RESUMO
OBJECTIVE: To assess the diagnostic performance of transvaginal sonography (TVS) for the preoperative evaluation of lymph-node metastasis in gynecological cancer. METHODS: This was a systematic review and meta-analysis of studies published between January 1990 and May 2023 evaluating the role of ultrasound in detecting pelvic lymph-node metastasis (index test) in gynecological cancer, using histopathological analysis as the reference standard. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity, specificity and diagnostic odds ratio were estimated. RESULTS: The literature search identified 2638 citations. Eight studies reporting on a total of 967 women were included. The mean prevalence of pelvic lymph-node metastasis was 24.2% (range, 14.0-65.6%). The risk of bias was low for most domains assessed. Pooled sensitivity, specificity and diagnostic odds ratio of TVS were 41% (95% CI, 26-58%), 98% (95% CI, 93-99%) and 32 (95% CI, 14-72), respectively. High heterogeneity was found between studies for both sensitivity and specificity. CONCLUSION: TVS showed a high pooled specificity for the detection of pelvic lymph-node metastasis in gynecological cancer, but pooled sensitivity was low. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Assuntos
Neoplasias dos Genitais Femininos , Linfonodos , Metástase Linfática , Sensibilidade e Especificidade , Ultrassonografia , Humanos , Feminino , Metástase Linfática/diagnóstico por imagem , Ultrassonografia/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Neoplasias dos Genitais Femininos/patologia , Pelve/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate the role of transvaginal/transrectal ultrasound for preoperative identification of high-risk cases among women with well-differentiated (G1) or moderately differentiated (G2) endometrioid carcinoma of the endometrium. METHODS: This was a single-center prospective observational cohort study comprising a consecutive series of women with a preoperative diagnosis of G1/G2 endometrioid carcinoma of the endometrium. All women underwent transvaginal or transrectal ultrasound examination by a single examiner. According to the examiner's subjective impression, patients were considered high risk if myometrial infiltration was ≥ 50% and/or involvement of the cervix and/or adnexa was suspected. FIGO surgical staging was performed in all cases. According to definitive histological data regarding myometrial infiltration, cervical involvement and adnexal involvement, women were classified as low risk (no myometrial infiltration, no cervical involvement and no adnexal involvement) or high risk (myometrial infiltration ≥ 50% and/or cervical involvement and/or adnexal involvement). Sensitivity, specificity and positive (LR+) and negative (LR-) likelihood ratios, with 95% CIs, of transvaginal/transrectal ultrasound for detecting stage ≥ IB were calculated. Agreement between risk determined by transvaginal/transrectal ultrasound and postoperative definitive histology was calculated. RESULTS: Of 209 eligible women, 169 were included in the study. Mean (± SD) age of the study cohort was 60.7 ± 10.3 years, with a range of 32-91 years. Sensitivity, specificity, LR+ and LR- of transvaginal/transrectal ultrasound identifying high-risk cases according to myometrial infiltration, cervical involvement and adnexal involvement were 78.0% (95% CI, 63.7-88.0%), 89.1% (95% CI, 81.7-93.8%), 7.14 (95% CI, 4.19-12.18) and 0.25 (95% CI, 0.15-0.42), respectively. CONCLUSIONS: Preoperative transvaginal/transrectal ultrasound may play a significant role in identifying high-risk cases among those with G1/G2 endometrioid carcinoma of the endometrium according to preoperative biopsy, and could be a useful test in this clinical setting. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Carcinoma Endometrioide/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Miométrio/patologia , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Invasividade Neoplásica , Estadiamento de Neoplasias , Período Pré-Operatório , Estudos ProspectivosRESUMO
