RESUMO
BACKGROUND: Diagnostic accuracy for estimating myometrial infiltration by ultrasound in endometrial cancer requires experience. The objective of this study is to determine the learning curve (LC) for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS). METHODS: Five trainees (one staff radiologist and four fourth-year OB/GYN residents) participated in this study. All trainees had experience in performing TVS, but none of them had specific training on the assessment of myometrial infiltration. Trainees were given one specific lecture about the topic, and then they observed videoclips from 10 cases explained by the trainer. After this, all trainees visualized 45 videoclips of uterine ultrasound scans of endometrial cancer cases. The assessment of myometrial infiltration was based on the subjective impression. Definitive histology was used as a reference standard. Trainees stated whether myometrial infiltration was ≥50% or <50%. LC-CUSUM and standard CUSUM graphics were plotted to determine how many cases were needed to reach competence, allowing a mistake rate of 15%. RESULTS: All trainees completed the study. LC-CUSUM graphics showed that three trainees reached competence at the 33rd, 35th and 36th case, respectively. All three of them kept the process under control after reaching competence. One trainee reached competence but did not maintain it in the cumulative analysis. One trainee did not reach competence. CONCLUSION: Our study suggests that 30-40 cases would be needed to be trained for assessing myometrial infiltration by TVS by visual interpretation of videoclips by most trainees.
RESUMO
BACKGROUND: The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. METHODS: Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. RESULTS: The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. CONCLUSION: Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.
RESUMO
El síndrome del folículo vacío (SFV) es el fracaso total para recuperar los ovocitos después de la estimulación ovárica, a pesar de un desarrollo folicular aparentemente normal y una esteroidogénesis folicular adecuada. Se han descrito dos variantes de SFV: la forma genuina, que ocurre en presencia de niveles adecuados de hCGβ circulante o de LH en el momento de la aspiración de ovocitos, y la forma 'falsa', que se asocia a niveles séricos de hCG/LH por debajo de un umbral crítico. En nuestra paciente, tras un protocolo aceptado de estimulación ovárica con gonadotropina menopáusica humana y folitropina alfa y posterior maduración folicular con coriogonadotropina alfa no se obtuvieron cúmulos ovocitarios en la punción ecoguiada, con lo que se trató de emplear otras estrategias encaminadas a corregir esta situación. El tratamiento y el pronóstico de estas pacientes aún no se conocen bien. Se necesitan grandes estudios multicéntricos y revisiones sistemáticas para aumentar la comprensión del SFV y así, su manejo, diseñando mejores estrategias como tratamos de hacer con nuestra paciente con el empleo de doble descarga para maduración ovocitaria.
Empty follicle syndrome (EFS) is the complete failure to retrieve oocytes after ovarian stimulation, despite apparently normal follicular development and adequate follicular steroidogenesis. Two variants of EFS have been described: the genuine form, which occurs in the presence of adequate circulating βhCG or LH levels at the time of oocyte aspiration, and the 'false' form, which is associated with serum hCG/ LH levels below a critical threshold. In our patient, after an accepted protocol of ovarian stimulation with human menopausal gonadotropin and follitropin alfa and subsequent follicular maturation with choriogonadotropin alfa, no oocyte clusters were obtained in the ultrasound-guided puncture, so an attempt was made to use other strategies aimed at correcting this situation. The treatment and prognosis of these patients are still poorly understood. Large multicenter studies and systematic reviews are needed to increase understanding of EFS and thus its management, designing better strategies as we tried to do with our patient with the use of double discharge for oocyte maturation.