the part with highest vascularization as detected by bi-directional Power Doppler were analyzed for both groups of ovaries. Values of volumetric S/D indices and volumetric PI indices were statistically lower in ovarian malignant tumors compared to normal ovaries: 1.096 vs. 1.794 and 0.092 vs. 0.558, respectively (p < 0.001). The 4D bi-directional Power Doppler vascular indices were statistically different between malignant tumors and normal ovaries. These findings could support the rationale for future studies for assessing this technology to discriminate between malignant and benign tumors.
Autores: Boria Alegre, Félix (Autor de correspondencia); Rodríguez Pérez, María; Vázquez Vicente, Daniel; et al.

Título: PleurX indwelling pleural catheter for the treatment of recurrent pleural effusion in advanced ovarian cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.31 N° 4 2021 págs. 635 - 636
Autores: Engels, V. (Autor de correspondencia); Medina, M.; Antolín, E.; et al.

Título: Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study

Revista: JOURNAL OF GYNECOLOGY OBSTETRICS AND HUMAN REPRODUCTION

ISSN: 2468-7847 Vol.50 N° 5 2021 págs. 102004

Resumen

Objective: To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. Methods: This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. Results: Nine hundred fifteen women were included in the ¿nal analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ¿ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. Conclusion: HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.
Autores: Van den Bosch, T. (Autor de correspondencia); Verbakel, J. Y.; Valentin, L.; et al.

Título: Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.57 N° 1 2021 págs. 164 - 172

Resumen

Objective: To describe the ultrasound features of different endometrial and other intracavitary pathologies inpre- and postmenopausal women presenting with abnormal uterine bleeding, using the International Endometrial Tumor Analysis (IETA) terminology. Methods: This was a prospective observational multicenter study of consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler and fluid-instillation sonography were performed. Endometrial sampling was performed according to each center's local protocol. The histological endpoints were cancer, atypical endometrial hyperplasia/endometrioid intraepithelial neoplasia (EIN), endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma and other. For fluid-instillation sonography, the histological endpoints were endometrial polyp, intracavitary leiomyoma and cancer. For each histological endpoint, we report typical ultrasound features using the IETA terminology. Results: The database consisted of 2856 consecutive women presenting with abnormal uterine bleeding. Unenhanced sonography with color Doppler was performed in all cases and fluid-instillation sonography in 1857. In 2216 women, endometrial histology was available, and these comprised the study population. Median age was 49 years (range, 19-92 years), median parity was 2 (range, 0-10) and median body mass index was 24.9 kg/m(2) (range, 16.0-72.1 kg/m(2) ). Of the study population, 843 (38.0%) women were postmenopausal. Endometrial polyps were diagnosed in 751 (33.9%) women, intracavitary leiomyomas in 223 (10.1%) and endometrial cancer in 137 (6.2%). None (0% (95% CI, 0.0-5.5%)) of the 66 women with endometrial thickness < 3 mm had endometrial cancer or atypical hyperplasia/EIN. Endometrial cancer or atypical hyperplasia/EIN was found in three of 283 (1.1% (95% CI, 0.4-3.1%)) endometria with a three-layer pattern, in three of 459 (0.7% (95% CI, 0.2-1.9%)) endometria with a linear endometrial midline and in five of 337 (1.5% (95% CI, 0.6-3.4%)) cases with a single vessel without branching on unenhanced ultrasound. Conclusions: The typical ultrasound features of endometrial cancer, polyps, hyperplasia and atrophy and intracavitary leiomyomas, are described using the IETA terminology. The detection of some easy-to-assess IETA features (i.e. endometrial thickness < 3 mm, three-layer pattern, linear midline and single vessel without branching) makes endometrial cancer unlikely.
Autores: Bermejo López, C.; Puente Águeda, J. M.; Graupera Nicolau, B.; et al.

Título: Diagnóstico ecográfico de las malformaciones uterinas y anomalías del tracto genital inferior

Revista: PROGRESOS DE OBSTETRICIA Y GINECOLOGIA

ISSN: 0304-5013 Vol.64 N° 2 2021 págs. 94 - 105
Autores: Ruiz-Moyano, R. M.; Erasun Mora, D. (Autor de correspondencia); Alcázar Zambrano, Juan Luis; et al.

Título: Doppler color en la fertilización in vitro como predictor de la respuesta ovárica

Revista: PROGRESOS DE OBSTETRICIA Y GINECOLOGIA

ISSN: 0304-5013 Vol.64 N° 6 2021 págs. 211 - 220

Resumen

Objetivo: valoración de la señal Doppler ovárica como predictor de la respuesta ovárica en el tratamiento de la fecundación in vitro. Material y métodos: cohorte prospectiva (n = 62) de pacientes estériles sometidas a tratamiento de estimulación ovárica para la técnica de fecundación in vitro (FIV), medición de técnicas ecográficas no vasculares, de la señal Doppler de vasos ováricos y su análisis estadístico. Resultados: el recuento folicular (RFA) es el predictor más precoz de la respuesta ovárica y del número de ovocitos recuperados, así como el IP promedio de las arterias intraováricas estromales (IP-IOE) siendo significativo el día del control de la supresión hipofisaria. El volumen ovárico (VOM), el IP promedio de las arterias útero-ováricas (IP-UO) y el mapa color (SCOM) se relacionan tardíamente con el número de folículos presentes en el día de la administración de hCG.y que pueden ser considerados marcadores tardíos en un ciclo de FIV. Conclusión: hay parámetros en la ecografía Doppler transvaginal del ovario que son útiles predictores de la respuesta ovárica a la estimulación en el ciclo de fecundación in vitro.
Autores: Gultekin, M. (Autor de correspondencia); Ak, S.; Ayhan, A.; et al.

Título: Perspectives, fears and expectations of patients with gynaecological cancers during the COVID-19 pandemic: A Pan-European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe)

Revista: CANCER MEDICINE

ISSN: 2045-7634 Vol.10 N° 1 2021 págs. 208 - 219

Resumen

Background The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications. Methods A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. Findings We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients' age was 55 years (range: 18-89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3-12) and 8.1 (range: 3.8-13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients' anxiety. Interpretation Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients' communication and education.
Autores: Guerriero, S. (Autor de correspondencia); Conway, F. ; Pascual, M. A. ; et al.

Título: Ultrasonography and atypical sites of endometriosis

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.10 N° 6 2020 págs. 345

Resumen

In the present pictorial we show the ultrasonographic appearances of endometriosis in atypical sites. Scar endometriosis may present as a hypoechoic solid nodule with hyperechoic spots while umbilical endometriosis may appear as solid or partially cystic areas with ill-defined margins. In the case of endometriosis of the rectus muscle, ultrasonography usually demonstrates a heterogeneous hypoechogenic formation with indistinct edges. Inguinal endometriosis is quite variable in its ultrasonographic presentation showing a completely solid mass or a mixed solid and cystic mass. The typical ultrasonographic finding associated with perineal endometriosis is the presence of a solid lesion near to the episiotomy scar. Under ultrasonography, appendiceal endometriosis is characterized by a solid lesion in the wall of the small bowel, usually well defined. Superficial hepatic endometriosis is characterized by a small hypoechoic lesion interrupting the hepatic capsula, usually hyperechoic. Ultrasound endometriosis of the pancreas is characterized by a small hypoechoic lesion while endometriosis of the kidney is characterized by a hyperechoic small nodule. Diaphragmatic endometriosis showed typically small hypoechoic lesions. Only peripheral nerves can be investigated using ultrasound, with a typical solid appearance. In conclusion, ultrasonography seems to have a fundamental role in the majority of endometriosis cases in "atypical" sites, in all the cases where "typical" clinical findings are present.
Autores: Sanin-Ramirez, D. ; Carriles Rivero, Isabel María; Graupera, B. ; et al.

Título: Two-dimensional transvaginal sonography vs saline contrast sonohysterography for diagnosing endometrial polyps: systematic review and meta-analysis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 2020

Resumen

Objective To compare the diagnostic performance of two-dimensional transvaginal sonography (TVS) and saline contrast sonohysterography (SCSH) for the diagnosis of endometrial polyps in studies that used both tests in the same group of patients. Methods This was a systematic review and meta-analysis. An extensive search was conducted of Medline (PubMed), Cochrane Library and Web of Science, for studies comparing the diagnostic performance of TVS and SCSH for identifying endometrial polyps, published between January 1990 and December 2019, that reported a definition of endometrial polyp on TVS and SCSH and used pathologic analysis as the reference standard. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random-effects model was used to determine pooled sensitivity, specificity and positive and negative likelihood ratios of TVS and SCSH in the detection of endometrial polyps. Subanalysis according to menopausal status was performed. Results In total, 1278 citations were identified; after exclusions, 25 studies were included in the meta-analysis. In the included studies, the risk of bias evaluated using QUADAS-2 was low for most of the four domains, except for flow and timing, which had an unclear risk of bias in 13 studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of endometrial polyps were 55.0% (95% CI, 46.0-64.0%), 91.0% (95% CI, 86.0-94.0%), 5.8 (95% CI, 3.9-8.7) and 0.5 (95% CI, 0.41-0.61), respectively. The corresponding values for SCSH were 92.0% (95% CI, 87.0-95.0%), 93.0% (95% CI, 91.0-95.0%), 13.9 (95% CI, 9.9-19.5) and 0.08 (95% CI, 0.05-0.14), respectively. Significant differences were found when comparing the methods in terms of sensitivity (P < 0.001), but not for specificity (P = 0.0918). Heterogeneity was high for TVS and moderate for SCSH. On subanalysis according to menopausal status, SCSH was found to have higher diagnostic accuracy in both pre- and postmenopausal women; sensitivity and specificity did not differ significantly between the groups for either TVS or SCSH. Conclusion Given that SCSH has better diagnostic positive and negative likelihood ratios than does TVS in both pre- and postmenopausal women, those with clinical suspicion of endometrial polyps should undergo SCSH if TVS findings are inconclusive. (c) 2020 International Society of Ultrasound in Obstetrics and Gynecology
Autores: Vázquez Vicente, Daniel (Autor de correspondencia); Castellanos Alarcón, Teresa; Cabello Pérez, Alvaro; et al.

