Ovarian crescent sign and sonomorphological indices in preoperative determination of malignancy in adnexal masses.

OBJECTIVE: To compare the value of ovarian crescent sign (OCS) and various sonomorphologic scoring systems in consolidating pre-operative suspicion of ovarian malignancy in adnexal masses. MATERIALS AND METHODS: A prospective study was carried out in 60 consenting women with an undiagnosed adnexal mass requiring operative intervention. OCS was considered to be present if normal ovarian tissue was seen adjacent to the tumor area on ultrasound. Various other sonological parameters were noted to calculate five morphological scoring systems. Doppler velocimetry study values were available in 27 cases. The results were compared for correctness of suspicion with histopathologic examination report of the tumor obtained at surgery. RESULTS: Eleven of 60 specimens showed histopathologic diagnosis of malignancy. OCS was identified in 97% of the benign masses. The sign was not seen in 10 of the 11 cases with malignancy. Sensitivity and negative predictive value of crescent sign was better than values obtained for the compared sonomorphological indices and Doppler velocimetry studies. CONCLUSION: Ovarian crescent sign is a reliable and simple sonographic indicator comparable to sonomorphological indices and Doppler flow velocimetric studies for the preoperative detection of malignancy in adnexal masses.

Pregnancy associated breast cancer--the obstetrician's role.

Breast cancer is the most common cancer in many geographic areas, the most frequent cause of cancer deaths in women, and is also the cancer most likely to be seen during pregnancy and lactation. Delay in diagnosis appears to be the primary reason for the generally worse prognosis overall for all patients with breast cancer diagnosed during pregnancy and lactation. In this context, the patient's family physician or obstetrician who performs the routine antenatal examinations can play an important role by performing a vital breast examination which might bring to light and prompt timely investigation of otherwise asymptomatic breast masses.

Labour admission test--an effective risk screening tool.

Recording of foetal heart tracing on cardiotocogram for 30 minutes was done in 500 women on admission in labour and contraction mediated responses were recorded as labour admission test (LAT). Subjects were also stratified into high or low risk groups based on antenatal factors. Seventy-seven out of 500 labour cases (36 out of 433 cases with reactive, 16 out of 37 with suspicious and 25 out of 30 cases with ominous LATs) manifested foetal distress. Eighty-two per cent of antenatal high risk and 89% of low risk pregnancies showed reactive LATs. The LAT was found to have high specificity (93%) and negative predictive value (91%). However, the sensitivity and positive predictive values were lower (53% and 61% respectively). Patients with pre-existing risk factors showed intrapartum foetal distress by 3 hours of reactive LAT, whereas the ones with no antenatal risk factors did not develop foetal distress till 6 hours after reactive LAT. Reactive LAT tracing is of some predictive value; at least for the first few hours after admission in labour.