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ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors
Timmerman, D.; Planchamp, F.; Bourne, T. ...
Ultrasound in obstetrics & gynecology,
July 2021, Letnik:
58, Številka:
1
Journal Article
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 preoperative 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 preoperative 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 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 preoperative diagnosis of ovarian tumors and the assessment of carcinomatosis, together with a summary of the evidence supporting each statement.
več
15.
Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group
Fischerova, D.; Garganese, G.; Reina, H. ...
Ultrasound in obstetrics & gynecology,
June 2021, Letnik:
57, Številka:
6
Journal Article, Conference Proceeding
ABSTRACT
In centers with access to high‐end ultrasound machines and expert sonologists, ultrasound is used to detect metastases in regional lymph nodes from melanoma, breast cancer and vulvar cancer. ...
There is, as yet, no international consensus on ultrasound assessment of lymph nodes in any disease or medical condition. The lack of standardized ultrasound nomenclature to describe lymph nodes makes it difficult to compare results from different ultrasound studies and to find reliable ultrasound features for distinguishing non‐infiltrated lymph nodes from lymph nodes infiltrated by cancer or lymphoma cells. The Vulvar International Tumor Analysis (VITA) collaborative group consists of gynecologists, gynecologic oncologists and radiologists with expertise in gynecologic cancer, particularly in the ultrasound staging and treatment of vulvar cancer. The work herein is a consensus opinion on terms, definitions and measurements which may be used to describe inguinal lymph nodes on grayscale and color/power Doppler ultrasound. The proposed nomenclature need not be limited to the description of inguinal lymph nodes as part of vulvar cancer staging; it can be used to describe peripheral lymph nodes in general, as well as non‐peripheral (i.e. parietal or visceral) lymph nodes if these can be visualized clearly. The association between the ultrasound features described here and histopathological diagnosis has not yet been established. VITA terms and definitions lay the foundations for prospective studies aiming to identify ultrasound features typical of metastases and other pathology in lymph nodes and studies to elucidate the role of ultrasound in staging of vulvar and other malignancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
A video presentation summarizing the context of this article is available online here.
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16.
Imaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas
Heremans, R.; Valentin, L.; Sladkevicius, P. ...
Ultrasound in obstetrics & gynecology,
October 2022, Letnik:
60, Številka:
4
Journal Article
ABSTRACT
Objective
To describe the clinical and ultrasound features of ovarian mature cystic teratomas (MCTs).
Methods
This was a retrospective study. From the International Ovarian Tumor Analysis ...
(IOTA) database, we identified patients with a histologically confirmed diagnosis of MCT who had undergone transvaginal ultrasound examination between 1999 and 2016 (IOTA phases 1, 2, 3 and 5) in one of five centers. Ultrasound was performed by an experienced examiner who used the standardized IOTA examination technique and terminology. In addition to extracting data from the IOTA database, available two‐dimensional grayscale and color or power Doppler images were reviewed retrospectively to identify typical ultrasound features of MCT described previously and detect possible new features using pattern recognition. All images were reviewed by two independent examiners and further discussed with two ultrasound experts to reach consensus.
Results
Included in the study were 454 patients with histologically confirmed MCT. Median age was 33 (range, 8–90) years and 66 (14.5%) patients were postmenopausal. Most MCTs were described by the original ultrasound examiner as unilocular (262/454 (57.7%)) or multilocular (70/454 (15.4%)) cysts with mixed echogenicity of cystic fluid (368/454 (81.1%)), acoustic shadowing (328/454 (72.2%)) and no or little vascularization on color Doppler (color score 1, 240/454 (52.9%); color score 2, 123/454 (27.1%)). The median largest lesion diameter was 66 (range, 15–310) mm. A correct preoperative diagnosis of MCT was suggested by the original ultrasound examiner in 372/454 (81.9%) cases. On retrospective review of ultrasound images of 334 MCTs that had quality sufficient for assessment, ‘dots and/or lines’ and/or ‘echogenic white ball’ (typical features according to the literature) were present in 271/334 (81.1%) masses. We identified four new ultrasound features characteristic of MCT: ‘cotton wool tufts’, ‘mushroom cap sign’, ‘completely hyperechogenic lesion’ and ‘starry sky sign’. At least one classical or novel ultrasound feature was present in 315/334 (94.3%) MCTs. Twenty‐nine (8.7%) MCTs manifested vascularized solid tissue, of which seven exhibited no typical features.
Conclusion
We provide a comprehensive overview of conventional and newly described ultrasound features of MCTs. Only a small proportion of MCTs did not manifest any of the typical features. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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17.
Evaluating myometrial and cervical invasion in women with endometrial cancer: comparing subjective assessment with objective measurement techniques
Mascilini, F.; Testa, A. C.; Van Holsbeke, C. ...
Ultrasound in obstetrics & gynecology,
September 2013, Letnik:
42, Številka:
3
Journal Article
ABSTRACT
Objective
To compare the diagnostic accuracy of subjective ultrasound assessment with that of objective measurement techniques in the evaluation of myometrial and cervical invasion in women ...
with endometrial cancer.
Methods
This was a prospective multicenter study including 144 women with endometrial cancer undergoing transvaginal ultrasound. Myometrial and cervical invasion was evaluated subjectively, as well as objectively measured in different ways: endometrial thickness, tumor/uterine anteroposterior (AP) diameter ratio, minimal tumor‐free margin, minimal tumor‐free margin/uterine AP diameter ratio, tumor volume (three‐dimensional (3D)), tumor/uterine volume (3D) ratio, and distance from outer cervical os to lower margin of tumor (Dist‐OCO). Histological assessment following hysterectomy was the gold standard.
