Solitary fibrous mass of the omentum mimicking an ovarian tumor: case report.

There are some pelvic masses which are difficult to correctly classify as malignant or benign. The decision concerning method and choice of surgical intervention is not simple in this situation. Some tumors are extremely rare and need to be presented in the literature. The authors report a rare case of fibrous tumor of the omentum simulating a malignant ovarian tumor, which ultimately resulted to be a primary solitary fibrous tumor of the omentum. Ultrasound findings are mostly precise prognostic tools according ovarian masses. However, from time to time, Doppler blood flow examination may present false positive results.

The value of extended preoperative thromboprophylaxis with dalteparin in patients with ovarian cancer qualified to surgical treatment.

AIM: Ovarian cancer (OC) is associated with a high risk of venous thromboembolism (VTE) in both, pre- and postoperative period. The aim of the study was to analyse the efficacy and the safety of an early prophylaxis with dalteparin in patients with OC qualified to surgery. METHODS: The prospective, non-randomized study was performed in the group of OC patients qualified to surgical treatment. The study group (SG) consisted of 37 patients with OC in whom thromboprophylaxis was started at the moment of qualification to the surgery (mean 16,1 days ± 11,32 SD before procedure). The control group (CG) consisted of 61 patients with OC qualified to surgery in whom thromboprophylaxis was started 12 hour before surgical treatment. The duration of postoperative prophylaxis was 4 weeks in both groups. Dalteparin 5000 U/day was used in both groups. The primary end points were occurrence of VTE and major bleeding. The patients underwent color Doppler US and D-dimer (DD) assessment at the moment of qualification for surgery, 1 day before and 7, 14, 28 days and 3 months after procedure. RESULTS: The total duration of thromboprophylaxis was 45.3 ± 10.7 days in SG and 27.9 ± 3.7 days in CG (P < 0.0001). The deep venous thrombosis rate was 2,7% in SG and 16.4% in CG (P = 0.042). Neither pulmonary embolism, nor major bleeding were observed. Median preoperative DD concentration in all patients was 1700 ng/ml and was significantly higher in patients who developed postoperative DVT when compared to those who did not, 2556.8 and 1691.0 ng/mL respectively (P = 0.0009). CONCLUSION: Prolonged preoperative thromboprophylaxis with dalteparin in patients with ovarian cancer qualified to the surgical treatment is safe, decreases the risk of thromboembolic complications. To determine indication, dosage and timing of such thromboprophylaxis in this group of patients further studies are required.

The role of endothelin-1 and its correlation with CA125 levels, grayscale ultrasonography and doppler findings in differential diagnoses of ovarian tumors.

PURPOSE OF INVESTIGATION: Assessment of endothelin-1 (ET-1) level for the differential diagnosis of ovarian tumors was performed. METHODS: Fifty-three women with ovarian tumors (12 malignant, 41 benign) treated at the Division of Gynecological Surgery, Poznan, Poland were analyzed. ET-1 serum levels were compared with CA125 and Doppler parameters (RI, PI, PSV). The differences were evaluated using the unpaired t-test with Welch's correction (p < 0.05). RESULTS: There was statistically significant difference in ET-1 levels between the ovarian cancer and benign tumor groups (3.130 pg/ml and 1.819 pg/ml, respectively). The ROC area for ET-1 and CA125 were 0.727 and 0.791, respectively. A negative linear correlation between the level of ET-1 and RI and a positive linear correlation between the level of ET-1 and PSV in the ovarian cancer group were found. CONCLUSION: ET-1 as a new biomarker for predicting ovarian cancer is not satisfying. A correlation between ET-1 levels and Doppler parameters is very interesting and its role in angiogenesis should be studied extensively.

Comparison of diagnostic usefulness of predictive models in preliminary differentiation of adnexal masses.

The purpose of this study was to compare prognostic models evaluating the probability of an ovarian cancer occurrence based on a number of clinical and ultrasonographic data in women with adnexal masses. A total of 686 women with adnexal masses underwent the examinations between 1994 and 2002. The recorded parameters included: age, menopausal status, body mass index, the grayscale and Doppler ultrasonographic examination, and selected markers concentration levels. In order to find the best combination of features, which significantly influences the probability of malignancy, stepwise logistic regression analysis, as well as artificial neural network, was used. The diagnostic efficiency of received models was estimated and compared using receiver-operating characteristics (ROC) curve. The results indicate that 431 and 255 patients had a benign and malignant ovarian tumor, respectively. Application of stepwise logistic regression analysis revealed statistically significant importance of eight features. The sensitivity and specificity for the received model were 65.71% and 77.59%, respectively. Three-layer perceptron network shows 13 features as significant predictors of malignancy. The network gave a sensitivity of 85.7% and specificity of 93.1%. Comparison of area under ROC curve for received models was 0.9679 vs 0.9716. Prognostic values of the analyzed neural model are not optimal but seem to surpass logistic regression model in terms of the predictive possibilities.