Título: Multidisciplinary approach in the pelvic relapse of a previously irradiated cervical tumor

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 N° 5 2020 págs. 714
Autores: Bogani, G. (Autor de correspondencia); Ghezzi, F.; Chiva de Agustín, Luis; et al.

Título: Patterns of recurrence after laparoscopic versus open abdominal radical hysterectomy in patients with cervical cancer: a propensity-matched analysis

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 N° 7 2020 págs. 987 - 992

Resumen

Objective Recent evidence has suggested that laparoscopic radical hysterectomy is associated with an increased risk of recurrence in comparison with open abdominal radical hysterectomy. The aim of our study was to identify patterns of recurrence after laparoscopic and open abdominal radical hysterectomy for cervical cancer. Methods This a retrospective multi-institutional study evaluating patients with recurrent cervical cancer after laparoscopic and open abdominal surgery performed between January 1990 and December 2018. Inclusion criteria were: age >= 18 years old, radical hysterectomy (type B or type C), no recurrent disease, and clinical follow-up >30 days. The primary endpoint was to evaluate patterns of first recurrence following laparoscopic and open abdominal radical hysterectomy. The secondary endpoint was to estimate the effect of the primary surgical approach (laparoscopy and open surgery) in post-recurrence survival outcomes (event-free survival and overall survival). In order to reduce possible confounding factors, we applied a propensity-matching algorithm. Survival outcomes were estimated using the Kaplan-Meier model. Results A total of 1058 patients were included in the analysis (823 underwent open abdominal radical hysterectomy and 235 patients underwent laparoscopic radical hysterectomy). The study included 117 (14.2%) and 35 (14.9%) patients who developed recurrent cervical cancer after open or laparoscopic surgery, respectively. Applying a propensity matched comparison (1:2), we reduced the population to 105 patients (35 vs 70 patients with recurrence after laparoscopic and open radical hysterectomy). Median follow-up time was 39.1 (range 4-221) months and 32.3 (range 4-124) months for patients undergoing open and laparoscopic surgery, respectively. Patients undergoing laparoscopic radical hysterectomy had shorter progression-free survival than patients undergoing open abdominal surgery (HR 1.98, 95% CI 1.32 to 2.97; p=0.005). Patients undergoing laparoscopic radical hysterectomy were more likely to develop intrapelvic recurrences (74% vs 34%; p<0.001) and peritoneal carcinomatosis (17% vs 1%; p=0.005) than patients undergoing open surgery. Conclusions Patients undergoing laparoscopic radical hysterectomy are at higher risk of developing intrapelvic recurrences and peritoneal carcinomatosis. Further evidence is needed in order to corroborate our findings.
Autores: Esteves Krasteva, I. ; Mínguez Milio, José Ángel; Aramendía Beitia, José Manuel; et al.

Título: Complete cytoreductive surgery, the key factor for survival in advanced ovarian cancer. Experience of an intermediate volume hospital

Revista: EUROPEAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY

ISSN: 0392-2936 Vol.41 N° 6 2020 págs. 906 - 912

Resumen

Introduction: We aimed to analyze the outcome in a series of women with primary advanced ovarian cancer in an Intermediate Volume Hospital where new surgical and chemotherapy treatments were implemented over a period of 14 years. Material and Methods: One hundred and twenty-seven women with stage IIIB-IV disease underwent primary (76.4%) or interval debulking surgery (23.6%). Fifty-seven were operated on from 2000 to 2005 (Group 1) and 70 from 2006 to 2014 (Group 2). Results: No gross residual disease was achieved in 51.5% and 43.3% of women who underwent primary and interval surgery, respectively. For no gross and < 1cm residual disease, median overall and progression-free survival were 94.7 vs. 60.6 months (p = 0.001) and 25.3 vs. 20.0 months, respectively (p = 0.02). The rate of no gross residual (36.8 to 60.0%) and 5-yr median overall survival (56.3 to 73.7 months) increased between 2000-2005 (Group 1) and from 2006 to 2014 (Group 2). On multivariate analysis, interval surgery, multiple peritoneal implants and residual disease were predictive of overall and progression-free survival. Conclusions: Survival after primary and interval debulking surgery progressively correlates with decrease in residual disease. Increasing rates of successful primary surgery are possible through standardization and adoption of best practices without increasing morbidity.
Autores: Lago, V.; Fotopoulou, C.; Chiantera, V.; et al.

Título: Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction

Revista: GYNECOLOGIC ONCOLOGY

ISSN: 0090-8258 Vol.158 N° 3 2020 págs. 603 - 607

Resumen

Objective. To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. Methods. We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. Results. The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intraoperative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. Conclusions. The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients. (c) 2020 Elsevier Inc. All rights reserved.
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Zanagnolo, V.; Querleu, D. ; et al.

Título: SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 N° 9 2020 págs. 1269 - 1277

Resumen

Background Minimally invasive surgery in cervical cancer has demonstrated in recent publications worse outcomes than open surgery. The primary objective of the SUCCOR study, a European, multicenter, retrospective, observational cohort study was to evaluate disease-free survival in patients with stage IB1 (FIGO 2009) cervical cancer undergoing open vs minimally invasive radical hysterectomy. As a secondary objective, we aimed to investigate the association between protective surgical maneuvers and the risk of relapse. Methods We obtained data from 1272 patients that underwent a radical hysterectomy by open or minimally invasive surgery for stage IB1 cervical cancer (FIGO 2009) from January 2013 to December 2014. After applying all the inclusion-exclusion criteria, we used an inverse probability weighting to construct a weighted cohort of 693 patients to compare outcomes (minimally invasive surgery vs open). The first endpoint compared disease-free survival at 4.5 years in both groups. Secondary endpoints compared overall survival among groups and the impact of the use of a uterine manipulator and protective closure of the colpotomy over the tumor in the minimally invasive surgery group. Results Mean age was 48.3 years (range; 23-83) while the mean BMI was 25.7 kg/m(2)(range; 15-49). The risk of recurrence for patients who underwent minimally invasive surgery was twice as high as that in the open surgery group (HR, 2.07; 95% CI, 1.35 to 3.15; P=0.001). Similarly, the risk of death was 2.42-times higher than in the open surgery group (HR, 2.45; 95% CI, 1.30 to 4.60, P=0.005). Patients that underwent minimally invasive surgery using a uterine manipulator had a 2.76-times higher hazard of relapse (HR, 2.76; 95% CI, 1.75 to 4.33; P<0.001) and those without the use of a uterine manipulator had similar disease-free-survival to the open surgery group (HR, 1.58; 95% CI, 0.79 to 3.15; P=0.20). Moreover, patients that underwent minimally invasive surgery with protective vaginal closure had similar rates of relapse to those who underwent open surgery (HR, 0.63; 95% CI, 0.15 to 2.59; P<0.52). Conclusions Minimally invasive surgery in cervical cancer increased the risk of relapse and death compared with open surgery. In this study, avoiding the uterine manipulator and using maneuvers to avoid tumor spread at the time of colpotomy in minimally invasive surgery was associated with similar outcomes to open surgery. Further prospective studies are warranted.
Autores: Eriksson, L. S. E. (Autor de correspondencia); Epstein, E.; Testa, A. C.; et al.

Título: Ultrasound-based risk model for preoperative prediction of lymph-node metastases in women with endometrial cancer: model-development study

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.56 N° 3 2020 págs. 443 - 452

Resumen

Objective: To develop a preoperative risk model, using endometrial biopsy results and clinical and ultrasound variables, to predict the individual risk of lymph-node metastases in women with endometrial cancer. Methods: A mixed-effects logistic regression model for prediction of lymph-node metastases was developed in 1501 prospectively included women with endometrial cancer undergoing transvaginal ultrasound examination before surgery, from 16 European centers. Missing data, including missing lymph-node status, were imputed. Discrimination, calibration and clinical utility of the model were evaluated using leave-center-out cross validation. The predictive performance of the model was compared with that of risk classification from endometrial biopsy alone (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer) or combined endometrial biopsy and ultrasound (high-risk defined as endometrioid cancer Grade 3/non-endometrioid cancer/deep myometrial invasion/cervical stromal invasion/extrauterine spread). Results: Lymphadenectomy was performed in 691 women, of whom 127 had lymph-node metastases. The model for prediction of lymph-node metastases included the predictors age, duration of abnormal bleeding, endometrial biopsy result, tumor extension and tumor size according to ultrasound and undefined tumor with an unmeasurable endometrium. The model's area under the curve was 0.73 (95% CI, 0.68-0.78), the calibration slope was 1.06 (95% CI, 0.79-1.34) and the calibration intercept was 0.06 (95% CI, -0.15 to 0.27). Using a risk threshold for lymph-node metastases of 5% compared with 20%, the model had, respectively, a sensitivity of 98% vs 48% and specificity of 11% vs 80%. The model had higher sensitivity and specificity than did classification as high-risk, according to endometrial biopsy alone (50% vs 35% and 80% vs 77%, respectively) or combined endometrial biopsy and ultrasound (80% vs 75% and 53% vs 52%, respectively). The model's clinical utility was higher than that of endometrial biopsy alone or combined endometrial biopsy and ultrasound at any given risk threshold. Conclusions: Based on endometrial biopsy results and clinical and ultrasound characteristics, the individual risk of lymph-node metastases in women with endometrial cancer can be estimated reliably before surgery. The model is superior to risk classification by endometrial biopsy alone or in combination with ultrasound.
Autores: Ludwin, A.; Coelho Neto, M. A.; Ludwin, I.; et al.

