José Angel Mínguez

Clínica Universidad de Navarra, Madrid, Madrid, Spain

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Publications (37)101.58 Total impact


  • No preview · Article · Sep 2015 · Ultrasound in Obstetrics and Gynecology
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    Preview · Article · Sep 2015 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Transvaginal ultrasound (TVS) has been used for preoperative detection of deep endometriosis (DIE) in uterosacral ligaments (USL), recto-vaginal septum (RVS), vagina and bladder locations. However, there is no clear evidence up to date about the overall diagnostic performance in these locations. To perform a systematic review about the diagnostic accuracy of TVS in the preoperative detection of USL, RVS, vagina and bladder endometriosis in patients with clinical suspicion of DIE. An extensive search was performed in Medline (Pubmed) and EMBASE from January 1989 to December 2014. Eligibility criteria were studies using TVS in the preoperative detection of USL, RVS, vaginal and bladder endometriosis in women with clinical suspicion of DIE using the surgical data as a reference standard. Quality was assessed using PRISMA guidelines and QUADAS-2 tool. Of the 801 citations identified, 11 studies (involving 1532 patients) were eligible and included in the meta-analysis. Regarding USL, the overall pooled sensitivity and specificity was 53% (95% CI, 35-70%) and 93% (95% CI, 83-97%), respectively. The pretest probability of USL endometriosis was 42%, and this probability increased to 85% when TVS suspicion was present. Regarding RVS endometriosis, the overall pooled sensitivity and specificity was 49% (95% CI, 36-62%) and 98% (95% CI, 95-99%), respectively. The pretest probability of RVS endometriosis was 26%, and this probability increased to 90% when TVS suspicion was present. Regarding vaginal endometriosis, the overall pooled sensitivity and specificity was 58% (95% CI, 40-74%) and 96% (95% CI, 87-99%), respectively. The pretest probability of vaginal endometriosis was 18%, and this probability increased to 77% when TVS suspicion was present. Substantial heterogeneity was found for sensitivity and specificity for all these locations. Regarding bladder endometriosis, the overall pooled sensitivity and specificity was 62% (95% CI, 40-80%) and 100% (95% CI, 97-100%), respectively. Moderate heterogeneity was found for sensitivity and specificity. The pretest probability of bladder endometriosis was 6%, and this probability increased to 93% when TVS suspicion was present. Overall diagnostic performance of TVS for detecting deep endometriosis is fair but a high specificity is present for all the locations. This article is protected by copyright. All rights reserved.
    No preview · Article · Aug 2015 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Objective To compare diagnostic performance of TVS and intraoperative macroscopic examination for determining myometrial infiltration in low risk endometrial cancer and to estimate the agreement between both methods.Methods One single center observational study comprising women with preoperative diagnosis of well or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative transvaginal ultrasound (TVS) by a single examiner. According to subjective examiner's impression myometrial infiltration was stated as ≥ or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was done by pathologists unaware of ultrasound findings and myometrial infiltration was stated as ≥ or < 50%. Definitive histological diagnosis of myometrial infiltration was done by frozen section analysis and used as gold standard. Sensitivity and specificity with 95% confidence intervals for TVS and intraoperative macroscopic inspection were calculated and compared using McNemar test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's Kappa index (κ) and percentage of agreement.Results152 out of 209 eligible women were ultimately included. Patients’ mean age was 60.9 years old (SD: 10.2, range: 32 to 91 years). Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women, respectively. Sensitivity and specificity for TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively. Whereas these figures for intraoperative macroscopic examination were and 78.9% and 90.4%, respectively (McNemar test p > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between both methods was moderate (κ = 0.54, 95%CI: 0.39 to 0.69. Percentage of agreement 82%)Conclusions Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration is only moderate; both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might be reasonably proposed as a method for assessing myometrial infiltration instead of intraoperative macroscopic examination, at least when performed by an experienced examiner and image quality is not poor. Future research is needed to confirm this proposal.
    No preview · Article · May 2015 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Objective To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases in well (G1) or moderately (G2) differentiated endometrioid carcinoma of the endometrium.Methods Single center prospective observational cohort study comprising a consecutive series of women with preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound by a single examiner. According to subjective examiner's impression patients were considered at high-risk if myometrial infiltration was ≥ 50%, and/or cervical involvement and/or adnexal involvement was suspected. FIGO surgical staging was performed in all cases. Women were classified according to definitive histologic data regarding myometrial infiltration, cervical involvement and adnexal involvement as low-risk cases (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high-risk cases (myometrial infiltration >50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (−LR) with 95% confidence intervals for transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated.Results169 women out of 209 eligible were included in this study (patients’ mean age: 60.7 years old, SD: 10.3, range: 32 to 91 years). Sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (−LR) of transvaginal/transrectal ultrasound for identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI: 63.7% to 88.0%), 89.1% (95% CI: 81.7% to 93.8%), 7.14 (95% CI: 4.19 to 12.18) and 0.25 (95% CI: 0.15 to 0.42), respectively.Conclusions Preoperative transvaginal/transrectal ultrasound may play a significant role for identifying high-risk cases in G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy and could be a useful test in this clinical setting.
    No preview · Article · May 2015 · Ultrasound in Obstetrics and Gynecology
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    ABSTRACT: Background Transvaginal ultrasound (TVS) has been extensively used for assessing myometrial infiltration (MI) in endometrial cancer (EC). However, there is no clear evidence up to date about the overall diagnostic performance.Objective To perform a systematic review about the diagnostic accuracy of TVS in the preoperative detection of deep MI in patients with EC, comparing subjective and objective methods.Methods An extensive search was performed in Medline (Pubmed) and EMBASE from January 1989 to December 2014. Eligibility criteria were studies using TVS for preoperative assessment of MI subjective assessment and/or objective measurements, specifically Gordon's (the ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson's (endometrial tumor thickness/anterior-posterior uterine diameter ratio) approaches] in women with EC, using the surgical-pathologic data as a reference standard. Quality was assessed using PRISMA guidelines and QUADAS-2 tool.ResultsOur extended search identified a total of 184 citations but we finally examined the full text of the 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration was 82% (95% CI, 76-87%), 81% (95 % CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observed differences among all three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity for all three methods (I2 values ranging from 60.57 to 94.96). The main limitation was that very few studies compared different approaches in the same set of patients.Conclusion Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.
    No preview · Article · May 2015 · Ultrasound in Obstetrics and Gynecology
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    Juan Luis Alcázar · Sara Arribas · José Angel Mínguez · Matías Jurado
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    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.
    Full-text · Article · Oct 2014 · Journal of obstetrics and gynaecology of India
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    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.
    No preview · Article · Sep 2014 · Ultrasound in Obstetrics and Gynecology
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    Full-text · Article · Sep 2014 · Ultrasound in Obstetrics and Gynecology
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    Preview · Article · Sep 2014 · Ultrasound in Obstetrics and Gynecology
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    Preview · Article · Sep 2014 · Ultrasound in Obstetrics and Gynecology
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    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(2) 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.
    Full-text · Article · Mar 2013 · International Journal of Gynecological Cancer
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    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.
    Full-text · Article · Oct 2011 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
  • José Angel Mínguez · Maria Auba · Daysi Diaz-Cobos
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    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.
    No preview · Article · May 2011 · International Urogynecology Journal
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    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.
    No preview · Article · Mar 2011 · 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
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    Full-text · Conference Paper · Oct 2010
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    Full-text · Conference Paper · Oct 2010
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    Full-text · Conference Paper · Oct 2010
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    Full-text · Conference Paper · Oct 2010
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    Full-text · Conference Paper · Oct 2010