OBJECTIVE: To compare diagnostic performance of preoperative transvaginal ultrasound (TVS) and intraoperative macroscopic examination for determining myometrial infiltration in women with low-risk endometrial cancer, and to estimate the agreement between the two methods. METHODS: This was a single-center observational study comprising women with preoperative diagnosis of well- or moderately differentiated endometrioid carcinoma of the endometrium. All women underwent preoperative TVS by a single examiner. According to the examiner's subjective impression, myometrial infiltration was stated as ≥ 50% or < 50%. Surgical staging was performed in all cases. Intraoperative macroscopic examination of the removed uterus was performed by pathologists who were unaware of the ultrasound findings, and myometrial infiltration was stated as ≥ 50% or < 50%. Definitive histological diagnosis of myometrial infiltration was made by frozen section analysis and was used as the gold standard. Sensitivity and specificity with 95% CIs were calculated for TVS and intraoperative macroscopic inspection and compared using McNemar's test. Agreement between TVS and intraoperative macroscopic inspection was estimated using Cohen's kappa index (κ) and percentage of agreement. RESULTS: Of 209 eligible women, 152 were ultimately included. Mean (± SD) age was 60.9 ± 10.2 years, with a range of 32-91 years. Definitive histological diagnosis revealed that myometrial infiltration was < 50% in 114 women and ≥ 50% in 38 women. Sensitivity and specificity of TVS for detecting deep myometrial infiltration were 81.6% and 89.5%, respectively, whereas the respective values for intraoperative macroscopic examination were 78.9% and 90.4% (McNemar's test, P > 0.05 when comparing TVS and intraoperative macroscopic examination). Agreement between methods was moderate with κ = 0.54 (95% CI, 0.39-0.69) and percentage of agreement of 82%. CONCLUSIONS: Although the agreement between preoperative TVS and intraoperative macroscopic examination for detecting deep myometrial infiltration was only moderate, both methods had similar accuracy when compared with frozen section histology. Preoperative TVS might reasonably be proposed as a method for assessing myometrial infiltration as an alternative to intraoperative macroscopic examination, especially when performed by an experienced examiner and image quality is not poor. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Assuntos
Carcinoma Endometrioide/diagnóstico por imagem , Carcinoma Endometrioide/patologia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Miométrio/patologia , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/cirurgia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Endossonografia/métodos , Feminino , Secções Congeladas , Humanos , Histerectomia , Pessoa de Meia-Idade , Miométrio/diagnóstico por imagem , Miométrio/cirurgia , Invasividade Neoplásica , Estadiamento de Neoplasias , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of endometriosis in the uterosacral ligaments (USL), rectovaginal septum (RVS), vagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis (DIE). METHODS: An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. Studies were considered eligible if they reported on the use of TVS for the preoperative detection of endometriosis in the USL, RVS, vagina and bladder in women with clinical suspicion of DIE using the surgical data as a reference standard. Study quality was assessed using the PRISMA guidelines and QUADAS-2 tool. RESULTS: Of the 801 citations identified, 11 studies (n = 1583) were considered eligible and were included in the meta-analysis. For detection of endometriosis in the USL, the overall pooled sensitivity and specificity of TVS were 53% (95%CI, 35-70%) and 93% (95%CI, 83-97%), respectively. The pretest probability of USL endometriosis was 54%, which increased to 90% when suspicion of endometriosis was present after TVS examination. For detection of endometriosis in the RVS, the overall pooled sensitivity and specificity were 49% (95%CI, 36-62%) and 98% (95%CI, 95-99%), respectively. The pretest probability of RVS endometriosis was 24%, which increased to 89% when suspicion of endometriosis was present after TVS examination. For detection of vaginal endometriosis, the overall pooled sensitivity and specificity were 58% (95%CI, 40-74%) and 96% (95%CI, 87-99%), respectively. The pretest probability of vaginal endometriosis was 17%, which increased to 76% when suspicion of endometriosis was present after TVS assessment. Substantial heterogeneity was found for sensitivity and specificity for all these locations. For detection of bladder endometriosis, the overall pooled sensitivity and specificity were 62% (95%CI, 40-80%) and 100% (95%CI, 97-100%), respectively. Moderate heterogeneity was found for sensitivity and specificity for bladder endometriosis. The pretest probability of bladder endometriosis was 5%, which increased to 92% when suspicion of endometriosis was present after TVS assessment. CONCLUSION: Overall diagnostic performance of TVS for detecting DIE in uterosacral ligaments, rectovaginal septum, vagina and bladder is fair with high specificity.
