Massas anexiais: descrição e interpretação ultrassonográfica por IOTA / Adnexal masses: IOTA ultrasound description and interpretation

Este artigo visa apresentar ao médico ginecologista (clínico e/ou cirurgião), de forma prática, a normatização internacional da prática da ultrassonografia ginecológica para avaliação das massas anexiais. Desde 2000, o grupo europeu IOTA (International Ovarian Tumor Analysis) vem colhendo dados e difundindo conhecimento nessa área, de forma a padronizar o exame ultrassonográfico. Quais descritores ecográficos devem ser valorizados, como devem ser descritos e medidos, como aplicar o estudo Doppler e como interpretar a presença ou ausência desses descritores ecográficos na diferenciação das massas anexiais benignas de malignas, inferindo o risco de malignidade das massas, tudo isso está bem definido.(AU)

The main aim of this article is to present to gynecologists (clinicians and/or surgeons) the practical international gynecological ultrasound standardization for adnexal masses assessment. Since 2000, European group IOTA (International Ovarian Tumor Analysis) has been collecting data and disseminating knowledge in order to standardize ultrasound examination. It is already well-defined which ultrasound features should be described and measured, how power/color Doppler have to be applied and how the presence or absence of these features can differentiate benign from malign masses, inferring tumors malignancy risk.(AU)

Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses

SUMMARY OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.

RESUMO OBJETIVO O objetivo deste estudo é avaliar a eficácia da combinação da estratificação por ultrassonografia usando o Sistema de Relatórios e Dados de Imagem Ginecológica (GI-RADS) e ultrassonografia 3D com contraste (3D-CEUS) para diferenciar massas ovarianas benignas de malignas. METODOLOGIA Neste estudo, 102 pacientes com massas ovarianas foram examinadas usando ultrassonografia bidimensional (2D-US) e 3D-CEUS. As características ultrassonográficas das massas ovarianas obtidas com 3D-CEUS foram analisadas e comparadas com de 2D-US. Todos os pacientes com massas ovarianas tiveram o diagnóstico confirmado pelos resultados de patologia cirúrgica ou acompanhamento de longo prazo. RESULTADOS (1) O teste qui-quadrado e a regressão logística múltipla confirmaram a existência de apenas oito preditores independentes de massas malignas, incluindo septos espessos (≥3mm), projeções papilares espessas (≥7mm), áreas sólidas, presença de ascite, vascularização central, aumento de contraste, distribuição do agente de contraste e características vasculares da parte sólida e suas razões de possibilidades (OR), que foram 5,52, 5,39, 4,94, 4,34, 5,92, 7,44, 6,09 e 7.67, respectivamente (P< 0,05). (2) Esses oito preditores foram utilizados para combinar o GI-RADS com o sistema de escores da 3D-CEUS, para o qual o valor correspondente da área sob a curva (AUC) foi de 0,969, superior ao uso exclusivo do GI-RADS (valor de Z = 1,64, P < 0,025). Usando 4 pontos como corte, o sistema de escores mostrou que o desempenho foi muito melhor do que com o uso exclusivo do GI-RADS (P < 0,05). (3) O valor de Kappa foi 0,872, obtido por dois médicos diferentes com igual experiência. CONCLUSÃO A combinação do GI-RADS e do sistema de pontuação da 3D-CEUS é um método mais eficaz para distinguir massas ovarianas benignas de malignas.

Large hydatid cyst of ovary

Human Hydatid cyst is a wide spread disease. Its an endemic disease in Iran. It's caused by Echinococcus granulosus. Hydatid cyst although known to occur in most organs and body areas, is extremely rare in the female reproductive organs. This is a case report of ovarian Hydatid cyst in a 42-year-old woman. She presented with feeling of enlargement of abdomen and abdominal pain. On physical examination, a large mass in lower abdomen palpated. On imaging study, ultrasonography reported a large heterogeneous multicystic mass measuring 155 97 mm in pelvic cavity and hypo gastric area. The CT-scan with IV contrast reported a huge cystic lesion, containing multiple septi in pelvic cavity that could be due to ovarian lesion. After surgical procedure, histopathological examination showed typical laminated and germinative layers with hexagonal scolecies of Hydatid cyst. Since the common sites of hydaid cyst are liver and lung and the imaging studies are highly diagnostic for Hydatid cysts, this illustrated case is interesting for uncommon site, not suggested by imaging studies and with clinical [surgical] impression of malignant ovarian tumor

comparison of pelvic examination, pelvic ultrasound and operative findings in ovarian masses

To compare and correlate the pelvic examination in adnexal masses with pelvic ultrasound and peroperative findings. June 2006 to May 2007. Descriptive observational study. A sample set of 22 patients with adnexal masses have been included in the study to do a comparative study of the pelvic examination with pelvic ultrasound and peroperative findings. Our analysis show a wide range of diversity among the age groups of our sample set. The majority of the patients [81.8%] belong to the reproductive age group between 20-40 years and only 13% of patients are menopausal. Another important observation is that 87% of all patients visited out patient department with subacute symptoms and remaining 13% presented with acute symptoms in the Emergency Department. Moreover, 54.54% have right-sided adnexal masses and the remaining 45.45% have left-sided adnexal masses. We have seen only in the 9% of cases that the operative findings are different from that of the ultrasound examination. The final outcome of our research is that the ultrasound examination - an important noninvasive investigation - can only be used as a complementary method to the pelvic examination because the findings can be accurately confirmed only on laparoscopy

Apport de l'echographie endovaginale en gynecologie obstetrique

Echography imposes itself as a reliable, harmless and repectitive technique in the exploration of female pelvis. Endovaginal echography is a new technique that should be used complementarily with classical over the pubis echography. Authors insist on the contribution of endovaginal echography: In gynecology in the diagnosis of extra utrine pregnancies. itI completes the echography of over the pubis in the study of uterine and ovarian pathology - In obstetrics in the precocions diagnosis of the pregnancy and the study of low-inserted placentas And in interventional echography in the embryonary reduction and the punction of ovocys in the techniques of procreation that are medically aided