[Show abstract][Hide abstract] ABSTRACT: Uterine cervical cancer is the second most frequent gynecological malignancy worldwide. The assessment of the extent of disease is essential for planning optimal treatment. Imaging techniques are increasingly used in the pre-treatment work-up of cervical cancer. Currently, MRI for local extent of disease evaluation and PET-scan for distant disease assessment are considered as first-line techniques. Notwithstanding, in the last few years, ultrasound has gained attention as an imaging technique for evaluating women with cervical cancer. In this paper, current knowledge about the use of ultrasound for assessing uterine cervical cancer will be reviewed and discussed.
Journal of obstetrics and gynaecology of India 10/2014; 64(5):311-6.
[Show abstract][Hide abstract] ABSTRACT: Objective
To evaluate the contribution of 3D power Doppler angiography (3D –PDA) for the differential diagnosis of adnexal masses.Methods
This is a prospective study (January 2009 - December 2013) in a university tertiary hospital comprising all women diagnosed as having a persistent adnexal mass and scheduled for surgery. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol. Transabdominal ultrasound was also performed in some instances. First morphological evaluation was performed using the mode B "pattern recognition" (first step). Lesions diagnosed as having a benign pattern were considered as low risk for malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as high risk of malignancy. In both cases no further test was performed. Tumors with solid components but without signs of ascites or carcinomatosis were considered as intermediate risk of malignancy. These lesions were assessed using 2D Doppler power (2D-PDA) to evaluate tumor vascularization (color score) (second step). Lesions with color score 1 or color score 2 in cases of a solid tumor were considered as benign and no further test was performed, whereas tumors with color score 2,3 or 4 within solid components or color score 3 or 4 in case of solid tumor were considered as malignant. The latter group underwent 3D-PDA (third step) assessment. The vascularity index (VI) was calculated in a 1-cc sphere of the most vascularized area of the tumor. When a VI ≥ 24.015 % was found the tumor was considered as malignant. All masses were surgically removed and histological diagnosis definitive used as gold-standard. The sensitivity and specificity for each strategy is calculated and compared. In case of bilateral tumor, only the most suspicious was used for analysis.Results367 masses in 367 women (mean age 45.8 years, range: 11–81 years) were evaluated during the study period. 86 masses were malignant and 281 benign. The sensitivity and specificity for each strategy was as follows: One-step: 97.7% and 78.6%, respectively; Two-step: 94.2% and 97.9%, respectively (p < 0.001 for specificity as compared with one-step) and Three-step: 90.7% and 98.9, respectively (N.S. as compared with two-step)Conclusions
The addition of the 2D-PDA significantly increases the specificity whereas sensitivity remains high. The addition of 3D-PDA does not provide additional information and does not improve diagnostic performance.
Ultrasound in Obstetrics and Gynecology 09/2014; · 3.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: The objective of this study was to assess whether there are differences on ultrasound features between epithelial ovarian cancer (EOC) type I and type II. METHODS: This was a retrospective study comprising 244 women (mean age, 55.2 years old) with histologically proven EOC treated at our institution over a 12-year period. Clinical (patient age and symptoms and tumor stage), ultrasound (tumor volume, tumor appearance on gray-scale ultrasound, and color score), and histopathologic records were reviewed. Tumors were classified as EOC type I or type II. Type I tumors comprise low-grade serous, low-grade endometrioid, clear cell, mucinous, and transitional cell carcinomas, whereas type II tumors comprise high-grade serous, high-grade endometrioid, malignant mixed mesodermal tumors, and undifferentiated carcinomas. Categorical variables were compared using χ test. Continuous variables were compared using 1-way analysis of variance with Bonferroni post hoc test or Mann-Whitney U or Kruskal-Wallis test, depending on data distribution. RESULTS: Sixty-seven women (27.5%) had type I EOC, and 177 (72.3%) had type II EOC. We observed that women with type I EOC were younger, presented asymptomatic at diagnosis more frequently, and had lower CA-125 levels and lower tumor stage than women with type II EOC. Type II EOCs were more frequently identified as a solid mass and were smaller lesions than type I EOC. CONCLUSIONS: Some differences exist between type I and type II EOC in clinical and ultrasound manifestations. Although the clinical significance of these findings is still to be determined, this information could provide some clues to clinicians faced with the diagnosis of ovarian cancer.
International Journal of Gynecological Cancer 03/2013; · 1.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to assess whether a single determination of the serum cancer antigen 125 (CA-125) level provides additional information to sonography for specific diagnosis of benign adnexal masses in premenopausal women.