Assuntos
Endometriose/diagnóstico por imagem , Ligamentos/patologia , Reto/patologia , Ultrassonografia Doppler em Cores , Doenças da Bexiga Urinária/patologia , Vagina/patologia , Endometriose/patologia , Feminino , Humanos , Ligamentos/diagnóstico por imagem , Valor Preditivo dos Testes , Reto/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Doenças da Bexiga Urinária/diagnóstico por imagem , Vagina/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate the contribution of three-dimensional (3D) power Doppler angiography (3D-PDA) to the differential diagnosis of adnexal masses. METHODS: This was a prospective study in women diagnosed with a persistent adnexal mass and subsequently scheduled for surgery in a tertiary university hospital. All women were evaluated by transvaginal/transrectal ultrasound according to a predetermined three-step protocol, with transabdominal ultrasound being performed in some cases. First, morphological evaluation of the mass was performed using gray-scale 'pattern recognition' (first step). Lesions diagnosed as having a benign pattern were considered as being at low risk of malignancy whereas tumors with solid components, ascites and/or signs of carcinomatosis were considered as being at high risk of malignancy. In both cases no further test was performed and a decision regarding clinical management, either for follow-up or surgery, was taken. Tumors with solid components but without signs of ascites or carcinomatosis were considered as being at intermediate risk of malignancy. These lesions were assessed by two-dimensional (2D) PDA to evaluate tumor vascularity (color score) (second step). Solid tumors with a color score of 1 or 2 were considered as benign and no further test was performed, while tumors with a color score of 2, 3 or 4 within solid components or a color score of 3 or 4 in the case of a solid tumor were considered as malignant. The latter group underwent 3D-PDA assessment (third step). Vascularization index (VI) was calculated in a 1-mL sphere of the most vascularized area of the tumor. When a VI ≥ 24.015% was found, the tumor was considered as malignant. All masses were removed surgically and definitive histological diagnosis was used as the gold standard. Sensitivity and specificity for each strategy were calculated and compared. In the case of bilateral tumors, only the more suspicious one was used for analysis. RESULTS: A total of 367 adnexal masses diagnosed in 367 women (mean age, 46.5 (range, 18-80) years) were evaluated during the study period. Of these, 86 masses were malignant and 281 were benign. The sensitivity and specificity for each assessment strategy were as follows: one-step, 97.7% and 78.6%; two-step, 94.2% and 97.9% (P < 0.001 for specificity when compared with that of one-step); three-step, 90.7% and 98.9% (not statistically significant when compared with that of two-step). CONCLUSIONS: The addition of 2D-PDA in the differential diagnosis of an adnexal mass significantly increases specificity while sensitivity remains high; however performing subsequent 3D-PDA does not provide additional information or further improve diagnostic performance subsequent to 2D-PDA.
Assuntos
Doenças dos Anexos/patologia , Angiografia , Neoplasias Ovarianas/patologia , Ultrassonografia Doppler , Doenças dos Anexos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods. METHODS: An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative assessment of myometrial infiltration by subjective evaluation and/or objective measurements. Objective measurements included, specifically, the approaches of Gordon (ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson (endometrial tumor thickness/anteroposterior uterine diameter ratio), in women with endometrial cancer, using the surgical pathological data as a reference standard. Study quality was assessed using the QUADAS-2 tool. RESULTS: Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 82% (95% CI, 76-87%), 81% (95% CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I(2) range, 60.6-95.0). The main limitation was that very few studies compared different approaches in the same set of patients. CONCLUSION: Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.
Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Miométrio/diagnóstico por imagem , Miométrio/patologia , Neoplasias do Endométrio/cirurgia , Endossonografia/métodos , Feminino , Humanos , Miométrio/cirurgia , Invasividade Neoplásica , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Sensibilidade e Especificidade , VaginaRESUMO
BACKGROUND: Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage. METHODS: A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (1984-2000) at a median dose of 15 Gy (range 10-20 Gy) and 25 patients received adjuvant PHDRB (2001-2016) at a median dose of 32 Gy (range 24-40 Gy) in 6, 8, or 10 b.i.d. fractions. RESULTS: The median follow-up was 5.6 years (range 0.5-14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively. CONCLUSIONS: IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.
Assuntos
Braquiterapia , Elétrons/uso terapêutico , Neoplasias dos Genitais Femininos/radioterapia , Recidiva Local de Neoplasia/radioterapia , Reirradiação/métodos , Terapia de Salvação/métodos , Adulto , Idoso , Braquiterapia/efeitos adversos , Intervalo Livre de Doença , Elétrons/efeitos adversos , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Cuidados Intraoperatórios , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Reirradiação/efeitos adversos , Terapia de Salvação/efeitos adversos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the correlation between intratumoral vascularization using three-dimensional power Doppler angiography (3D-PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma. METHODS: Ninety-nine women (mean age, 61.7 (range, 31-84) years) diagnosed as having endometrial cancer were assessed by transvaginal 3D-PDA before surgical staging. Endometrial volume (EV) and 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL) method. All patients were surgically staged. Individual tumor features such as histological type, tumor grade, myometrial infiltration depth, lymph-vascular space involvement, cervical involvement, lymph node metastases and tumor stage were considered for analysis. Multivariate logistic regression (MLR) analysis was used to determine which 3D-PDA parameters were independently associated with each histological characteristic. RESULTS: MLR analysis showed that only EV and VI were independently associated with myometrial infiltration (EV: odds ratio (OR), 1.119 (95% CI, 1.025-1.221), P = 0.012; VI: OR, 1.127 (95% CI, 1.063-1.195), P = 0.001) and tumor stage (EV: OR, 1.103 (95% CI, 1.012-1.202), P = 0.025; VI: OR, 1.120 (95% CI, 1.057-1.187), P = 0.001), only VI was independently associated with tumor grade (OR, 1.056 (95% CI, 1.023-1.091), P = 0.001) and only EV was independently associated with lymph node metastases (OR, 1.086 (95% CI, 1.017-1.161), P = 0.001). CONCLUSION: 3D-PDA analysis of tumor vascularization in endometrial cancer correlates with some prognostic histological characteristics.
Assuntos
Neoplasias do Endométrio/diagnóstico , Neovascularização Patológica/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Neoplasias do Endométrio/irrigação sanguínea , Neoplasias do Endométrio/patologia , Feminino , Humanos , Imageamento Tridimensional , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neovascularização Patológica/patologia , Ultrassonografia Doppler em Cores/métodos , Neoplasias Uterinas/irrigação sanguínea , Neoplasias Uterinas/patologiaRESUMO
OBJECTIVES: To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment. METHODS: Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology. RESULTS: One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant. CONCLUSIONS: Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.
Assuntos
Doenças dos Anexos/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Triagem/métodos , Doenças dos Anexos/cirurgia , Adolescente , Adulto , Idoso , Algoritmos , Ecocardiografia Doppler , Feminino , Humanos , Laparoscopia , Laparotomia , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Adulto JovemRESUMO
We studied twenty women who became pregnant after porcine bioprosthetic valve replacement. Six patients had aortic valve, seven mitral, and seven aortic plus mitral valve replacement. All women were treated with aspirin (1 g daily or 500 mg every 48 hours) during pregnancy, delivery, and the postdelivery period. Thirteen patients experienced atrial fibrillation. There were 27 pregnancies with three ending in abortion. Twenty five normal babies were delivered. There was no maternal mortality or morbidity from thromboembolism or hemorrhage. Comparison of the pregnancy course of these women and the general population shows no difference with respect to fetal or maternal morbidity and mortality. Pregnant women with bioprosthetic valve replacement treated with aspirin had normal pregnancies without the risk of thromboembolism. Fetal and perinatal morbidity and mortality was also within normal limits.