Using logistic regression analysis in preliminary differential diagnosis of adnexal masses.

The aim of our study was to generate predictive model, which would allow to estimate the influence of analyzed parameters on predictive accuracy of differential diagnosis of adnexal masses and to evaluate prospectively diagnostic efficacy of the statistic model in the new set of patients. A total of 686 women diagnosed and surgically treated in the Gynecological and Obstetrical Teaching Hospital of University of Medical Sciences in Poznan, Poland, were recruited into the study. Preoperative diagnostics included gynecological examination, ultrasonographic evaluation, tumor Doppler blood flow analysis, and serum levels of CA125 and TPS. In order to find the best combination of features and to calculate the individual probability of the malignancy, stepwise logistic regression analysis with quasi-Newton estimation was applied. The essential part of the best prognostic model, described by foregoing variables, is as follows: [z = -6.005 + 0.058 x age + 1.174 x septa + 1.317 x tumor localization + 1.185 x ascites + 2.28 x solid element + 2.429 x vessels localization -2.386 x PI + 0.084 x MEDV]. The highest sensitivity and specificity for the obtained model were 87.84% and 93.74%, respectively. Prognostic model, constructed with the use of logistic regression analysis, is characterized by higher sensitivity and specificity than individually applied diagnostic tests. Prospective evaluation of this model application in a larger group of patients with adnexal masses will enable precise assessment of its objective clinical usefulness.

Artificial neural network computer prediction of ovarian malignancy in women with adnexal masses.

OBJECTIVE: Assessment of the usefulness of a neural model to predict which ovarian tumors are malignant. METHOD: Age, menopausal status, body mass index, grayscale and Doppler ultrasonographic features, as well as levels of specific markers (CA 125, tissue polypeptide specific antigen) were examined in 686 women with adnexal masses. The probability of malignancy was calculated using an artificial neural network software and the diagnostic efficiency of the received model was estimated using a receiver-operating characteristics (ROC) curve. RESULT: Of the 686 women, 431 (62.8%) had a benign and 255 (37.2%) had a malignant ovarian tumor. The significant malignancy predictors are age, menopausal status, maximum tumor diameter, internal wall structure of tumor, presence of septa and/or solid elements, tumor location, location of vessels, and blood flow indexes. The best network provided 96.0% sensitivity and 97.7% specificity. The area under the curve for the received model was 0.9716. CONCLUSIONS: An artificial neural network model based on clinical and ultrasonographic data allows to calculate the probability of tumor malignancy.

An ultrasonographic morphological index for prediction of ovarian tumor malignancy.

PURPOSE OF INVESTIGATION: A newly created ultrasonographic scale called the Poznan index as well as scales already well known (introduced by Sassone, De Priest and Lerner) were compared in our group of patients. METHOD: A morphological index was based on seven sonographic ovarian tumor features. Examinations on 686 patients were evaluated. Comparison of prognostic values of the Poznan index with other applied morphological indices in our group of patients was based on the area under receiver operating characteristic (ROC) curves. RESULTS: The cut-off level of the new index is 8 points. The new morphological index has a specificity of 77.0%, and negative and positive predictive values of 90.7% and 69.1%, respectively. It has a sensitivity of 86.7% and accuracy of 80.6%. The Poznan index proved its usefulness and superiority (AU ROC = 0.89). CONCLUSION: Using this morphological index it is possible to make a precise prognosis of ovarian tumor malignancy. It also makes it possible to make the right decision concerning the manner of surgical treatment.

Clinical value of the ultrasound Doppler index in determination of ovarian tumor malignancy.

PURPOSE OF INVESTIGATION: Clinical evaluation of the newly created Doppler index (DS) in preoperative early differentiation of ovarian tumor malignancy. PATIENTS AND METHODS: The study involved data concerning 464 ovarian tumor examinations of women treated between 1994 and 2002. One hundred and sixty-five woman had malignant ovarian tumors, and the other 299 tumors were benign on histopathology. Menopausal status of the studied women was also considered. Created ROC curves compare the diagnostic value of the suggested index. The number of vessels, their location and arrangement, shape of velocity waves as well as presence of the protodiastolic notch in the arterial vessels of the tumor were analyzed. Each of the mentioned features could acquire a point-value of 0 or 1. RESULTS: A cut-off point for the suggested Doppler index was determined at the level of 4 for the following prognostic values: sensitivity, specificity and accuracy which amounted to 86.7%; 93.3% and 90.9%, respectively. In the group of 101 postmenopausal women accuracy was higher--94.1%, specificity and positive predictive value (PPV) was estimated as 100%. CONCLUSIONS: The suggested Doppler index enables a precise prognosis of ovarian tumor malignancy and as a half-amount analysis helps in the decision making of the most effective therapeutic treatment.