Results
The sensitivity (72%) and specificity (76%) of tumor/uterine AP diameter (at cut‐off, 0.53) were not significantly different from those of subjective evaluation (sensitivity, 77% (P = 0.44); specificity, 81% (P = 0.32)) for the prediction of deep myometrial invasion; all other objective measurement techniques had either a significantly lower sensitivity or a lower specificity. For all objective measurement techniques, except minimal tumor‐free margin/uterine AP diameter ratio, fixing the sensitivity at the same level as that of subjective evaluation (i.e. 77%) gave a significantly lower specificity. Dist‐OCO was the only parameter that might have potential to predict cervical invasion; it had a non‐significantly higher sensitivity than did subjective evaluation (73% vs 54%, P = 0.06), but a significantly lower specificity (63% vs 93%, P < 0.001).
Conclusion
Subjective assessment of cervical and myometrial invasion is as good as or better than any objective measurement technique. The tumor/uterine AP diameter ratio and minimal tumor‐free margin/uterine AP diameter ratio seem to be the best objective measurement techniques to predict deep myometrial invasion. It remains to be shown if objective measurements are useful to predict cervical invasion. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
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18.
Imaging in gynecological disease (14): clinical and ultrasound characteristics of ovarian clear cell carcinoma
Pozzati, F.; Moro, F.; Pasciuto, T. ...
Ultrasound in obstetrics & gynecology,
December 2018, Letnik:
52, Številka:
6
Journal Article
ABSTRACT
Objective
To describe the clinical and ultrasound characteristics of ovarian pure clear cell carcinoma.
Methods
This was a retrospective study involving data from 11 ultrasound centers. From ...
the International Ovarian Tumor Analysis (IOTA) database, 105 patients who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016 were identified with a histologically confirmed pure clear cell carcinoma of the ovary. An additional 47 patients diagnosed with pure clear cell carcinoma between 1999 and 2016 and with available complete preoperative ultrasound reports were identified retrospectively from the databases of the departments of gynecological oncology in the participating centers. The ultrasound images of all tumors were described using IOTA terminology. Clinical and ultrasound characteristics were analyzed for the whole group, and separately, for patients with and those without histologically confirmed endometriosis, and for patients with evidence of tumor developing from endometriosis.
Results
Median age of the 152 patients was 53.5 (range, 28–92) years and 92/152 (60.5%) tumors were FIGO Stage I. Most tumors (128/152, 84.2%) were unilateral. On ultrasound examination, all tumors contained solid components and 36/152 (23.7%) were completely solid masses. The median largest diameter of the lesion was 117 (range, 25–310) mm. Papillary projections were present in 58/152 (38.2%) masses and, in most of these (51/56, 91.1%), vascularized papillary projections were seen. Information regarding the presence, site and type of pelvic endometriosis at histology was available for 130/152 patients. Endometriosis was noted in 54 (41.5%) of these. In 24/130 (18.6%) patients, the tumor was judged to have developed from endometriosis. Patients with, compared to those without, evidence of tumor developing from endometriosis were younger (median 47.5 vs 55.0 years, respectively), and ground‐glass echogenicity of cyst fluid was more common in pure clear cell cancers developing from endometriosis (10/20 vs 13/79 (50.0% vs 16.5%), respectively).
Conclusions
Ovarian pure clear cell carcinoma is usually diagnosed at an early stage and typically appears as a large unilateral mass with solid components. Patients with clear cell carcinoma developing from endometriosis are younger than other patients with clear cell carcinoma, and clear cell cancers developing from endometriosis more often manifest ground‐glass echogenicity of cyst fluid. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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19.
20.
Endometriomas: their ultrasound characteristics
Van Holsbeke, C.; Van Calster, B.; Guerriero, S. ...
Ultrasound in obstetrics & gynecology,
June 2010, Letnik:
35, Številka:
6
Journal Article
Objectives
To describe the ultrasound characteristics of endometriomas in pre‐ and postmenopausal patients and to develop rules that characterize endometriomas.
Methods
All patients included in the ...
International Ovarian Tumor Analysis (IOTA) studies were used in our analysis. Patients with an adnexal mass were scanned by experienced sonologists using a standardized research protocol. The gold standard was the histology of the surgically removed adnexal mass. The gray‐scale and Doppler ultrasound characteristics of the endometriomas were compared with those of other benign and malignant masses. Based on decision‐tree analysis, the existing literature and clinical experience, ultrasound rules for the detection of endometriomas were created and evaluated.
Results
Of all 3511 patients included in the IOTA studies, 713 (20%) had endometriomas. Fifty‐one per cent of the endometriomas were unilocular cysts with ground glass echogenicity of the cyst fluid. These characteristics were found less often among other benign tumors or malignancies, or among the small set of endometriomas (4%) that were found in postmenopausal patients. Based on the decision‐tree analysis, the optimal rule to detect endometriomas was ‘an adnexal mass in a premenopausal patient with ground glass echogenicity of the cyst fluid, one to four locules and no papillations with detectable blood flow’. Based on clinical considerations, the following rule: ‘premenopausal status, ground glass echogenicity of the cyst fluid, one to four locules and no solid parts’ seems preferable.
Conclusions
Several rules had a good ability to characterize endometriomas. The ultrasound characteristics of endometriomas differ between pre‐ and postmenopausal patients. Masses in postmenopausal women whose cystic contents have a ground glass appearance have a high risk of malignancy. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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