Assuntos
Aspirina/uso terapêutico , Bioprótese , Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia/prevenção & controle , Adulto , Valva Aórtica , Feminino , Feto/efeitos dos fármacos , Humanos , Valva Mitral , Gravidez , RiscoRESUMO
Thirty-eight women with mechanical valve prostheses had a total of 47 pregnancies. All patients were on oral anticoagulants before pregnancy. A high incidence of complications was seen in both the mothers and the fetuses. The rate of spontaneous abortion was 23.4% (11/47), and 2 of the 36 newborns had chondrodysplasia punctata. Three of the women (7.9%) had acute valvular thrombosis; 1 died after replacement of the thrombosed valve. Thus, the overall mortality for the series was 2.6%. More complications were observed in the fetuses and infants of women treated with oral anticoagulants during pregnancy than in women treated with heparin. However, the mothers had more complications with heparin anticoagulation. Neither heparin nor oral anticoagulants clearly proved superior as the anticoagulation regimen of choice for pregnant women with mechanical valves. Counseling before conception occurs and avoidance of pregnancy are recommended for women with mechanical valve prostheses because of the high risk of serious or fatal complications in the mother and fetus. Use of tissue valves in women of childbearing age who desire to have children also seems advisable, even with the possibility of having to undergo another operation as a result of degeneration of the valve tissue.
Assuntos
Próteses Valvulares Cardíacas , Complicações na Gravidez/etiologia , Aborto Espontâneo/etiologia , Anticoagulantes/efeitos adversos , Feminino , Doenças Fetais/etiologia , Heparina/efeitos adversos , Humanos , Gravidez , RiscoRESUMO
OBJECTIVE: To compare diagnostic performance of color Doppler ultrasound and CA-125 in suspicious adnexal masses on B-mode sonography. MATERIALS AND METHODS: Data on 94 patients (mean age: 47.4 years, range: 17-79 years. Fifty-two (55.3%) premenopausal and 42 (44.7%) postmenopausal women) managed in our institution because of a suspicious adnexal mass were reviewed. All patients were evaluated by transvaginal color Doppler ultrasonography (CD) and serum CA-125 level determination prior to surgery. Definitive histopathological diagnosis was obtained in each case. Sonographic morphology evaluation was suspicious in all cases. CD was considered as suspicious when flow was detected and the lowest RI found was < or = 0.45. CA-125 cut-off was > or = 35 UI/ml. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method and compared. ROC analysis was performed for RI and CA-125. Areas under curve (AUC) were calculated and compared. RESULTS: Fifty-six (59.6%) tumors were found to be malignant and 38 (40.4%) benign. Sensitivity, specificity, PPV and NPV for CD were 87.5% (95% CIs: 75.3-94.4), 84.2% (95% CIs: 68.7-94), 89.1% (95% CIs: 77.7-95.9) and 82.1% (95% CIs: 66.5-92.5), respectively. Sensitivity, specificity, PPV and NPV for CA-125 were 83.9% (95% CIs: 71.7-92.4), 68.4% (95% CIs: 51.3-82.5), 79.7% (95% CIs: 66.2-89) and 74.3% (95% CIs: 56.7-87.5), respectively. Sensitivity, PPV and NPV were not statistically different. CD had higher specificity (P = 0.01). AUC curve for Doppler (0.75) was significantly higher than for CA-125 (0.61) (P = 0.0002). CONCLUSIONS: Our results indicate that color Doppler ultrasound has a better diagnostic performance as compared with CA-125, being significantly more specific.