Estimation of neovascularisation in hyperplasia and carcinoma of endometrium using a "power" angio-Doppler technique.

The aim of this study was to estimate neovascularisation in hyperplasia and carcinoma of the endometrium using a "power" angio-Doppler technique. One hundred and eighty-two postmenopausal patients with irregular bleeding from the sexual organs were investigated. Age of the patients ranged between 46 and 78 years. No neovascularisation in a control group of women with normal histopathological results of the endometrium was observed. The sensitivity of this method with reference to the diagnosis of hyperplasia and cancer of the endometrium was 12.2% and 81.2%, respectively. The specificity and positive prediction values were equal to 100% each in both pathologies. The values of the analysed flow indices in the neovascular arteries in endometrial cancer were significantly lower (p<0.05) (properly PI-0.92+/-0.12; RI-0.46+/-0.08) in comparison to the corresponding values in hyperplasia of the endometrium (PI-1.38+/-0.28 and RI-0.66+/-0.18). In conclusion, using a "power" angio-Doppler technique irregular vascularity of the endometrium in a group of patients with hyperplasia was observed in 12.2% of all patients and in 81.2% of those with cancer of the endometrium. The analysis of the values of the blood flow qualitative parameters in the neovascularisation areas in the endometrium at the significance level of PI < or = 1.0; RI < or = 0.5 and TAMV > 18.0 cm can help determine the essential element in the differential diagnosis of benign and malicious lesions. Transvaginal ultrasonography with a "power" angio-Doppler technique can be a valuable diagnostic method in hyperplasia and cancer of the endometrium, especially useful in the early stages of these pathologies.

[Ectopic cervical pregnancy--conservative treatment with methotrexate]. / Ciaza ektopowa szyjkowa--leczona zachowawczo methotrexatem.

Ectopic pregnancy regardless its localization always remains difficult diagnostic and therapeutical problem. Special attention is paid to cervical pregnancy because of its rare incidence and poor prognosis (even in this day and age maternal death rate is 40-45%). In this paper there has been reported the case of 38 years old patient, admitted to Dept of Gynecological Oncology with suspicion of alive cervical pregnancy. Diagnostic procedures have been described as well as positive results of conservative treatment with Methotrexate (under careful monitoring--ultrasound, beta hCG levels). Also there has been presented detailed description of endocervix curettage after fetal death confirmed ultrasonographically. Current conservative therapy methods for cervical pregnancy have been discussed.

[Doppler ultrasonography for detection of pathologic changes in uterine body endometrium]. / Ultrasonografia dopplerowska w wykrywaniu zmian patologicznych blony sluzowej trzonu macicy.

This study was conducted to evaluate the role of transvaginal color Doppler ultrasonography in detecting endometrial pathology in postmenopausal women A group of 140 women with abnormal postmenopausal bleeding was examined by TVS with color Doppler before D & C. Histopathologic and blood flow characteristics were evaluated. Abnormal blood flow characteristics were evaluated. Abnormal blood flow within endometrium was visualized in 78% cases of cancer. RI and PI values were lowered in hyperplasia and significantly in cancer groups. Transvaginal color Doppler ultrasonography can depict endometrial pathology, even in asymptomatic women.

[Evaluation of blood flow in uterine arteries in patients with cancer of the cervix uteri using transvaginal color doppler ultrasonography]. / Ocena przeplywu krwi w tetnicach macicznych u chorych z rakiem szyjki macicy przy wykorzystaniu ultrasonografii dopochwowej z kolorowym Dopplerem.

The purpose of the study was to estimate blood flow in uterine arteries in patients with uterus cervix invasive carcinoma. In the study the colour Doppler ultrasonography was used. It was found out that in the group of patients with uterus cervix carcinoma pulsation index (PI)--1.82 +/- 1.44 as well as resistance index (RI)--0.72 +/- 0.12 are statistically significantly lower than adequate indices in the control group (PI)--3.36 +/- 1.04 and (RI)--0.81 +/- 0.17 (p < 0.05).

[Prognostic value of vaginal ultrasound with color Doppler in differentiating the malignancy of ovarian tumors]. / Wartosc prognostyczna ultrasonografii dopochwowej z kolorowym Dopplerem w róznicowaniu charakteru zlosliwosci guzów jajnika.