Título: Congenital uterine malformation by experts (CUME): diagnostic criteria for T-shaped uterus

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.55 N° 6 2020 págs. 815 - 829

Resumen

Objectives: To identify uterine measurements that are reliable and accurate to distinguish between T-shaped and normal/arcuate uterus, and define T-shaped uterus, using Congenital Uterine Malformation by Experts (CUME) methodology, which uses as reference standard the decision made most often by several independent experts. Methods: This was a prospectively planned multirater reliability/agreement and diagnostic accuracy study, performed between November 2017 and December 2018, using a sample of 100 three-dimensional (3D) datasets of different uteri with lateral uterine cavity indentations, acquired from consecutive women between 2014 and 2016. Fifteen representative experts (five clinicians, five surgeons and five sonologists), blinded to each others' opinions, examined anonymized images of the coronal plane of each uterus and provided their independent opinion as to whether it was T-shaped or normal/arcuate; this formed the basis of the CUME reference standard, with the decision made most often (i.e. that chosen by eight or more of the 15 experts) for each uterus being considered the correct diagnosis for that uterus. Two other experienced observers, also blinded to the opinions of the other experts, then performed independently 15 sonographic measurements, using the original 3D datasets of each uterus. Agreement between the diagnoses made by the 15 experts was assessed using kappa and percent agreement. The interobserver reliability of measurements 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 by calculating Youden's index, according to the CUME reference standard. Sensitivity, specificity, negative and positive likelihood ratios (LR- and LR+) and post-test probability were calculated. Results: According to the CUME reference standard, there were 20 T-shaped and 80 normal/arcuate uteri. Individual experts recognized between 5 and 35 (median, 19) T-shaped uteri on subjective judgment. The agreement among experts was 82% (kappa = 0.43). Three of the 15 sonographic measurements were identified as having good diagnostic test accuracy, according to the CUME reference standard: lateral indentation angle (AUC = 0.95), lateral internal indentation depth (AUC = 0.92) and T-angle (AUC = 0.87). Of these, T-angle had the best interobserver reproducibility (CCC = 0.87 vs 0.82 vs 0.62 for T-angle vs lateral indentation depth vs lateral indentation angle). The best cut-off values for these measurements were: lateral indentation angle ¿ 130° (sensitivity, 80%; specificity, 96%; LR+, 21.3; LR-, 0.21), lateral indentation depth ¿ 7 mm (sensitivity, 95%; specificity, 77.5%; LR+, 4.2; LR-, 0.06) and T-angle ¿ 40° (sensitivity, 80%; specificity, 87.5%; LR+, 6.4; LR-, 0.23). Most of the experts diagnosed the uterus as being T-shaped in 0% (0/56) of cases when none of these three criteria was met, in 10% (2/20) of cases when only one criterion was met, in 50% (5/10) of cases when two of the three criteria were met, and in 93% (13/14) of cases when all three criteria were met. Conclusions: The diagnosis of T-shaped uterus is not easy; the agreement among experts was only moderate and the judgement of individual experts was commonly insufficient for accurate diagnosis. The three sonographic measurements with cut-offs that we identified (lateral internal indentation depth ¿ 7 mm, lateral indentation angle ¿ 130° and T-angle ¿ 40°) had good diagnostic test accuracy and fair-to-moderate reliability and, when applied in combination, they provided high post-test probability for T-shaped uterus. In the absence of other anomalies, we suggest considering a uterus to be normal when none or only one criterion is met, borderline when two criteria are met, and T-shaped when all three criteria are met. These three CUME criteria for defining T-shaped uterus may aid in determination of its prevalence, clinical implications and best management and in the assessment of post-surgical morphologic outcome. The CUME definition of T-shaped uterus may help in the development of interventional randomized controlled trials and observational studies and in the diagnosis of uterine morphology in everyday practice, and could be adopted by guidelines on uterine anomalies to enrich their classification systems.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Jurado Chacón, Matías; Mínguez Milio, José Ángel; et al.

Título: En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer

Revista: TURKISH-GERMAN GYNECOLOGICAL ASSOCIATION. JOURNAL

ISSN: 1309-0399 Vol.21 N° 3 2020 págs. 156 - 162

Resumen

Objective: "En-bloc" resection of pelvic tumor in ovarian cancer (OC) is still controversial. The aim was to analyze results in an OC series from a single center, all of whom underwent "en-bloc" resection as part of cytoreductive surgery. Material and Methods: Clinical and surgical records from sixty patients with ovarian carcinoma who underwent "en-bloc" resection surgery were retrospectively analyzed. Results: Patients' mean age was 56 years; 36 patients had primary disease and 24 had recurrent disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was performed in 49 and interval debulking surgery in eleven. Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction [odds ratio (OR): 0.22; p=0.021]. Mesorectal infiltration occurred in 83% of patients. Risk of death was non-significantly higher (hazard ratio: 1.9) in women with mesorectal infiltration. Median overall survival was longer for patients without infiltration (46.1 vs 79.1 months; p=0.15). Eighty-five percent suffered from mild to moderate complications and colorectal anastomosis (CRA) leak occurred in two patients (3.6%) with CRA below 6 cm. Diaphragm resection had >5 times the risk for major complications (OR: 5.35; p=0.014). There was no three month mortality. Conclusion: When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with advanced OC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making "en-bloc" resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.
Autores: Verbakel, J. Y.; Mascilini, F.; Wynants, L.; et al.

Título: Validation of ultrasound strategies to assess tumor extension and to predict high-risk endometrial cancer in women from the prospective IETA (International Endometrial Tumor Analysis)-4 cohort

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.55 N° 1 2020 págs. 115 - 124

Resumen

Objectives: To compare the performance of ultrasound measurements and subjective ultrasound assessment (SA) in detecting deep myometrial invasion (MI) and cervical stromal invasion (CSI) in women with endometrial cancer, overall and according to whether they had low- or high-grade disease separately, and to validate published measurement cut-offs and prediction models to identify MI, CSI and high-risk disease (Grade-3 endometrioid or non-endometrioid cancer and/or deep MI and/or CSI). Methods: The study comprised 1538 patients with endometrial cancer from the International Endometrial Tumor Analysis (IETA)-4 prospective multicenter study, who underwent standardized expert transvaginal ultrasound examination. SA and ultrasound measurements were used to predict deep MI and CSI. We assessed the diagnostic accuracy of the tumor/uterine anteroposterior (AP) diameter ratio for detecting deep MI and that of the distance from the lower margin of the tumor to the outer cervical os (Dist-OCO) for detecting CSI. We also validated two two-step strategies for the prediction of high-risk cancer; in the first step, biopsy-confirmed Grade-3 endometrioid or mucinous or non-endometrioid cancers were classified as high-risk cancer, while the second step encompassed the application of a mathematical model to classify the remaining tumors. The 'subjective prediction model' included biopsy grade (Grade 1 vs Grade 2) and subjective assessment of deep MI or CSI (presence or absence) as variables, while the 'objective prediction model' included biopsy grade (Grade 1 vs Grade 2) and minimal tumor-free margin. The predictive performance of the two two-step strategies was compared with that of simply classifying patients as high risk if either deep MI or CSI was suspected based on SA or if biopsy showed Grade-3 endometrioid or mucinous or non-endometrioid histotype (i.e. combining SA with biopsy grade). Histological assessment from hysterectomy was considered the reference standard. Results: In 1275 patients with measurable lesions, the sensitivity and specificity of SA for detecting deep MI was 70% and 80%, respectively, in patients with a Grade-1 or -2 endometrioid or mucinous tumor vs 76% and 64% in patients with a Grade-3 endometrioid or mucinous or a non-endometrioid tumor. The corresponding values for the detection of CSI were 51% and 94% vs 50% and 91%. Tumor AP diameter and tumor/uterine AP diameter ratio showed the best performance for predicting deep MI (area under the receiver-operating characteristics curve (AUC) of 0.76 and 0.77, respectively), and Dist-OCO had the best performance for predicting CSI (AUC, 0.72). The proportion of patients classified correctly as having high-risk cancer was 80% when simply combining SA with biopsy grade vs 80% and 74% when using the subjective and objective two-step strategies, respectively. The subjective and objective models had an AUC of 0.76 and 0.75, respectively, when applied to Grade-1 and -2 endometrioid tumors. Conclusions: In the hands of experienced ultrasound examiners, SA was superior to ultrasound measurements for the prediction of deep MI and CSI of endometrial cancer, especially in patients with a Grade-1 or -2 tumor. The mathematical models for the prediction of high-risk cancer performed as expected. The best strategies for predicting high-risk endometrial cancer were combining SA with biopsy grade and the subjective two-step strategy, both having an accuracy of 80%.
Autores: Ambrosio, M. ; Testa, A. C.; Moro, F. ; et al.