Assuntos
Doenças dos Anexos/diagnóstico , Biomarcadores Tumorais/sangue , Antígeno Ca-125/sangue , Neoplasias Ovarianas/diagnóstico , Ultrassonografia Doppler em Cores , Doenças dos Anexos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico por imagem , Pós-Menopausa , Valor Preditivo dos Testes , Pré-Menopausa , Curva ROC , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Próteses Valvulares Cardíacas/efeitos adversos , Complicações Cardiovasculares na Gravidez , Aborto Espontâneo/etiologia , Aspirina/uso terapêutico , Cesárea , Anormalidades Congênitas/etiologia , Doença das Coronárias/etiologia , Feminino , Heparina/uso terapêutico , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológicoRESUMO
Varicella pneumonia can endanger the life of pregnant women. We have a case of varicella pneumonia complicating pregnancy in the third trimester. The patient required intubation, early treatment with acyclovir (700 mg/IV every eight hours), as well as the extraction of the fetus by cesarean section before the time gestation was completed. Early treatment with acyclovir has improved hope for these patients.
Assuntos
Varicela/virologia , Pneumonia Viral/virologia , Complicações Infecciosas na Gravidez/virologia , Aciclovir/uso terapêutico , Adulto , Varicela/tratamento farmacológico , Feminino , Humanos , Intubação , Pneumonia Viral/tratamento farmacológico , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Resultado da Gravidez , Terceiro Trimestre da GravidezRESUMO
OBJECTIVE: To evaluate the role of transvaginal power Doppler sonography to discriminate between benign and malignant endometrial conditions in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography. METHODS: Ninety-one postmenopausal women (median age, 58 years; range, 47-83 years) presenting with uterine bleeding and a thickened endometrium (> or = 5-mm double-layer endometrial thickness) on transvaginal sonography were included in this prospective study. Endometrial blood flow distribution was assessed in all patients by power Doppler immediately after B-mode transvaginal sonography. Three different vascular patterns were defined: Pattern A: multiple-vessel pattern, Pattern B: single-vessel pattern and Pattern C: scattered-vessel pattern. Histological diagnoses were obtained in all cases. No patient taking tamoxifen citrate or receiving hormone replacement therapy was included. RESULTS: Histological diagnoses were as follows: endometrial cancer: 33 (36%), endometrial polyp: 37 (41%), endometrial hyperplasia: 14 (15%), endometrial cystic atrophy: 7 (8%). Blood flow was found in 97%, 92%, 79% and 85% of cases of carcinoma, polyp, hyperplasia and endometrial cystic atrophy, respectively. A total of 81.3% of vascularized endometrial cancers showed Pattern A, 97.1% of vascularized polyps exhibited Pattern B and 72.7% of vascularized hyperplasias showed Pattern C. Sensitivity and specificity for endometrial cancer were 78.8% and 100%. For endometrial polyp these respective values were 89.2% and 87% and for hyperplasia they were 57.1% and 88.3%. CONCLUSIONS: Transvaginal power Doppler blood flow mapping is useful to differentiate benign from malignant endometrial pathology in women presenting with postmenopausal bleeding and thickened endometrium at baseline sonography.