The authors presented results of research on pathological vascularization in ovarian tumors by Doppler's method. 60 records of blood flow were analysed to estimate: pulsation index (PI) and resistance index (RI). Among benign ovarian tumors (26 cases) PI was 1.82 +/- 0.93 and RI 0.93 +/- 0.36. On the contrary, for malignant neoplasms (11 cases) the blood flow was low resistance PI: 0.89 +/- 0.38 and RI: 0.44 +/- 0.19.

[The evaluation of ovarian tumor vascularization using color Doppler transvaginal ultrasonography]. / Ocena unaczynienia nowotworów jajnika przy zastosowaniu utrasonografii dopochwowej z kolorowym Dopplerem.

The aim of this study was the evaluation of blood flow factors prognostical value in differentiation of malignancy among ovarian tumors--sensitivity of this method was 81.8--90.9%, specificity was 88.5%, positive predict value 75.0--76.9% and negative predict value 92.0--95.8%. It was stated that Dopplers method is very usefull in diagnosis of malignant ovarian neoplasms. Moreover it was shown that pulsation index (PI) is more suitable than resistance index (RI), particularly in preoperative diagnostics.

[Evaluation of the influence of placental localization on qualitative estimation of waveforms of blood flow velocity in uterine and arcuate arteries in third trimester physiologic pregnancy]. / Ocena wplywu lokalizacji lozyska na jakosciowa ocene ksztaltu fali predkosci przeplywu krwi w tetnicach macicznych i lukowatych w trzecim trymestrze ciazy fizjologicznej.

We presented in our study methods and results of blood flow measurements with Doppler ultrasound in uterine and arcuate arteries in relation to localization of placenta in physiological pregnancy. We performed examinations in 154 pregnant women with pregnancy age of 32-42 wk. On the basis of qualitative analysis of blood flow waveforms we discovered the difference in the blood flow in utero-placental compartment in relation to placental localization and we proved that this change takes place in uterine as well an in arcuate arteries.

[Evaluation of qualitative values of blood flow indices in uterine and arcuate arteries during the third trimester of normal pregnancy]. / Ocena wartosci jakosciowych wskazników przeplywu krwi w tetnicach macicznych i lukowatych w trzecim trymestrze ciazy o przebiegu prawidlowym.

We presented in our study obtained values of qualitative indices of blood flow in uteroplacental circulation in the third trimester of normal pregnancy. We performed examinations in 154 pregnant women with pregnancy age of 32-42 wk. We evaluated blood flow velocity in uterine and arcuate arteries by means of qualitative analysis of blood flow waveforms. We proved that in the third trimester of normal pregnancy qualitative parameters of blood flow decrease slightly what may suggest that there is systematic placental perfusion increase.

[Predictive value of absent or reverse end-diastolic blood flow in the umbilical artery in the diagnosis of fetal distress]. / Wartosc prognostyczna zaniku lub odwrócenia koncowo-rozkurczowego przeplywu krwi w tetnicy pepowinowej w diagnostyce zagrozenia plodu.

To examine the significance of the absence of reverse of end-diastolic (ARED) velocity in umbilical artery, outcome of pregnancy in 24 women with this complication was evaluated. Acute or chronic hypoxia was evident in 87.5% fetuses with ARED. Such situation is a definable high-risk state that demands intensive surveillance.

[Evaluation of the clinical value in doing complex analysis of blood flow velocity parameters of the umbilical artery for determining prognosis of fetal status]. / Ocena wartosci klinicznej kompleksowej analizy parametrów przeplywu krwi w tetnicy pepowinowej w prognozowaniu stanu plodu.

Complex analysis of the clinical value of the doppler flow indices was undertaken. A/B, RI and PI were compared separately and in different combinations with fetal status and neonate's condition. Statistical analysis revealed that complex and detailed analysis of few quality indices is of greater clinical value and increases sensitivity, specificity and positive predictive value of the doppler technique in the sense of prognosis of fetal distress and neonate's condition.

[Doppler evaluation of blood flow in the umbilical artery when confronted with morphologic changes in human placenta of pregnancy complicated by diabetes]. / Dopplerowska ocena przeplywu krwi w tetnicy pepowinowej w konfrontacji ze zmianami morfologicznymi w lozysku ludzkim w ciazy powiklanej cukrzyca.

Doppler ultrasound velocimetry in umbilical artery was performed in 23 pregnant women in different classes of the diabetes. Results obtained were compared with the afterbirths' morphology. Strict correlation was found between arteries obliteration in the placenta and vascular resistance in higher classes of the diabetes. Normal structure of the villi with signs of their morphological maturity has basic influence on proper umbilical artery flow maintenance.