Accuracy in Referrals to Gynecologic Oncologists Based on Clinical Presentation for Ovarian Mass.

Ovarian cancer is one of the most lethal gynecological cancers in women due to late diagnosis. Despite technological advancements, experienced physicians have high sensitivities and specificities in subjective assessments when combining ultrasound findings and clinical history in analyzing adnexal masses. This study aims to demonstrate general obstetricians and gynecologists' (OB/GYN) appropriateness in gynecologic oncologist referrals for malignant ovarian masses based on history and physical (H&P), imaging, and available tumor markers. Three board certified OB/GYNs were given 148 cases and determined whether or not they would refer them to a gynecologic oncologist. Results showed that OB/GYNs were 81-85% accurate in diagnosing patients with a benign or malignant disease. Among the malignant cases, reviewers had a high sensitivity ranging from 74-81% in appropriately referring a malignancy. In our study, OB/GYNs referred between 23-32% of ovarian masses to a gynecologic oncologist with only 9.5% of cases found to be malignant. Despite the high referral rates, generalists showed a high degree of sensitivity in accurately referring malignant diseases based solely on clinical experience and imaging studies, which could improve survival rates with early intervention by gynecologic oncologists.

Pregnancy after uterine artery embolization using Gelfoam™.

We present a case study of a patient who underwent uterine artery embolization (UAE) using Gelfoam™ (Pfizer, New York, NY, USA) and had a subsequent pregnancy. Our patient, a 38-year-old female (4 Gravida/2 Para), underwent UAE for treatment of symptomatic myoma in September 2005. At the patient's seven-month post procedure visit, she experienced a 43.9% volume reduction in uterine size and 74.5% reduction in volume of the largest fibroid and relief of bulk symptoms and menorrhagia. The patient had a term delivery of healthy twin infants 15 months post embolization.

Anti Müllerian hormone levels before and after uterine artery embolization: A preliminary report.

OBJECTIVE: To determine the effects of uterine artery embolization on Anti-Müllerian hormone levels for women under 40 years of age. MATERIAL AND METHODS: Non-randomized, observational study of women under 40 years of age and who received UAE. Twenty-seven women under the age of 40 who underwent UAE were included in the study. Hormone levels were measured prior to UAE, and at least six months post UAE. RESULTS: Statistical analysis from a paired t-test showed that the AMH levels pre- and post-embolization of these women fell within the normal range. The average AMH level prior to embolization was 2.54 ± 3.99 ng/mL. The mean AMH concentration after embolization was 2.33 ± 2.70 ng/mL. The average change in AMH levels between pre-and post-embolization was -0.21 ± 1.08 ng/mL. There is no statistically significant difference between the pre- and post- UAE AMH levels (95% CI -0.64 to 0.22, p=0.32). CONCLUSION: UAE does not affect ovarian reserve in women under 40 as evidenced by no significant change in AMH levels before and after embolization. Women who are of reproductive age and have fibroids can consider UAE without concern for adverse effects on their fertility.