Título: Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST)

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.56 N° 5 2020 págs. 749 - 758

Resumen

Objective: To describe the clinical and sonographic characteristics of extragastrointestinal stromal tumors (eGISTs). Methods: This was a retrospective multicenter study. The data of patients with a histological diagnosis of eGIST who had undergone preoperative ultrasound examination were retrieved from the databases of nine large European gynecologic oncology centers. One investigator from each center reviewed stored images and ultrasound reports, and described the lesions using the terminology of the International Ovarian Tumor Analysis and Morphological Uterus Sonographic Assessment groups, following a predefined ultrasound evaluation form. Clinical, surgical and pathological information was also recorded. Results: Thirty-five women with an eGIST were identified; in 17 cases, the findings were incidental, and 18 cases were symptomatic. Median age was 57 years (range, 21-85 years). Tumor marker CA 125 was available in 23 (65.7%) patients, with a median level of 23 U/mL (range, 7-403 U/mL). The vast majority of eGISTs were intraperitoneal lesions (n = 32 (91.4%)); the remaining lesions were retroperitoneal (n = 2 (5.7%)) or preperitoneal (n = 1 (2.9%)). The most common site of the tumor was the abdomen (n = 23 (65.7%)), and less frequently the pelvis (n = 12 (34.3%)). eGISTs were typically large (median largest diameter, 79 mm) solid (n = 31 (88.6%)) tumors, and were less frequently multilocular-solid tumors (n = 4 (11.4%)). The echogenicity of solid tumors was uniform in 8/31 (25.8%) cases, which were all hypoechogenic. Twenty-three solid eGISTs were non-uniform, either with mixed echogenicity (9/23 (39.1%)) or with cystic areas (14/23 (60.9%)). The tumor shape was mainly lobular (n = 19 (54.3%)) or irregular (n = 10 (28.6%)). Tumors were typically richly vascularized (color score of 3 or 4, n = 31 (88.6%)) with no shadowing (n = 31 (88.6%)). Based on pattern recognition, eGISTs were usually correctly classified as a malignant lesion in the ultrasound reports (n = 32 (91.4%)), and the specific diagnosis of eGIST was the most frequent differential diagnosis (n = 16 (45.7%)), followed by primary ovarian cancer (n = 5 (14.3%)), lymphoma (n = 2 (5.7%)) and pedunculated uterine fibroid (n = 2 (5.7%)). Conclusions: On ultrasound, eGISTs were usually solid, non-uniform pelvic or abdominal lobular tumors of mixed echogenicity, with or without cystic areas, with rich vascularization and no shadowing. The presence of a tumor with these features, without connection to the bowel wall, and not originating from the uterus or adnexa, is highly suspicious for eGIST.
Autores: Van-Calster, B.; Valentin, L.; Froyman, W.; et al.

Título: Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study

Revista: BMJ (ONLINE)

ISSN: 1756-1833 Vol.370 2020 págs. m2614

Resumen

OBJECTIVE To evaluate the performance of diagnostic prediction models for ovarian malignancy in all patients with an ovarian mass managed surgically or conservatively. DESIGN Multicentre cohort study. SETTING 36 oncology referral centres (tertiary centres with a specific gynaecological oncology unit) or other types of centre. PARTICIPANTS Consecutive adult patients presenting with an adnexal mass between January 2012 and March 2015 and managed by surgery or follow-up. MAIN OUTCOME MEASURES Overall and centre specific discrimination, calibration, and clinical utility of six prediction models for ovarian malignancy (risk of malignancy index (RMI), logistic regression model 2 (LR2), simple rules, simple rules risk model (SRRisk), assessment of different neoplasias in the adnexa (ADNEX) with or without CA125). ADNEX allows the risk of malignancy to be subdivided into risks of a borderline, stage I primary, stage II-IV primary, or secondary metastatic malignancy. The outcome was based on histology if patients underwent surgery, or on results of clinical and ultrasound follow-up at 12 (+/- 2) months. Multiple imputation was used when outcome based on follow-up was uncertain. RESULTS The primary analysis included 17 centres that met strict quality criteria for surgical and follow-up data (5717 of all 8519 patients). 812 patients (14%) had a mass that was already in follow-up at study recruitment, therefore 4905 patients were included in the statistical analysis. The outcome was benign in 3441 (70%) patients and malignant in 978 (20%). Uncertain outcomes (486, 10%) were most often explained by limited follow-up information. The overall area under the receiver operating characteristic curve was highest for ADNEX with CA125 (0.94, 95% confidence interval 0.92 to 0.96), ADNEX without CA125 (0.94, 0.91 to 0.95) and SRRisk (0.94, 0.91 to 0.95), and lowest for RMI (0.89, 0.85 to 0.92). Calibration varied among centres for all models, however the ADNEX models and SRRisk were the best calibrated. Calibration of the estimated risks for the tumour subtypes was good for ADNEX irrespective of whether or not CA125 was included as a predictor. Overall clinical utility (net benefit) was highest for the ADNEX models and SRRisk, and lowest for RMI. For patients who received at least one follow-up scan (n=1958), overall area under the receiver operating characteristic curve ranged from 0.76 (95% confidence interval 0.66 to 0.84) for RMI to 0.89 (0.81 to 0.94) for ADNEX with CA125. CONCLUSIONS Our study found the ADNEX models and SRRisk are the best models to distinguish between benign and malignant masses in all patients presenting with an adnexal mass, including those managed conservatively.
Autores: Guerriero, S. (Autor de correspondencia); Ajossa, S.; Pascual, M. A.; et al.

Título: Ultrasonographic soft markers for detection of rectosigmoid deep endometriosis

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.55 N° 2 2020 págs. 269 - 273

Resumen

Objectives: The aim of this study was to evaluate the use of ultrasound (US) soft markers as a first-line imaging tool to raise suspicion of rectosigmoid (RS) involvement in women suspected of having deep endometriosis. Methods: We included in this prospective observational study all patients with clinical suspicion of deep endometriosis who underwent diagnostic transvaginal US evaluation at our unit from January 2016 to February 2017. Several US soft markers were evaluated for prediction of RS involvement (presence of US signs of uterine adenomyosis, presence of an endometrioma, adhesion of the ovary to the uterus (reduced ovarian mobility), presence of 'kissing ovaries' (KO) and absence of the 'sliding sign'), using as the gold standard expert US examination for the presence of RS endometriosis. Results: Included were 333 patients with clinical suspicion of deep endometriosis. Of these, 106 had an US diagnosis of RS endometriosis by an expert. The only significant variables found in the prediction model were absence of the sliding sign (odds ratio (OR), 13.95; 95% CI, 7.7-25.3), presence of KO (OR, 22.5; 95% CI, 4.1-124.0) and the interaction between these two variables (OR, 0.03; 95% CI, 0.004-0.28). Regarding their interaction, RS endometriosis was present when KO was absent and the sliding sign was present in 10% (19/190) of cases, when both KO and the sliding sign were present in 71.4% (5/7) of cases, when both KO and the sliding sign were absent in 60.8% (76/125) of cases and when KO was present and the sliding sign was absent in 54.5% (6/11) of cases. Thus, when the sliding sign was absent and/or KO was present, transvaginal US showed a specificity of 75% (95% CI, 69-80%) and a sensitivity of 82% (95% CI, 73-88%). Conclusions: US findings of absence of the sliding sign and/or presence of KO in patients with clinical suspicion of endometriosis should raise suspicion of RS involvement and indicate referral for expert US examination, with a low rate of false-negative diagnosis.
Autores: Ruiz Zambrana, Álvaro (Autor de correspondencia); Berga, S. L.

Título: A clinician's guide to functional hypothalamic amenorrhea

Revista: CLINICAL OBSTETRICS AND GYNECOLOGY

ISSN: 0009-9201 Vol.63 N° 4 2020 págs. 706 - 719

Resumen

Patients and clinicians alike want to know if stress causes infertility. Stress could impair with reproductive function by a variety of mechanisms, including compromise of ovarian function, spermatogenesis, fertilization, endometrial development, implantation, and placentation. Herein we focus on the pathogenesis and treatment of stress-induced anovulation, which is often termed functional hypothalamic amenorrhea (FHA), with the objective of summarizing the actual knowledge as a clinical guide. FHA is a reversible form of anovulation due to slowing of gonadotropin-releasing hormone pulse frequency that results in insufficient pituitary secretion of gonadotropins to support full folliculogenesis. Importantly, FHA heralds a constellation of neuroendocrine alterations with health concomitants. The activity of the hypothalamic-pituitary-adrenal axis is increased in women with FHA and this observation supports the notion that stress is the cause. The extent of reproductive suppression relates to individual endocrinological and physiological sensitivity to stressors, both metabolic and psychogenic, and chronicity.
Autores: Manzour Sifontes, Nabil; Chacon Cruz, Enrique Maria; Martín Calvo, Nerea; et al.

Título: Design and validation of a recurrence risk predicting score in early stage cervical cancer after radical hysterectomy

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 N° Suppl. 4 2020 págs. A8 - A8
Autores: Raspagliesi, F.; Pinelli, C. ; Ghezzi, F.; et al.

Título: Patterns of recurrence after minimally invasive and open abdominal radical hysterectomy for cervical cancer: A propensity-matched analysis

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.31 N° Suppl.4 2020 págs. S640 - S641
Autores: Boria Alegre, Félix; Vázquez Vicente, Daniel; Castellanos Alarcón, Teresa; et al.

Título: Preoperative measurement of tumor volume in early cervical cancer. Is it reliable?

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 2020 págs. A16 - A17
Autores: Chacon Cruz, Enrique Maria; Manzour Sifontes, Nabil; Mínguez Milio, José Ángel; et al.

Título: Succor cone: is it cervical conization a protective maneuver

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 N° Suppl. 4 2020 págs. A7 - A8
Autores: Sundar, S. S.; Leung, E. ; Khan, T.; et al.

Título: Impact of the covid pandemic on gynaecological cancer surgery - results from the covidsurg gynaecological cancer international study

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 2020 págs. A123 - A124
Autores: Boria Alegre, Félix; Vázquez Vicente, Daniel; Castellanos Alarcón, Teresa; et al.

Título: Radical hysterectomy in early cervical cancer: characteristics and outcomes of a large-controlled european population

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.30 2020 págs. A11 - A11
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Perez, L.; Guell, O. ; et al.

Título: Diagnostic performance of transvaginal ultrasound for detecting cervical invasion in women with endometrial carcinoma: a systematic review and meta-analysis

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.38 N° 1 2019 págs. 179 - 188

Resumen

Objectives To evaluate the role of transvaginal ultrasound (TVUS) for diagnosing cervical invasion in the preoperative assessment of endometrial carcinoma. Methods A search for studies evaluating the role of TVUS for assessing cervical invasion in endometrial carcinoma from January 1990 to December 2016 was performed in the PubMed/MEDLINE, Web of Science, , and . The quality of the studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2. Results We identified 211 citations. Ultimately, 17 studies comprising 1751 women were included. The mean prevalence of cervical invasion was 16.3%. The risk of bias was high in 7 studies for the domains "patient selection" and "index test," whereas it was considered low for the "reference test" domain. Overall, the pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of TVUS for detecting cervical invasion were 63% (95% confidence interval [CI], 51%-74%), 91% (95% CI, 87%-94%), 10.2 (95% CI, 5.7-18.3), and 0.38 (95% CI, 0.28-0.53), respectively. Heterogeneity was high for both sensitivity and specificity. Conclusions Transvaginal ultrasound has acceptable diagnostic performance for detecting cervical invasion in women with endometrial carcinoma.
Autores: Chacon Cruz, Enrique Maria; Dasi, J.; Caballero, C.; et al.