Assuntos
Endométrio/irrigação sanguínea , Hemorragia Uterina/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Cistos/diagnóstico por imagem , Cistos/fisiopatologia , Hiperplasia Endometrial/diagnóstico por imagem , Hiperplasia Endometrial/fisiopatologia , Neoplasias do Endométrio/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/fisiopatologia , Pós-Menopausa , Ultrassonografia Doppler/métodos , Hemorragia Uterina/diagnóstico por imagemRESUMO
We studied 59 pregnancies in 48 female carriers of prosthetic heart valves. In 44 pregnancies the mother had a metal valve mostly with coumarin therapy and in 15 a bioprosthesis usually without hematologic treatment. In the patients with metal prostheses we had the following maternal complications: 1 maternal death, 3 valve thromboses, 2 heart failures and 1 puerperal hemorrhage. There was also a significantly increased rate of preterm, low birth weight infants and intrauterine growth retardation. Concerning malformations we found only 2 cases of mild nasal hypoplasia. Regarding the complications of bioprosthesis, we had only 1 case of paroxysmal tachycardia and no fetal complications. Comparing the results we came to the conclusion that pregnancy is much better tolerated in patients with bioprostheses and that in patients with metal prostheses the risk is increased if the mother is older than 30 years, if time of replacement is more than 5 years or if there is a history of previous thromboembolism or gravidic heart failure.
Assuntos
Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez , Aborto Espontâneo/etiologia , Adulto , Valva Aórtica/cirurgia , Bioprótese , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Masculino , Mortalidade Materna , Valva Mitral/cirurgia , Complicações do Trabalho de Parto/etiologia , Complicações Pós-Operatórias , Gravidez , Transtornos Puerperais/etiologia , RiscoRESUMO
In a prospective study, 140 patients had an oxytocin challenge test with either a continuous or a pulsed infusion (one minute of infusion in every five minutes). Both infusion regimens had similar success rates in terms of uterine contractions (97.1 vs 98.6%). The potency ratio (pulsed versus continuous infusion) was significant at 2.7 (1.27 to 5.2), which means that more uterine activity was induced with each mU of oxytocin with pulsatile than with continuous administration. The total amount of oxytocin required to obtain three good contractions in 10 minutes was about 40% less with pulsed administration than with continuous infusion, but the test took 40 minutes longer with the pulsed than with the continuous infusion (P < 0.01).
Assuntos
Ocitocina , Contração Uterina/efeitos dos fármacos , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Recém-Nascido , Bombas de Infusão , Infusões Intravenosas , Ocitocina/administração & dosagem , Gravidez , Fluxo PulsátilRESUMO
OBJECTIVE: To describe the sonographic characteristics of ovarian cystadenofibromas. METHODS: We conducted a retrospective study of 23 ovarian tumors histopathologically confirmed as ovarian cystadenofibromas that were preoperatively evaluated by transvaginal color Doppler sonography. RESULTS: In all cases the mass was predominantly cystic. Septations appeared in 30.4% of the tumors. Papillary projections or solid nodules appeared in 56.5% of the cases. The most frequent appearance was a unilocular complex cystic mass. In 47.8% of the tumors, vascularization was detected, having a typical pattern of peripheral vascularization with scattered vessels of high blood flow impedance. CONCLUSIONS: We have described the sonographic spectrum of findings of ovarian cystadenofibromas. The most frequent appearance was a unilocular cystic mass with gross papillary projections or solid nodules. In almost half of the tumors, vascularization could be detected.
Assuntos
Adenofibroma/diagnóstico por imagem , Cistadenoma Seroso/diagnóstico por imagem , Neoplasias Ovarianas/diagnóstico por imagem , Adenofibroma/patologia , Adulto , Idoso , Cistadenoma Seroso/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Estudos Retrospectivos , UltrassonografiaRESUMO
We present a retrospective study of 245 pregnancies in 157 women who had undergone commissurotomy (closed surgery) and whose delivery was assisted at the Maternity La Paz (Madrid, Spain) between 1965 and 1981. There was a statistically significant increase in the rate of fetal complications (perinatal mortality, 44.3 per 1,000; pre-term 8.5%; intra-uterine growth retardation, 17.3%; low weight, 12.5%) and maternal mortality. The most frequent and severe maternal complication was congestive heart failure which was more common among primigravidas and was of statistical significance. In patients with atrial fibrillation or heart failure during pregnancy or puerperium, the results were even more remarkable. There were no complications in patients who underwent commissurotomy during pregnancy. Preterm delivery was three times more common in patients undergoing digitalis therapy.