S Guerriero

University Hospital of Parma, Parma, Emilia-Romagna, Italy

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Publications (237)691.78 Total impact

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    ABSTRACT: Background:To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3.Methods:This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery.Results:The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917-0.942), 0.918 (0.905-0.930), 0.914 (0.886-0.936) and 0.875 (0.853-0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90-96%, specificity 74-79% and diagnostic odds ratio (DOR) 32.8-50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6-75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5.Conclusions:This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference.British Journal of Cancer advance online publication 17 June 2014; doi:10.1038/bjc.2014.333 www.bjcancer.com.
    British journal of cancer. 06/2014;
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    ABSTRACT: Several imaging options are available today to diagnose endometriosis. Currently, the two techniques most used are sonography and magnetic resonance imaging (MRI). Three-dimensional (3D) sonography has proved to be particularly sensitive in the diagnosis of endometriosis. In recent years, MRI has emerged as a high reproducible method to explore endometriosis; moreover, its capability to evaluate tissue signal is an extremely powerful system in the differential diagnosis with other pathologies and for the identification of malignant degeneration. The purpose of this paper is to present the state-of-the-art of MRI of endometriosis by performing a review of the literature and showing the epidemiology, pathogenesis, and classification of endometriosis. In this work, the technique that should be used, MR findings of endometriosis and the principles of differential diagnosis are explained.
    Acta Radiologica 03/2014; · 1.33 Impact Factor
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    ABSTRACT: In the use of 'tenderness-guided' transvaginal ultrasound, is the diagnostic accuracy of three-dimensional (3D) ultrasonography better than two-dimensional (2D) ultrasonography in the identification of deep endometriosis? Three-dimensional ultrasonography has a significantly higher diagnostic accuracy in the diagnosis of posterior locations of deep endometriosis without intestinal involvement, such as the uterosacral ligaments, vaginal and rectovaginal endometriosis. The only previous study of the diagnosis of posterior compartment endometriosis reported an poor sensitivity of 3D ultrasonography for uterosacral and sigmoid colon involvement. This diagnostic test study included 202 patients scheduled for surgery because of clinical suspicion of deep pelvic endometriosis and was carried out between January 2009 and September 2012. Modified transvaginal ultrasonography was performed on all of the women by a single examiner. Two locations of deep endometriosis were considered: intestinal involvement and other posterior lesions (including vaginal location, rectovaginal septum and uterosacral ligaments). Once the 2D ultrasonography had been performed, the 3D acquisition was performed and the obtained volume was stored. To avoid the risk of recall bias, the same operator evaluated the 3D volumes 6 months after the last examination using virtual navigation to provide a presumptive diagnosis of the presence and localization of deep endometriosis. In addition, to evaluate the reproducibility of 3D, two operators with different levels of expertise performed a retrospective review of 3D volumes from a random sample of 35 patients, twice, 1 week apart to also assess intraobserver agreement. The diagnostic performance of both tests was expressed as area under the receiver-operating characteristics curve (AUC), sensitivity, specificity, positive and negative predictive values, positive (LR+) and negative (LR-) likelihood ratios, with their respective 95% confidence interval (CI). Reproducibility was evaluated using kappa statistics. Surgery revealed deep endometriosis in 129 patients. The AUCs for endometriosis of intestinal location were similar for both ultrasound techniques. The AUCs for endometriosis of other posterior locations were significantly different (0.891, 95% CI 0.839-0.943 for 3D versus 0.789, 95% CI 0.720-0.858 for 2D; P = 0.0193). For the intestinal involvement, the specificity, sensitivity, positive and negative predictive value, and LR+ and LR- were 93% (89-95%), 95% (88-98%), 89% (83-92%), 97% (93-99%), 13, and 0.06, respectively, for 2D ultrasound and 97% (93-99%), 91% (84-94%), 95% (88-98%), 95% (91-96%), 25, and 0.09, respectively, for 3D ultrasound. For other posterior locations, the specificity, sensitivity, positive and negative predictive value, and LR+ and LR- were 88% (82-93%), 71% (64-77%), 83% (75-90%), 79% (74-83%), 6.10, 0.32, respectively, for 2D ultrasound and 94% (89-97%), 87% (81-91%), 92% (86-96%), 90% (85-93%), 14.0, 0.14, respectively, for 3D ultrasound. Intraobserver agreement was substantial for both examiners (kappa 0.8754, for operator A and 0.7087, for operator B, respectively). Interobserver agreement was also substantial. The disadvantages