Título: Risk of ovarian malignancy algorithm versus risk malignancy Index-I for preoperative assessment of adnexal masses: a systematic review and meta-analysis

Revista: GYNECOLOGIC AND OBSTETRIC INVESTIGATION

ISSN: 0378-7346 Vol.84 N° 6 2019 págs. 591 - 598

Resumen

Purpose: To perform a systematic review and meta-analysis of studies comparing the diagnostic accuracy of Risk of Ovarian Malignancy Algorithm (ROMA) and risk of malignancy index (RMI) for detecting ovarian cancer. Methods: A systematic review and meta-analysis was performed according to PRISMA statement. A search for studies evaluating the diagnostic performance of ROMA and RMI-I indices for detecting ovarian malignancy from January 2010 to October 2018 was performed in the PubMed/MEDLINE and Web of Science databases. The quality of the studies was evaluated by the Quality Assessment of Diagnostic Accuracy Studies 2. Results: Sixty-six citations were identified. After exclusions, 8 papers comprising 2,662 women (1,319 premenopausal and 1,343 postmenopausal) were ultimately included. The mean prevalence of ovarian malignancy was 29.0% in premenopausal women and 51.0% in postmenopausal women. High risk of bias for patient selection was observed for most studies. ROMA and RMI-I had a similar diagnostic performance in postmenopausal women (pooled sensitivity [87 vs. 77%] and specificity [75 vs. 85%], respectively. p = 0.29). In premenopausal women, RMI-I showed better specificity than ROMA (89 vs. 78%, p = 0.022) with similar sensitivity (73 vs. 80%, p= 0.27). Significant heterogeneity was found for sensitivity and specificity in comparisons of both groups. Conclusions: ROMA and RMI-I have similar diagnostic performance for detecting ovarian cancer in women presenting with an adnexal mass. However, RMI-I showed a higher specificity than ROMA in premenopausal women. Notwithstanding, as the risk of bias is high in most studies, our results should be interpreted with caution.
Autores: Alcázar Zambrano, Juan Luis

Título: Three- /four-dimensional ultrasound for the assessment of ovarian tumors

Revista: DONALD SCHOOL JOURNAL OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0973-614X Vol.13 N° 4 2019 págs. 229 - 235

Resumen

Adnexal masses are a common clinical problem in gynecology. Most adnexal masses are benign, but few of them are malignant. An accurate diagnosis is essential for adequate management. There is a possibility to make a distinction between benign and malignant adnexal masses using two-dimensional grayscale ultrasound (2D-US) and color Doppler ultrasound, which are the best imaging techniques for that purpose. Objective: To review current state-of-art of 3D/4D ultrasound in assessing ovarian masses. Materials and methods: Narrative review of literature published from 1995 to 2017 using 3D/4D ultrasound for assessing adnexal masses masses. Results: Three-dimensional ultrasound (3D-US) has become a routine practice in many gynecologic ultrasound laboratories because it overcomes the limitations of two-dimensional ultrasound (2D-US). This technique allows a surface rendering of the internal aspect of the cyst¿s wall. It can also present the masses in new different ways, such as ¿inversion mode¿ or ¿silhouette mode¿ or it can represent the vascular tree of the tumor using a 3D reconstruction, or even allowing a unique way for estimating the amount of vessels within the tumor or a part of the tumor. The reproducibility of 3D-US performed by different sonographers has been assessed in several studies. All of them have found that this technique is reproducible among different observers. The main limitations of all the studies are a few cases compared to the high prevalence of malignancies. Conclusion: 3D-US probably have better diagnostic performance than 2D-US assessing malignancies in adnexal masses. However, better-designed studies are needed to draw definitive conclusions.
Autores: Chiva de Agustín, Luis (Autor de correspondencia); Cibula, D. ; Querleu, D. ; et al.

Título: Minimally Invasive or Abdominal Radical Hysterectomy for Cervical Cancer

Revista: NEW ENGLAND JOURNAL OF MEDICINE

ISSN: 0028-4793 Vol.380 N° 8 2019 págs. 793 - 794
Autores: Vergote, I. (Autor de correspondencia); Harter, P. ; Chiva de Agustín, Luis

Título: Is There a Role for Intraperitoneal Chemotherapy, Including HIPEC, in the Management of Ovarian Cancer?

Revista: JOURNAL OF CLINICAL ONCOLOGY

ISSN: 0732-183X Vol.37 N° 27 2019 págs. 2420 - +
Autores: Chiva de Agustín, Luis (Autor de correspondencia)

Título: The hook of the humanitarian medicine: an exciting adventure in Congo

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° 1 2019 págs. 221 - 222
Autores: Platero Mihi, Maria; Espinosa Mariscal, Íñigo; Suárez Vega, Victor Manuel; et al.

Título: Early-stage mucinous carcinoma (infiltrative type) of the ovary and fertility preservation

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° 4 2019 págs. 835 - 839
Autores: Ludovisi, M. (Autor de correspondencia); Moro, F.; Pasciuto, T. ; et al.

Título: Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.54 N° 5 2019 págs. 676 - 687

Resumen

Objective To describe the clinical and ultrasound characteristics of uterine sarcomas. Methods This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology. Results We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26-86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91mm (range, 7-321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan-shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color-Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar. Conclusions Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan-shaped shadowing. Most are moderately or very well vascularized. Copyright (C) 2019 ISUOG. Published by John Wiley & Sons Ltd.
Autores: Stukan, M. (Autor de correspondencia); Alcázar Zambrano, Juan Luis; Gebicki, J.; et al.

Título: Ultrasound and clinical preoperative characteristics for discrimination between ovarian metastatic colorectal cancer and primary ovarian cancer: a case-control study

Revista: DIAGNOSTICS

ISSN: 2075-4418 Vol.9 N° 4 2019 págs. 210

Resumen

The aim of this study was to describe the clinical and sonographic features of ovarian metastases originating from colorectal cancer (mCRC), and to discriminate mCRC from primary ovarian cancer (OC). We conducted a multi-institutional, retrospective study of consecutive patients with ovarian mCRC who had undergone ultrasound examination using the International Ovarian Tumor Analysis (IOTA) terminology, with the addition of evaluating signs of necrosis and abdominal staging. A control group included patients with primary OC. Clinical and ultrasound data, subjective assessment (SA), and an assessment of different neoplasias in the adnexa (ADNEX) model were evaluated. Fisher's exact and Student's t-tests, the area under the receiver-operating characteristic curve (AUC), and classification and regression trees (CART) were used to conduct statistical analyses. In total, 162 patients (81 with OC and 81 with ovarian mCRC) were included. None of the patients with OC had undergone chemotherapy for CRC in the past, compared with 40% of patients with ovarian mCRC (p < 0.001). The ovarian mCRC tumors were significantly larger, a necrosis sign was more frequently present, and tumors had an irregular wall or were fixed less frequently; ascites, omental cake, and carcinomatosis were less common in mCRC than in primary OC. In a subgroup of patients with ovarian mCRC who had not undergone treatment for CRC in anamnesis, tumors were larger, and had fewer papillations and more locules compared with primary OC. The highest AUC for the discrimination of ovarian mCRC from primary OC was for CART (0.768), followed by SA (0.735) and ADNEX calculated with CA-125 (0.680). Ovarian mCRC and primary OC can be distinguished based on patient anamnesis, ultrasound pattern recognition, a proposed decision tree model, and an ADNEX model with CA-125 levels.
Autores: Guerriero, S. (Autor de correspondencia); Pascual, M. A.; Ajossa, S.; et al.

Título: Learning curve for ultrasonographic diagnosis of deep infiltrating endometriosis using structured offline training program

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.54 N° 2 2019 págs. 262 - 269

Resumen

Objective To assess the learning curves of trainees during a structured offline/hands-on training program for the ultrasonographic diagnosis of deep infiltrating endometriosis (DIE). Methods Four trainees (all Ob/Gyn postgraduates with at least 5 years' experience in ultrasonography in obstetrics and gynecology, but with no experience of sonographic examination of DIE) participated in the study. They underwent a 2-week training program with a single trainer. Day 1 was devoted to theoretical issues and guided offline analysis of 10 three-dimensional ultrasound volumes. During the following days, four sessions of real-time sonographic examinations were performed in a DIE referral center ultrasound unit. In between these sessions, the trainees analyzed four datasets offline, each containing 25 volumes. At the end of each set, misinterpreted volumes were reassessed with the trainer. Presence or absence of DIE at surgery was considered the gold standard. The trainees' learning process was evaluated by learning-curve cumulative summation (LC-CUSUM) and the deviations of the trainees' level of performance at the control stage was assessed by CUSUM (standard CUSUM), for different locations of DIE. Results The trainees reached competence after an average of 17 (range, 14-21) evaluations for bladder, 40 (range, 30-60) for rectosigmoid, 25 (range, 14-34) for forniceal, 44 (range, 25-66) for uterosacral ligament (USL) and 21 (range, 14-43) for rectovaginal septum (RVS) locations of DIE, and then kept the process under control, with error levels of less than 4.5% until the end of the test. The overall accuracy for each trainee in diagnosis of DIE at the different locations ranged from 0.91 to 0.98 for bladder DIE, from 0.80 to 0.94 for rectosigmoid DIE, from 0.90 to 0.94 for forniceal DIE, from 0.79 to 0.82 for USL DIE and from 0.89 to 0.98 for RVS DIE. Conclusions The suggested 2-week training program, based on a mixture of offline and live scanning sessions, is feasible and apparently provides effective training for the ultrasonographic diagnosis of DIE. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Caparrós Cerdán, María; Arraiza Sarasa, María; et al.