We conducted a retrospective study comprising 1058 premenopausal women (mean age, 34.8 years) with histologically proven benign adnexal masses. All women had undergone transvaginal sonography and serum CA-125 determination within 1 week before surgery and tumor removal. According to "pattern recognition" analysis, a presumptive diagnosis was provided on gray scale transvaginal sonography for all masses. Positive and negative likelihood ratios were calculated for gray scale sonography and gray scale sonography plus CA-125.
Eighty-five women had bilateral masses (1143 masses analyzed). In 7 women with bilateral masses, the histologic diagnoses of the masses were discordant and were excluded. Histologic diagnoses were as follows: endometrioma, n = 452; dermoid cyst, n = 180; serous cyst, n = 158; hemorrhagic cyst, n = 119; mucinous cyst, n = 54; hydrosalpinx, n = 37; and other, n = 109. The median CA-125 level was significantly higher in endometrioma (71.9 IU/mL; range: 5-2620 IU/mL) and hydrosalpinx (59.2 IU/mL; range, 5-601 IU/mL) compared to all other tumor types (P < .001). The CA-125 level was 35 IU/mL or higher in 74% of endometriomas, 58% of hydrosalpinges, 34% of hemorrhagic cysts, 18% of mucinous cysts, 14% of dermoid cysts, and 8% of serous cysts. The positive and negative likelihood ratios for sonography and sonography plus CA-125 (335 IU/mL) for each kind of tumor were not statistically different except for endometrioma, for which the positive likelihood ratio for sonography plus CA-125 (55.0; 95% confidence interval, 27.5-109.9) was significantly higher than for sonography alone (19.2; 95% confidence interval, 13.6-27.1).
Cancer antigen 125 screening does not add useful information for specific diagnosis of benign adnexal tumors, except for endometrioma. An elevated CA-125 level significantly increases the probability of such a lesion.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 10/2011; 30(10):1381-6. · 1.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Vaginal evisceration is a rare gynecologic complication with less than 100 cases reported in the literature. We present a case of vaginal evisceration in a woman with multiple previous surgeries including a sacrocolpopexy. Vaginal mesh grafts have to be applied properly during sacrocolpopexy.
International Urogynecology Journal 05/2011; 22(12):1597-9. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of the mode of delivery (vaginal or cesarean section) on survival, morbidity, and long-term psychomotor development of extremely low birth weight (ELBW) infants.
A longitudinal observational study including 138 ELBW infants (73 born by c-section and 65 vaginally) was conducted. We analyzed the survival and short-term morbidity. We also studied the long-term neurocognitive and motor development using the McCarthy Scales of Children's Abilities (MSCA).
Mortality was significantly higher in newborns delivered vaginally (49.3%) than those delivered by c-section (23.1%). Newborns delivered vaginally had a higher incidence of retinopathy and peri-intraventricular hemorrhage (P-IVH). Children who died had lower gestational age at birth and lower birth weight. After multivariate analysis only birth weight, gestational age at birth and P-IVH were independently associated to mortality. Regarding the long-term evaluation (MSCA), we observed that children born by c-section had lower incidence of abnormal results.
The mode of delivery does not affect survival. Cesarean section provides lower morbidity and better prognosis for neurodevelopment long-term outcome in ELBW infants.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 03/2011; 24(10):1235-8. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the correlation between intratumoral vascularization using three-dimensional power Doppler angiography (3D-PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma.
Ninety-nine women (mean age, 61.7 (range, 31-84) years) diagnosed as having endometrial cancer were assessed by transvaginal 3D-PDA before surgical staging. Endometrial volume (EV) and 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL) method. All patients were surgically staged. Individual tumor features such as histological type, tumor grade, myometrial infiltration depth, lymph-vascular space involvement, cervical involvement, lymph node metastases and tumor stage were considered for analysis. Multivariate logistic regression (MLR) analysis was used to determine which 3D-PDA parameters were independently associated with each histological characteristic.
MLR analysis showed that only EV and VI were independently associated with myometrial infiltration (EV: odds ratio (OR), 1.119 (95% CI, 1.025-1.221), P = 0.012; VI: OR, 1.127 (95% CI, 1.063-1.195), P = 0.001) and tumor stage (EV: OR, 1.103 (95% CI, 1.012-1.202), P = 0.025; VI: OR, 1.120 (95% CI, 1.057-1.187), P = 0.001), only VI was independently associated with tumor grade (OR, 1.056 (95% CI, 1.023-1.091), P = 0.001) and only EV was independently associated with lymph node metastases (OR, 1.086 (95% CI, 1.017-1.161), P = 0.001).
3D-PDA analysis of tumor vascularization in endometrial cancer correlates with some prognostic histological characteristics.
Ultrasound in Obstetrics and Gynecology 03/2010; 35(6):723-9. · 3.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.
Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology.
One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant.
Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.
Ultrasound in Obstetrics and Gynecology 07/2008; 32(2):220-5. · 3.56 Impact Factor