of 3D ultrasound to be considered are the necessity of newer ultrasonographic equipment and that fewer sonographers completely know the 3D technique. There are also some limitations within this study. First, an expert examiner performed the real-time ultrasound and 3D volume acquisitions. Second, the same operator also performed the 3D evaluations but at least 6 months after the last acquisition to avoid a possible recall bias. The diagnostic performance obtained in the present study is superior to the accuracy reported in other studies of 3D ultrasonography, but not superior to all other published articles of 2D ultrasonography. The reported high diagnostic accuracy of 3D ultrasound could be widely generalizable because good reproducibility was demonstrated even with an operator with less expertise. This study was supported in part by the Regione Autonoma della Sardegna (project code CPR-24750).
    Human Reproduction 03/2014; · 4.67 Impact Factor
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  • edited by Luca Saba× U. Rajendra Acharya× Stefano Guerriero× Jasjit S. Suri, 01/2014; Springer., ISBN: 10: 1461486327
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    Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
  • Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2013; 42(s1). · 3.56 Impact Factor
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    ABSTRACT: To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis. Sixty-five patients (mean age 33; range 19-45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR-). The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834. Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations. • Magnetic resonance imaging (MRI) is increasingly used to assess endometriosis • The diagnostic confidence of observers varies according to the location of endometriosis • The diagnosis is more difficult to establish by MRI in some anatomical locations • Specific training should be given concerning those locations that cause difficulty.
    European Radiology 09/2013; · 4.34 Impact Factor
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    ABSTRACT: To analyze the reproducibility of the IOTA simple ultrasound rules for classifying adnexal masses as benign or malignant among examiners with different level of expertise using stored 3D volumes of adnexal masses. Five examiners, with different levels of experience and blinded to each other, evaluated 100 stored 3D volumes from adnexal masses and looked for the presence or absence of malignant or benign features according to the IOTA definitions. Multiplanar view and virtual navigation were used. All examiners had to assess the 3D volume of each adnexal mass and classify it as benign or malignant. To analyze intra-observer agreement each examiner performed the assessment twice with a two-week interval between the first and second assessments. To analyze the inter-observer agreement, the second assessment from each examiner was used. Reproducibility was assessed calculating the weighted Kappa index. Intra-observer reproducibility was moderate or good for all observers (Kappa index ranging from 0.59 to 0.74). Inter-observer reproducibility was moderate to good (Kappa index range: 0.46-0.67). The simple rules are reasonably reproducible among observers with different level of expertise when assessed in stored 3D volumes.
    European journal of obstetrics, gynecology, and reproductive biology 08/2013; · 1.97 Impact Factor
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    ABSTRACT: To describe the clinical history and ultrasound findings in patients with tubal carcinoma. Patients with a histological diagnosis of tubal cancer who had undergone preoperative ultrasound examination were identified from the databases of 11 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed together all available digital ultrasound images and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings. We identified 79 women with a histological diagnosis of primary tubal cancer, 70 of whom (89%) had serous carcinomas and 46 (58%) presented at FIGO stage III. Forty-nine (71%) women were asymptomatic (incidental finding), whilst the remaining 30 complained of abdominal bloating or pain. Fifty-three (67%) tumors were described as solid at ultrasound examination, 14 (18%) as multilocular-solid, ten (13%) as unilocular-solid, two (3%) as unilocular. No tumor was described as a multilocular mass. Most tumors (70/79, 89%) were moderately or very well vascularized on color or power Doppler ultrasound. Normal ovarian tissue was identified adjacent to the tumor in 39/77 (51%) of cases. Three types of ultrasound appearance were identified as being typical of tubal carcinoma using pattern recognition: a sausage shaped cystic structure with solid tissue protruding into it like a papillary projection (11/62, 18%); a sausage shaped cystic structure with a large solid component filling part of the cyst cavity (13/62, 21%); an ovoid or oblong completely solid mass (36/62, 58%). A well vascularized ovoid or sausage shaped structure either completely solid or with large solid component(s) in the pelvis should raise the suspicion of tubal cancer, especially if normal ovarian tissue is seen adjacent to it.