Título: Pre-operative assessment of intra-abdominal disease spread in epithelial ovarian cancer: a comparative study between ultrasound and computed tomography

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° 2 2019 págs. 227 - 233

Resumen

Objective: To compare the diagnostic performance of ultrasound and computed tomography (CT) for detecting pelvic and abdominal tumor spread in women with epithelial ovarian cancer. Methods: An observational cohort study of 93 patients (mean age 57.6 years) with an ultrasound diagnosis of adnexal mass suspected of malignancy and confirmed histologically as epithelial ovarian cancer was undertaken. In all cases, transvaginal and transabdominal ultrasound as well as CT scans were performed to assess the extent of the disease within the pelvis and abdomen prior to surgery. The exploration was systematic, analyzing 12 anatomical areas. All patients underwent surgical staging and/or cytoreductive surgery with an initial laparoscopy for assessing resectability. The surgical and pathological findings were considered as the 'reference standard'. Sensitivity and specificity of ultrasound and CT scanning were calculated for the different anatomical areas and compared using the McNemar test. Agreement between ultrasound and CT staging and the surgical stage was estimated using the weighted kappa index. Results: The tumorous stage was International Federation of Gynecology and Obstetrics (FIGO) stage I in 26 cases, stage II in 11 cases, stage III in 47 cases, and stage IV in nine cases. Excluding stages I and IIA cases (n=30), R0 (no macroscopic residual disease) was achieved in 36 women (62.2%), R1 (macroscopic residual disease <1cm) was achieved in 13 women (25.0%), and R2 (macroscopic residual disease >1cm) debulking surgery occurred in three women (5.8%). Eleven patients (11.8%) were considered not suitable for optimal debulking surgery during laparoscopic assessment. Overall sensitivity of ultrasound and CT for detecting disease was 70.3% and 60.1%, respectively, and specificity was 97.8% and 93.7%, respectively. The agreement between radiological stage and surgical stage for ultrasound (kappa index 0.69) and CT (kappa index 0.70) was good for both techniques. Overall accuracy to determine tumor stage was 71% for ultrasound and 75% for CT. Conclusion: Detailed ultrasound examination renders a similar diagnostic performance to CT for assessing pelvic/abdominal tumor spread in women with epithelial ovarian cancer.
Autores: Froyman, W.; Landolfo, C.; De Cock, B. ; et al.

Título: Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study

Revista: LANCET ONCOLOGY

ISSN: 1470-2045 Vol.20 N° 3 2019 págs. 448 - 458

Resumen

Background Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified as benign by use of ultrasonography. Methods In the international, prospective, cohort International Ovarian Tumor Analysis Phase 5 (IOTA5) study, patients aged 18 years or older with at least one adnexal mass who had been selected for surgery or conservative management after ultrasound assessment were recruited consecutively from 36 cancer and non-cancer centres in 14 countries. Follow-up of patients managed conservatively is ongoing at present. In this 2-year interim analysis, we analysed patients who were selected for conservative management of an adnexal mass judged to be benign on ultrasound on the basis of subjective assessment of ultrasound images. Conservative management included ultrasound and clinical follow-up at intervals of 3 months and 6 months, and then every 12 months thereafter. The main outcomes of this 2-year interim analysis were cumulative incidence of spontaneous resolution of the mass, torsion or cyst rupture, or borderline or invasive malignancy confirmed surgically in patients with a newly diagnosed adnexal mass. IOTA5 is registered with ClinicalTrials.gov, number NCT01698632, and the central Ethics Committee and the Belgian Federal Agency for Medicines and Health Products, number S51375/B32220095331, and is ongoing. Findings Between Jan 1, 2012, and March 1, 2015, 8519 patients were recruited to IOTA5. 3144 (37%) patients selected for conservative management were eligible for inclusion in our analysis, of whom 221 (7%) had no follow-up data and 336 (11%) were operated on before a planned follow-up scan was done. Of 2587 (82%) patients with follow-up data, 668 (26%) had a mass that was already in follow-up at recruitment, and 1919 (74%) presented with a new mass at recruitment (ie, not already in follow-up in the centre before recruitment). Median follow-up of patients with new masses was 27 months (IQR 14-38). The cumulative incidence of spontaneous resolution within 2 years of follow-up among those with a new mass at recruitment (n=1919) was 20.2% (95% CI 18.4-22.1), and of finding invasive malignancy at surgery was 0.4% (95% CI 0.1-0.6), 0.3% (< 0.1-0.5) for a borderline tumour, 0.4% (0.1-0.7) for torsion, and 0.2% (< 0.1-0.4) for cyst rupture. Interpretation Our results suggest that the risk of malignancy and acute complications is low if adnexal masses with benign ultrasound morphology are managed conservatively, which could be of value when counselling patients, and supports conservative management of adnexal masses classified as benign by use of ultrasound.
Autores: Juez Viana, Leire; Núñez Córdoba, Jorge María; Couso, N.; et al.

Título: Hypopressive technique versus pelvic floor muscle training for postpartum pelvic floor rehabilitation: A prospective cohort study

Revista: NEUROUROLOGY AND URODYNAMICS

ISSN: 0733-2467 Vol.38 N° 7 2019 págs. 1924 - 1931

Resumen

Aims: Abdominal hypopressive technique (AHT) is gaining popularity as an alternative to pelvic floor muscle training (PFMT) during postpartum. Although, there is no solid evidence for its recommendation. Methods: We conducted a prospective observational cohort study in a university hospital with 105 primiparae who performed a two-month PFMT or AHT program. The aim was to compare the effectiveness of both treatments in terms of morphofunctional changes in 3D transperineal ultrasound, manometry, dynamometry, and differences in urinary incontinence symptoms (ICIQ-IU-SF) and satisfaction. Results: The average change in levator ani muscle was 1.2 mm higher in AHT group vs PFMT (95% confidence interval [CI], -2.2 to -0.2; P = .017). No statistically significant differences were shown in maximal strength changes between groups. After AHT, basal tone change was 63.0 g/cm(2) higher than PFMT (95% CI, -129 to 2.9; P = .06). A statistically significant reduction in ICIQ-IU-SF was observed after both treatments [(PFMT, -0.8 points; 95% CI, -1.4 to -0.1; P = .015), (AHT, -0.7 points; 95% CI, -1.3 to -0.1; P = .018]. AHT showed a higher median satisfaction score than PFMT (P = .004). Conclusions: This preliminary study is the first that analyses the effect of AHT vs PFMT during postpartum. The results suggest a higher improve for AHT in levator muscle thickness and satisfaction compared to PFMT. These must be considered with caution due to the limitations of the study. Further randomized clinical trials about both techniques during postpartum are required.
Autores: Hidalgo, J. J.; Ros, F.; Auba Guedea, María; et al.

Título: Prospective external validation of IOTA three¿step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two¿step strategy using simple¿rules risk

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.53 N° 5 2019 págs. 693 - 700

Resumen

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.
Autores: Garcia Prado, Javier; Gonzalez Hernando, Concepcion; Varillas Delgado, David; et al.

Título: Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: Diagnostic performance in correlation with surgical findings

Revista: EUROPEAN JOURNAL OF RADIOLOGY

ISSN: 1872-7727 Vol.121 2019
Autores: Germanova, Anna; Raspagliesi, Francesco; Chiva de Agustín, Luis; et al.

Título: Oncological outcome of surgical management in patients with recurrent uterine cancer-a multicenter retrospective cohort study-CEEGOG EX01 Trial

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1525-1438 Vol.29 N° 4 2019 págs. 711-720
Autores: Subtil Íñigo, José Carlos; Alcázar Zambrano, Juan Luis (Autor de correspondencia); Betes Ibáñez, María Teresa; et al.

Título: Gastrointestinal endoscopic ultrasound-guided fine-needle aspiration for assessing suspected deep pelvic or abdominal recurrence in gynecologic cancer: a feasibility study

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.38 N° 3 2019 págs. 761 - 765

Resumen

Objectives To assess the feasibility of gastrointestinal endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) for histologic confirmation of cancer recurrence in women with gynecologic cancer. Methods This work was a retrospective cohort study comprising 46 consecutive women treated for gynecologic cancer and suspected of having a deep pelvic or abdominal recurrence on ultrasound imaging, computed tomography, positron emission tomography-computed tomography, or magnetic resonance imaging, evaluated at our institution from January 2010 to December 2017. Primary cancer was ovarian (n = 22), cervical (n = 13), endometrial (n = 4), sarcoma (n = 4), and other (n = 3). All women underwent EUS examinations for locating the lesion and guiding FNA. The results of FNA (benign/malignant) were assessed. Procedure-related complications were recorded. Results The patients' mean age was 57.8 years. A total of 66 procedures were performed. Eleven women underwent 2 procedures; 2 women underwent 3 procedures; and 1 woman underwent 6 procedures at different times during the study period. In 1 case, no lesion was detected on the EUS assessment, and in 2 cases, FNA was not successful. Most lesions were located in the retroperitoneum or involved the intestine. Fine-needle aspiration could be performed in 63 cases (94.5%). Cytologic samples were adequate in 62 of 63 (98.4%). Recurrence was confirmed in 56 cases (90.3%) and ruled out in 6 (9.7%). No patient had any complication related to the procedure. Conclusions Endoscopic ultrasound-guided FNA is a minimally invasive, feasible, and safe technique for confirming pelvic/abdominal recurrence of gynecologic cancer.
Autores: Manzour Sifontes, Nabil; Chacon Cruz, Enrique Maria; Areta, I.; et al.

