Groin Surveillance by Serial Ultrasonography Rather Than Sentinel Node Biopsy or Inguinofemoral Lymphadenectomy for Patients with Vulvar Cancer: A Pilot Study.

A pilot study was conducted to determine whether 3-monthly groin ultrasonography could eliminate groin dissection after a negative bilateral groin ultrasound in three groups of patients: (i) Those with a unifocal stage 1B squamous cell carcinoma of up to 20 mm in diameter. (ii) Those with an ipsilateral squamous cell carcinoma of any size which extended to within 1 cm either side of the midline. These patients underwent ipsilateral inguinofemoral lymphadenectomy and ultrasonic surveillance of the contralateral groin. (iii) Patients with multifocal invasive lesions with the largest individual focus 20 mm or less in diameter. Three additional patients were added because they either refused groin dissection or were considered unfit for surgery. All ultrasonically positive nodes were confirmed histologically. Thirty-two patients were entered, and no patients were lost to follow-up. Forty-three groins were followed. With a median follow-up of 37 months, three positive nodes (9.4%) were detected. One patient died of her recurrence (3.1%), and 39 groins (90.7%) were preserved. The overall sensitivity of ultrasonic surveillance was 100% (95% CI: 44-100%), with a specificity of 97% (95% CI: 83-99%) and a negative predictive value of 100% (95% CI: 88-100%). This pilot justifies a larger study on serial ultrasonography in lieu of groin dissection in selected patients with vulvar cancer.

Reducing transmission risk through high-level disinfection of transvaginal ultrasound transducer handles.

Intracavity ultrasound transducer handles are not routinely immersed in liquid high-level disinfectants. We show that residual bacteria, including pathogens, persist on more than 80% of handles that are not disinfected, whereas use of an automated device reduces contamination to background levels. Clinical staff should consider the need for handle disinfection.

Accuracy of sonographic prediction of birth weight.

Many clinicians use ultrasound estimates of fetal weight to assess fetal growth. This study assessed the accuracy of the Hadlock IV equation, the equation used at the Royal Hospital for Women, Randwick, NSW, in estimating birth weight. The accuracy of the Hadlock IV equation was assessed based on systematic and random error as well as absolute error. 709 women who underwent ultrasound examination within 8 weeks of delivery between January 2009-May 2011 were included. 305 women underwent ultrasound less than 2 weeks before delivery. The systematic, random and absolute errors of the Hadlock IV equation were -0.47, 27.45 and 8.52%, respectively. This study demonstrates that clinicians may rely on ultrasound estimates of fetal weight performed by well-trained staff in a tertiary institution within 2 weeks of delivery. The accuracy diminishes as the interval between testing and delivery increases. Absolute errors tended to increase with increasing birth weight for all ultrasound-delivery intervals.

A standardised ultrasonic diagnosis and an accurate prevalence for the retroverted uterus in general gynaecology patients.

Transvaginal ultrasound with an empty bladder is recommended as a standardised ultrasonic technique for the accurate diagnosis of the retroverted uterus. Using this method, the prevalence of the retroverted uterus in 480 general gynaecological patients attending for subspecialist gynaecological ultrasound was 18%. The anteverting effect of the full bladder required for transabdominal ultrasound reduces the prevalence of the retroverted uterus to 13% (P < 0.001).