    Ultrasound in Obstetrics and Gynecology 07/2013; · 3.56 Impact Factor
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    ABSTRACT: Objectives- The aim of this study was to evaluate the interobserver agreement for diagnosis of deep endometriosis of the rectovaginal septum using introital 3-dimensional (3D) sonography. Methods- Two experienced observers (observers A and B) performed a retrospective review of stored 3D sonographic volumes from a sample of 84 consecutive patients with a clinical suspicion of endometriosis. Each observer, independently and blinded to each other, evaluated the presence or absence of involvement of the rectovaginal septum. When no lesion was seen, the observers were asked to judge whether the acquisition of the volume was suboptimal for interpretation or whether no lesion on the rectovaginal septum was detectable. One inadequate acquisition case was discarded; a total of 83 cases were evaluated. To calculate the performance of introital 3D sonography, 7 discordant cases were reviewed by a third observer. Interobserver agreement was assessed by calculating the κ index, and the sensitivity, specificity, positive predictive value, and negative predictive value for the 3 observers were also determined. Results- Interobserver agreement was 0.816 (95% confidence interval, 0.69-0.93), representing very good agreement. Sensitivity was 74.1%; specificity, 85.7%; positive predictive value, 71.4%; and negative predictive value, 87.3%. Conclusions- Our results show that introital 3D sonography for diagnosis of deep endometriosis of the rectovaginal septum is reproducible, with very good interobserver agreement.
    Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2013; 32(6):931-935. · 1.40 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine the diagnostic performance of simple rules for discriminating between benign and malignant adnexal masses. METHODS: A prospective study was performed between January 2011 and June 2012. Eligible patients were all women diagnosed as having a persistent adnexal mass. Four trainees evaluated the adnexal mass by transvaginal ultrasound under the supervision of an expert examiner. The trainee had to analyze the mass according to IOTA simple rules providing a diagnosis of malignant, benign or inconclusive. All women ultimately included underwent surgery and tumor removal in the center of recruitment. Diagnostic performance was assessed by calculating the sensitivity and specificity as well as positive (LR+) and negative (LR-) likelihood ratios. RESULTS: 340 women were included (patients' mean age: 42.1 years, range: 13 to 79). Fifty-five (16.2%) tumors were malignant and 285 (83.8%) were benign. Simple rules could be applied in 270 (79.4%). Sensitivity, specificity, LR+ and LR- in those 270 cases in which the rules could be applied were 87.9% (95%CI 72.4% to 95.2%), 97.5% (95%CI 94.6% to 98.8%), 34.7 (95%CI 15.6 to 77.3) and 0.12 (95%CI 0.05 to 0.31), respectively. CONCLUSIONS: Simple rules perform acceptably well in terms of specificity in hands of non-expert examiners. However, non-experts examiners had a 12% false-negative rate, which is relatively high.
