Contrast-enhanced US to Improve Diagnostic Performance of O-RADS US Risk Stratification System for Malignancy.

Background The Ovarian-Adnexal Reporting and Data System (O-RADS) has limited specificity for malignancy. Contrast-enhanced US can help distinguish malignant from benign lesions, but its added value to O-RADS has not yet been assessed. Purpose To establish a diagnostic model combining O-RADS and contrast-enhanced US and to validate whether O-RADS plus contrast-enhanced US has a better diagnostic performance than O-RADS alone. Materials and Methods This prospective study included participants from May 2018 to March 2021 who underwent contrast-enhanced US before surgery and had lesions categorized as O-RADS 3, 4, or 5 by US, with a histopathologic reference standard. From April 2021 to July 2022, participants with pathologically confirmed ovarian-adnexal lesions were recruited for the validation group. In the pilot group, the initial enhancement time and enhancement intensity in comparison with the uterine myometrium, contrast agent distribution pattern, and dynamic changes in enhancement of lesions were assessed. Contrast-enhanced US features were used to calculate contrast-enhanced US scores for benign (score ≤2) and malignant (score ≥4) lesions. Lesions were then re-rated according to O-RADS category plus contrast-enhanced US scores. Receiver operating characteristic curves were constructed and compared using the DeLong method. The combined system was validated in an independent group. Results The pilot group included 76 women (mean age, 44 years ± 13 [SD]), and the validation group included 46 women (mean age, 42 years ± 14). Differences in initial enhancement time (P < .001), enhancement intensity (P < .001), and dynamic changes in enhancement (P < .001) between benign and malignant lesions were observed in the pilot group. Contrast-enhanced US scores were calculated using these features. The O-RADS risk stratification was upgraded one level for contrast-enhanced US scores of 4 or more and downgraded one level for contrast-enhanced US scores of 2 or less. In the validation group, the diagnostic performance of O-RADS plus contrast-enhanced US score was higher (area under the receiver operating characteristic curve [AUC] = 0.93) than O-RADS (AUC = 0.71, P < .001). Conclusion Contrast-enhanced US improved the diagnostic performance for malignancy of the O-RADS categories 3-5. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Grant in this issue.

Metformin down-regulates endometrial carcinoma cell secretion of IGF-1 and expression of IGF-1R.

As metformin can inhibit endometrial carcinoma (EC) cell growth and the insulin growth factor (IGF) system is active in EC, the question of whether t can regulate endometrial carcinoma cell secretion of IGF-1 or expression of IGF-1 receptor (IGF-1R) is of interest. In this study, serum IGF-1 levels in EC patients were found to be comparable with that in the non EC patients (p>0.05). However, the IGF-1 level in the medium of cultured cells after treatment with metformin was decreased (p<0.05). IGF-1R was highly expressed in human endometrial carcinoma paraffin sections, but IGF-1R and phosphor-protein kinase B/protein kinase B (p-Akt/ Akt) expression was down-regulated after metformin treatment (p<0.05). In summary, metformin can reduce the secretion of IGF-1 by Ishikawa and JEC EC cell lines and their expression of IGF-1R to deactivate downstream signaling involving the PI-3K/Akt pathway to inhibit endometrial carcinoma cell growth.

Hysteroscopic treatment of postcesarean scar defect.

STUDY OBJECTIVE: To estimate the usefulness of hysteroscopy in the diagnosis and treatment of postcesarean scar defect. DESIGN: Retrospective study (Canadian Task Force classification III). SETTING: Two university-affiliated hospitals. PATIENTS: Sixty-two patients with postcesarean scar defects were retrospectively analyzed. INTERVENTIONS: All patients with postcesarean scar defects diagnosed using ultrasonography and hysteroscopy underwent hysteroscopic surgery, and were followed up for longer than 1 year. MEASUREMENTS AND MAIN RESULTS: Hysteroscopy revealed that 38 patients had valve-like motions at the incision sites, 22 had dome-like defects, and 2 with a history of 2 previous deliveries via cesarean section had umbilications of 2 different shades. Fifty-seven of 62 patients underwent corrective surgery via hysteroscopy. In another 3 patients, because the left wall of the fundus of the uterus was too thin (<2 mm at ultrasonography) to undergo corrective surgery, only clearance of residual blood and/or suture materials was performed. Of these 57 patients, 5 underwent removal of residual suture materials and endometrial fulguration. No complications were observed in these patients. Furthermore, after surgery, abnormal vaginal bleeding stopped in 38 patients, and its duration was shortened in 20 patients. In addition, dysmenorrhea was alleviated in 15 patients, and resolved in 7 patients. CONCLUSION: Hysteroscopy is an accurate means of diagnosis apart from surgical correction.

[Expression of heparanase and angiopoietin-2 mRNA in endometriosis].

OBJECTIVE: To investigate the relationship between heparanase (Hpa) and angiopoietin-2 (Ang-2) gene expression and the development of endometriosis (EM). METHODS: Expression of Hpa gene and Ang-2 mRNA in the eutopic and ectopic endometrium collected from 86 patients with endometriosis (EM group) and the normal endometrium from 30 women without endometriosis (control group) was determined by RT-PCR. RESULTS: (1) Hpa gene expression was detected in 53 ectopic endometrium and 47 eutopic endometrium specimens in the EM group and 8 normal endometrium specimens in the control group. There was no significant difference in Hpa gene expression between ectopic and eutopic endometrium in the EM group (P > 0.05). However, the Hpa gene expression in normal endometrium in the control group was significantly lower than that in ectopic and eutopic endometrium in the EM group (P < 0.05). (2) Ang-2 gene expression was detected in 61 ectopic endometrium and 56 eutopic endometrium specimens in the EM group and 10 normal endometrium specimens in the control group. There was no significant difference in Ang-2 gene expression between ectopic and eutopic endometrium in the EM group (P > 0.05), however, the Ang-2 positive rate in normal endometrium in the control group was significantly lower than that in ectopic and eutopic endometrium in the EM group (P < 0.05). (3) The expression of Hpa gene in stage III-IV endometriosis was significantly higher than that in stage I-II endometriosis (P < 0.05). (4) The difference of Ang-2 mRNA expression between stage III-IV and stage I-II endometriosis was not significant (P > 0.05). (5) The expression of Hpa gene was shown to be significantly correlated to the expression of Ang-2 gene in ectopic endometrium specimens from patients with endometriosis (P < 0.05). CONCLUSION: Hpa and Ang-2 genes are highly expressed in both ectopic and eutopic endometrium of patients with endometriosis. Over-expression of these two genes may play a role in the development and progression of endometriosis.