Título: Assessment of cervical volume at 19-22 weeks for predicting a prolonged pregnancy

Revista: DONALD SCHOOL JOURNAL OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0973-614X Vol.13 N° 3 2019 págs. 99 - 102

Resumen

Objective: To determine whether the transvaginal ultrasonographic measurement of the cervical volume at 19¿22 weeks could predict a post-term pregnancy. Materials and methods: This work involves a retrospective case¿control study comprising 44 women who delivered beyond 41 weeks and 87 women who delivered at term (37¿40 + 6 weeks), matched by age and parity. All of them had undergone cervical length measurement and cervical volume estimation at 19¿22 weeks. Results: Patients¿ median of age was 35 years in term gestations and 34.5 years in prolonged pregnancies (p= 0.313). The mean of gestational age during delivery in the term gestation group was 275.41 days vs 289.34 days on prolonged gestations (p < 0.001). We did not observe differences in the mean cervical volume between term delivery (37.37 cm3, 95% CI: 34.59¿40.14) and those who had post-term delivery (38.06 cm3, 95% CI: 33.34¿42.77) (p = 0.788). In addition, we did not find differences in the median cervical length (39.0 mm vs 37.0 mm) (p= 0.610). Conclusion: It seems that there is no relationship between the cervical volume measured in the ultrasound of 20-week gestation and the prolongation of pregnancy beyond week 41.
Autores: Ledent, E.; Gabutti, G.; de Bekker-Grob, E. W.; et al.

Título: Attributes influencing parental decision-making to receive the Tdap vaccine to reduce the risk of pertussis transmission to their newborn - outcome of a cross-sectional conjoint experiment in Spain and Italy

Revista: HUMAN VACCINES & IMMUNOTHERAPEUTICS

ISSN: 2164-5515 Vol.15 N° 5 2019 págs. 1080 - 1091

Resumen

Pertussis vaccination of parents and household contacts ('cocooning') to protect newborn infants is an established strategy in many countries, although uptake may be low. Many aspects may influence such decision-making. We conducted a cross-sectional survey (NCT01890447) of households and other close contacts of newborns aged <= 6 months (or of expectant mothers in their last trimester) in Spain and Italy, using an adaptive discrete-choice experiment questionnaire. Aims were to assess the relative importance of attributes influencing vaccine adoption, and to estimate variation in vaccine adoption rates and the impact of cost on vaccination rates. Six hundred and fifteen participants (Spain, n = 313; Italy, n = 302) completed the survey. Of 144 available questionnaire scenarios, the most frequently selected (14% of respondents in both countries) were infant protection by household vaccination at vaccination center, recommendation by family physician and health authorities, with information available on leaflets and websites. The attribute with highest median relative importance was 'reduction in source of infection' in Spain (23.1%) and 'vaccination location' in Italy (18.8%). Differences between other attributes were low in both countries, with media attributes showing low importance. Over 80% of respondents indicated a definite or probable response to vaccine adoption (at no-cost) with estimated probability of adoption of 89-98%; applying vaccine costs (25euro per person) would reduce the probability of uptake by 7-20% in definite/probable respondents. Awareness of these determinants is helpful in informing Health Authorities and healthcare practitioners implementing a cocooning strategy for those populations where maternal immunization is not a preferred option.
Autores: Minig, L. (Autor de correspondencia); de Santiago, J.; Domingo, S.; et al.

Título: Optimization of surgical treatment of advanced ovarian cancer: a Spanish expert perspective

Revista: CLINICAL & TRANSLATIONAL ONCOLOGY

ISSN: 1699-3055 Vol.21 N° 5 2019 págs. 656 - 664

Resumen

BackgroundOptimal upfront treatment of patients with advanced ovarian cancer is complex and requires the adequate function of a multidisciplinary team. Specific standard of quality of care needs to be taken into consideration.MethodsA literature search in PubMed was performed using the following criteria: (ovarian neoplasms[MeSH Terms] OR (ovarian[All Fields] AND neoplasms[All Fields]) OR ovarian neoplasms[All Fields] OR (ovarian[All Fields] AND cancer[All Fields]) OR ovarian cancer[All Fields])[Date - Publication]: 2018/01/14[Date - Publication]).ResultsThis article describes how to optimize the surgical management of advanced ovarian cancer, to achieve the best results in terms of survival and quality of life. For this purpose, this document will cover aspects related to pre-, intra- and postoperative care of newly diagnosed advanced ovarian cancer patients.ConclusionOptimizing upfront treatment of patients with advanced ovarian cancer is complex and requires a structured quality management program including the wise judgment of a multidisciplinary team. Surgeries performed by gynecologic oncologists with formal training in cytoreductive techniques at referral centers are crucial factors to obtain better clinical and oncological outcomes. However, other factors such as the patient's clinical status, the hospital infrastructure and equipment, as well as the tumor biology of each individual patient should also be taken into account before deciding on an initial therapeutic st
Autores: Chiva de Agustín, Luis; Zanagnolo, V. ; Kucukmetin, A. ; et al.

Título: Succor study. An international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 (FIGO 2009, < 4 CM) cervical cancer operated in 2013-2014

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° Supl. 4 2019 págs. A1 - A2
Autores: Vázquez Vicente, Daniel; Cabello Pérez, Alvaro; Cambeiro Vázquez, Felix Mauricio; et al.

Título: Anterior infra levator exenteration plus colpectomy and intraoperative radiation for recurrent cervical cancer

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° Supl. 4 2019 págs. A653
Autores: Fischerova, D.; Ambrosio, M. ; Testa, A. C. ; et al.

Título: Clinical and ultrasound features of extra gastrointestinal stromal tumors (EGIST)

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° Supl. 4 2019 págs. A288
Autores: Gaston, B.; Alcázar Zambrano, Juan Luis; Muruzabal, J. C.; et al.

Título: Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial invasion in patients with endometrial cancer: prospective study

Revista: INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER

ISSN: 1048-891X Vol.29 N° Supl. 4 2019 págs. A324
Autores: Mora, J. J. H. (Autor de correspondencia); Llop, N. R.; Bernal, F. R.; et al.

Título: Classification systems and prediction of risk of malignancy of the adnexal masses

Revista: CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA

ISSN: 0210-573X Vol.45 N° 1 2018 págs. 24 - 31

Resumen

The diagnosis of an adnexal mass is a common problem in gynaecological consultation. The main objective of an adnexal mass evaluation is the diagnosis or exclusion of malignancy. This is the case because ovarian cancer is the most lethal gynaecological neoplasia and appropriate initial surgery is one of the main prognostic factors. Ultrasound scans continue to be the best method of classifying an adnexal mass. If there is any suspicion of a malignant tumour, the patient must be referred to a specialist gynaecological oncology centre. However, if there is any suspicion of a benign tumour, watchful waiting or minimally invasive surgery may be indicated. The objective of this article is to carry out a review of the most important and widely used classification systems of adnexal masses, analysing their methodology and the results of their application in the main validation studies published to date. (c) 2017 Elsevier Espana, S.L.U. All rights reserved.
Autores: Vergote, I. (Autor de correspondencia); Chiva de Agustín, Luis; du Bois, A.

Título: Hyperthermic intraperitoneal chemotherapy in ovarian cancer

Revista: NEW ENGLAND JOURNAL OF MEDICINE

ISSN: 0028-4793 Vol.378 N° 14 2018 págs. 1362 - 1363
Autores: Fotopoulou, C. (Autor de correspondencia); Sehouli, J.; Mahner, S.; et al.

Título: HIPEC: HOPE or HYPE in the fight against advanced ovarian cancer?

Revista: ANNALS OF ONCOLOGY

ISSN: 0923-7534 Vol.29 N° 8 2018 págs. 1610 - 1613
Autores: Vázquez Vicente, Daniel (Autor de correspondencia); del Bas, B. F. ; Villayzan, J. G.; et al.

Título: Retroperitoneal laparoscopic para-aortic lymphadenectomy in para-aortic staging of locally advanced cervical cancer

Revista: JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY

ISSN: 1553-4650 Vol.25 N° 7 2018 págs. 1142 - 1143
Autores: Harter, P. (Autor de correspondencia); du Bois, A.; Sehouli, J. ; et al.

Título: Is there a role for HIPEC in ovarian cancer?

Revista: ARCHIVES OF GYNECOLOGY AND OBSTETRICS

ISSN: 0932-0067 Vol.298 N° 5 2018 págs. 859 - 860

Resumen

Hyperthermic intraperitoneal chemotherapy (HIPEC) is promoted by some as a standard treatment for peritoneal carcinomatosis of epithelial ovarian cancer (EOC) and other tumor entities, despite lack of robust data supporting this. Publicly available evidence addressing the value of HIPEC in EOC is rather inconclusive, revealing contradictory and inconsistent results while some studies even report harm to the patients from a higher morbidity. On this ground, we cannot recommend the implementation and use of HIPEC outside of a randomized clinical trial setting.
Autores: Alcázar Zambrano, Juan Luis (Autor de correspondencia); Bonilla, L.; Marucco, J. ; et al.

Título: Risk of endometrial cancer and endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness >= 11 mm: A systematic review and meta-analysis

Revista: JOURNAL OF CLINICAL ULTRASOUND

ISSN: 0091-2751 Vol.46 N° 9 2018 págs. 565 - 570

Resumen

Purpose To evaluate the risk of endometrial cancer and/or endometrial hyperplasia with atypia in asymptomatic postmenopausal women with endometrial thickness >= 11 mm. Methods Results Systematic review of literature using database search (PubMed and Web of Science) of articles published between January 1990 and December 2016 evaluating the correlation between endometrial thickness as measured by transvaginal ultrasound (double layer) and histopathological findings in asymptomatic postmenopausal women, using the following terms: "endometrial thickness," "postmenopausal," "postmenopause," and "asymptomatic." Inclusion criteria were prospective or retrospective studies of more than 150 cases that provided information on endometrial thickness and its correlation with histopathological data. Studies that included patients with hormone replacement therapy, tamoxifen, or aromatase inhibitors were excluded. The overall relative risk (RR) for EC/EHA was calculated, stratifying the patients into two groups according to endometrial thickness (<11 mm and >= 11 mm). Heterogeneity was assessed by calculating I-2. The search identified 289 studies. After exclusions, nine articles that met all the inclusion criteria were included, comprising data from 4751 women. The prevalence of endometrial cancer and/or endometrial hyperplasia with atypia was 2.4%. The relative risk of endometrial cancer and/or endometrial hyperplasia with atypia in the >= 11 mm group was 2.59 (95% CI: 1.66-4.05). High heterogeneity was observed between studies (I-2: 57.3%, P = .016). Conclusions Overall the risk for EC/EHA was 2.6 times greater in women with ET >= 11 mm vs women with ET 5-10 mm, although there was significant heterogeneity in estimates across studies.
Autores: Coelho Neto, M. A.; Ludwin, A. ; Borrell, A.; et al.