    Ultrasound in Obstetrics and Gynecology 04/2013; · 3.56 Impact Factor
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    ABSTRACT: The imaging techniques have a fundamental role in the diagnosis of endometriosis. Ovarian endometriosis (endometrioma) and deep endometriosis can be recognized using transvaginal ultrasound and/or magnetic resonance imaging (MRI). Although transvaginal ultrasound is the first choice of imaging modality when investigating women with pelvic pain, MRI have a role for the wider field of visions. The reproducibility of both techniques has been investigated. The three-dimensional ultrasonography has been proposed. Also studies regarding unusual localizations are reported in the literature. New insights are present about the role of imaging in the detection of the malignant transformations. This review summarizes the current evidence on the diagnostic accuracy of these two techniques in the pre-surgical assessment of endometriosis.
    Minerva ginecologica 04/2013; 65(2):143-166.
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    ABSTRACT: OBJECTIVE: To assess the feasibility of a specific training program for ultrasound diagnosis of adnexal masses. METHODS: A two-month intensive training program was developed. Program protocol consisted of one-day intense theoretical course focused on clinical and ultrasonography issues related to adnexal masses and ovarian cancer followed by a four-week real-time ultrasound training in a reference center (about 25-30 adnexal masses evaluated per month) and a final four-week period for off-line assessment of 3D volumes from adnexal masses. In this later period the trainee evaluated five sets of 100 3D-volumes each. 3D-volumes contained gray-scale and power Doppler information and the trainee was provided with clinical data of each case (patient's age, menopausal status and complaints). 3D-volumes were from masses surgically removed and histologic diagnosis was available or from masses followed-up until resolution. After each set assessment, trainee's diagnostic performance was calculated (sensitivity and specificity) and then the trainee evaluated with the trainer each mass incorrectly classified. The objective was to achieve a sensitivity > 95% and specificity > 90%. LC-CUSUM graphics were plotted to assess the learning curve for trainees. RESULTS: One trainer and two trainees with very low experience on gynecological ultrasound (one gynecologist and one radiologist) participated in this study. LC-CUSUM graphics showed that competence was achieved after 170 examinations. The objectives for diagnostic performance were achieved after the second set of 3D volumes (200 cases) for each trainee. CONCLUSIONS: The proposed training program seems feasible. High diagnostic performance can be achieved after 200 cases analyzed and it is maintained after.
    Ultrasound in Obstetrics and Gynecology 02/2013; · 3.56 Impact Factor
  • 01/2013: pages 399-412; , ISBN: 978-1-4614-8633-6
  • 01/2013: pages 425-440;

Publication Stats

2k Citations
691.78 Total Impact Points


  • 2010–2014
    • University Hospital of Parma
      Parma, Emilia-Romagna, Italy
    • Azienda Ospedaliera Universitaria Cagliari
      Cagliari, Sardinia, Italy
    • Universitair Ziekenhuis Leuven
      • Department of Gynaecology and obstetrics
      Leuven, VLG, Belgium
  • 2013
    • Azienda Ospedaliero Universitaria Foggia
      Foggia, Apulia, Italy
  • 2009–2013
    • Lund University
      • Department of Obstetrics and Gynecology
      Lund, Skåne, Sweden
    • Ziekenhuis Oost Limburg
      Genck, Flanders, Belgium
  • 2003–2013
    • San Giovanni Di Dio Hospital
      Florens, Tuscany, Italy
    • Universidad de Navarra
      • Department of Obstetrics and Gynecology
      Pamplona, Navarre, Spain
  • 1991–2013
    • Università degli studi di Cagliari
      • Department of Surgical Science
      Cagliari, Sardinia, Italy
  • 2012
    • Ngee Ann Polytechnic
      • School of Engineering
      Tumasik, Singapore
  • 2009–2011
    • KU Leuven
      • • Department of Electrical Engineering (ESAT)
      • • Department of Reproduction, Development and Regeneration
      Leuven, VLG, Belgium
  • 2006–2011
    • Clínica Universidad de Navarra
      Madrid, Madrid, Spain
  • 2005
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 1997
    • Università degli Studi del Sannio
      Benevento, Campania, Italy
  • 1990
    • Università di Pisa
      • Department of Clinical and Experimental Medicine
      Pisa, Tuscany, Italy