Título: Counting ovarian antral follicles by ultrasound: a practical guide

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.51 N° 1 2018 págs. 10 - 20

Resumen

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.
Autores: Chiva de Agustín, Luis; Pagan, J. I.; Lopez, I.; et al.

Título: The effects of sediment used in beach nourishment: Study case El Portet de Moraira beach

Revista: SCIENCE OF THE TOTAL ENVIRONMENT

ISSN: 1879-1026 Vol.628-629 2018 págs. 64-73
Autores: Epstein, E. (Autor de correspondencia); Fischerova, D.; Valentin, L.; et al.

Título: Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.51 N° 6 2018 págs. 818 - 828

Resumen

Objective To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. Methods This was a prospective multicenter study of 1714 women with biopsy-confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high-end ultrasound equipment. Clinical and sonographic data were entered into a web-based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c-statistic. Results In total, 1538 women were included in the final analysis. Median age was 65 (range, 27-98) years, median body mass index was 28.4 (range 16-67) kg/m(2), 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High-risk tumors, compared with low-risk tumors, were less likely to have regular endometrial-myometrial junction (difference of -23%; 95% CI, -27 to -18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non-uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). Conclusion Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high- and low-risk endometrial cancer. Copyright (c) 2017 ISUOG. Published by John Wiley & Sons Ltd.
Autores: Ludwin, A. ; Martins, W. P. (Autor de correspondencia); Nastri, C. O.; et al.

Título: Congenital Uterine Malformation by Experts (CUME): better criteria for distinguishing between normal/arcuate and septate uterus?

Revista: ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

ISSN: 0960-7692 Vol.51 N° 1 2018 págs. 101 - 109

Resumen

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.
Autores: Green, R. W. (Autor de correspondencia); Valentin, L.; Alcázar Zambrano, Juan Luis; et al.

Título: Endometrial cancer off-line staging using two-dimensional transvaginal ultrasound and three-dimensional volume contrast imaging: Intermethod agreement, interrater reliability and diagnostic accuracy

Revista: GYNECOLOGIC ONCOLOGY

ISSN: 0090-8258 Vol.150 N° 3 2018 págs. 438 - 445

Resumen

Objectives. The aim is to estimate agreement between two-dimensional transvaginal ultrasound (2D-TVS) and three-dimensional volume contrast imaging (3D-VCI) in diagnosing deep myometrial invasion (MI) and cervical stromal involvement (CSI) of endometrial cancer and to compare the two methods regarding inter-rater reliability and diagnostic accuracy. Methods. Fifteen ultrasound experts assessed off-line de-identified 3D-VCI volumes and 2D-1VU video clips from 58 patients with biopsy-confirmed endometrial cancer regarding the presence of deep (>= 50%) MI and CSI. Video clips and 3D volumes were assessed independently. Interrater reliability was measured using kappa statistics. Histological diagnosis after hysterectomy served as gold standard. Accuracy measurements were correlated to rater experience using Spearman's rank correlation coefficient (rho). Results. Agreement between 2D-TVU and 3D-VCI for diagnosing MI was median 76% (range 64-93%) and for CSI median 88% (range 79-97%). Interrater reliability was better for 2D-TVU than for 3D-VCI (Fleiss' kappa 0.41 vs. 0.31 for MI and 0.55 vs. 0.45 for CSI). Median accuracy for diagnosing deep MI was 76% (range 59-84%) with 2D-TVU and 69% (range 52-83%) for 3D-VCI; the corresponding figures for CSI were 88% (range 81-93%) and 86% (range 72-95%). Accuracy was significantly correlated to how many cases the raters assessed annually. Conclusions. Off-line assessment of MI and CSI in women with endometrial cancer using 3D-VCI has lower interrater reliability and lower accuracy than 2D-1VU video clip assessment. Since accuracy was correlated to the number of cases assessed annually it is advised to centralize these examinations to high-volume centres. (C) 2018 Elsevier Inc. All rights reserved.
Autores: Padilla-Iserte, P.; Minig, L.; Zapardiel, I.; et al.

Título: Current situation in gynecological oncology training in Spain: where we are and where we want to go

Revista: CLINICAL & TRANSLATIONAL ONCOLOGY

ISSN: 1699-3055 Vol.20 N° 4 2018 págs. 517-523
Autores: Guerriero, S.; Alcázar Zambrano, Juan Luis; Pascual, M. A.; et al.

Título: Deep infiltrating endometriosis: comparison between 2-dimensional ultrasonography (US), 3-dimensional US, and magnetic resonance imaging

Revista: JOURNAL OF ULTRASOUND IN MEDICINE

ISSN: 0278-4297 Vol.37 N° 6 2018 págs. 1511 - 1521

Resumen

ObjectivesTo evaluate the diagnostic accuracy of 2-dimensional (2D) and 3-dimensional (3D) transvaginal ultrasonography (US) in comparison with magnetic resonance imaging (MRI) for identification of deep infiltrating endometriosis. MethodsIn this prospective observational study, 159 premenopausal women who underwent surgery for a clinical suspicion of deep infiltrating endometriosis were prospectively enrolled. All women underwent 2DUS, 3DUS, and MRI. The following 3 locations of deep endometriosis were considered: (1) intestinal; (2) other posterior lesions (retrocervical septum, rectovaginal septum, uterosacral ligaments, and vaginal fornix); and (3) anterior. The sensitivity, specificity, positive predictive value, and negative predictive value of 2D and 3D transvaginal US in comparison with MRI were determined. ResultsIntestinal deep infiltrating endometriosis was identified by 2DUS in 56 of 66 patients, by 3DUS in 59 of 66, and by MRI in 61 of 66. A receiver operating characteristic curve analysis showed optimal results for 2DUS, 3DUS, and MRI (areas under the curve, 0.86, 0.915, and 0.935, respectively) with a statistically significant difference between 2DUS and MRI (P=.0103), even when the 95% confidence interval showed an overlap. Other posterior deep infiltrating endometriosis was identified by 2DUS in 55 of 75 patients, by 3DUS in 65 of 75, and by MRI in 66 of 75. A receiver operating characteristic curve analysis showed very good results for 2DUS, 3DUS, and MRI (areas under the curve, 0.801, 0.838, and 0.857) with no statistically significant differences. In the 12 women with deep infiltrating endometriosis in the anterior location, the nodules were correctly identified by 2DUS in 3 of 12 patients, by 3DUS in 5 of 12, and by MRI in 6 of 12. ConclusionsOur results seem to suggest that there is a statistically significant difference between 2DUS and MRI for the intestinal location of deep infiltrating endometriosis, whereas no differences were found among the techniques for the other locations.
Autores: Vázquez Vicente, Daniel (Autor de correspondencia); del Bas, B. F.; Villayzan, J. G. ; et al.

Título: Laparoscopic paraaortic surgical staging in locally advanced cervical cancer: a single-center experience

Revista: CLINICAL AND TRANSLATIONAL ONCOLOGY

ISSN: 1699-048X Vol.20 N° 11 2018 págs. 1455 - 1459

Resumen

BackgroundOne aim of this study was to assess the efficacy and safety of laparoscopic paraaortic lymphadenectomy for paraaortic lymph node staging in locally advanced cervical carcinoma. The second aim was to identify prognostic factors in the evolution of this disease and to evaluate how the results of the surgery modify the oncological treatment of patients.Materials and methodsWe analyzed 59 patients diagnosed with locally advanced cervical cancer International Federation of Gynecology and Obstetrics stage IB2-IVA who underwent laparoscopic paraaortic lymphadenectomy at our hospital between 2009 and 2015. Depending on the results of the paraaortic lymphadenectomy, treatment consisted of pelvic- or extended-field chemoradiotherapy.ResultsThe mean age at diagnosis was 52.3years. The median operative time was 180min. The mean hospital stay was 1.7days. The mean number of paraaortic lymph nodes excised was 16.4. Eight patients (13.5%) had positive paraaortic lymph nodes. Thirteen patients (22%) underwent surgery via the transperitoneal route, and 46 (78%) underwent surgery via the retroperitoneal route. The sensitivity and specificity of computerized axial tomography (CT) scanning for detecting paraaortic lymph node involvement was 75 and 86%, respectively. The statistically significant prognostic factors that affected survival were surgical paraaortic lymph node involvement, radiological pelvic lymph node involvement, and radiological tumor size as assessed with nuclear magnetic resonance. The rate of serious complications was 1.7%.ConclusionsPretherapeutic laparoscopic paraaortic lymphadenectomy for locally advanced cervical carcinoma allows the adaption of radiotherapy fields to avoid false-positive and false-negative imaging results.

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Título: Papel de la resonancia magnética y de los marcadores séricos CA-125 y HE-4 en la evaluación de las masas anexiales "indeterminadas" según ecografía convencional

Código de expediente: PI17/01326

Investigador principal: JUAN LUIS ALCAZAR ZAMBRANO.

Financiador: INSTITUTO DE SALUD CARLOS III

Convocatoria: AES2017 PROYECTOS DE INVESTIGACIÓN

Fecha de inicio: 01-01-2018

Fecha fin: 31-12-2021

Importe concedido: 62.920,00€

Otros fondos: Fondos FEDER

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