Application of Ultrasound Scores (Subjective Assessment, Simple Rules Risk Assessment, ADNEX Model, O-RADS) to Adnexal Masses of Difficult Classification.

BACKGROUND: Ultrasound features help to differentiate benign from malignant masses, and some of them are included in the ultrasound (US) scores. The main aim of this work is to describe the ultrasound features of certain adnexal masses of difficult classification and to analyse them according to the most frequently used US scores. METHODS: Retrospective studies of adnexal lesions are difficult to classify by US scores in women undergoing surgery. Ultrasound characteristics were analysed, and masses were classified according to the Subjective Assessment of the ultrasonographer (SA) and other US scores (IOTA Simple Rules Risk Assessment-SRRA, ADNEX model with and without CA125 and O-RADS). RESULTS: A total of 133 adnexal masses were studied (benign: 66.2%, n:88; malignant: 33.8%, n:45) in a sample of women with mean age 56.5 ± 7.8 years. Malignant lesions were identified by SA in all cases. Borderline ovarian tumors (n:13) were not always detected by some US scores (SRRA: 76.9%, ADNEX model without and with CA125: 76.9% and 84.6%) nor were serous carcinoma (n:19) (SRRA: 89.5%), clear cell carcinoma (n:9) (SRRA: 66.7%) or endometrioid carcinoma (n:4) (ADNEX model without CA125: 75.0%). While most teratomas and serous cystadenomas have been correctly differentiated, other benign lesions were misclassified because of the presence of solid areas or papillae. Fibromas (n:13) were better identified by SA (23.1% malignancy), but worse with the other US scores (SRRA: 69.2%, ADNEX model without and with CA125: 84.6% and 69.2%, O-RADS: 53.8%). Cystoadenofibromas (n:10) were difficult to distinguish from malignant masses via all scores except SRRA (SA: 70.0%, SRRA: 20.0%, ADNEX model without and with CA125: 60.0% and 50.0%, O-RADS: 90.0%). Mucinous cystadenomas (n:12) were misdiagnosed as malignant in more than 15% of the cases in all US scores (SA: 33.3%, SRRA: 16.7%, ADNEX model without and with CA125: 16.7% and 16.7%, O-RADS:41.7%). Brenner tumors are also difficult to classify using all scores. CONCLUSION: Some malignant masses (borderline ovarian tumors, serous carcinoma, clear cell carcinoma, endometrioid carcinomas) are not always detected by US scores. Fibromas, cystoadenofibromas, some mucinous cystadenomas and Brenner tumors may present solid components/papillae that may induce confusion with malignant lesions. Most teratomas and serous cystadenomas are usually correctly classified.

Ultrasound Features and Ultrasound Scores in the Differentiation between Benign and Malignant Adnexal Masses.

BACKGROUND: Several ultrasound (US) features help ultrasound experts in the classification of benign vs. malignant adnexal masses. US scores serve in this differentiation, but they all have misdiagnoses. The main objective of this study is to evaluate what ultrasound characteristics are associated with malignancy influencing ultrasound scores. METHODS: This is a retrospective analysis of ultrasound features of adnexal lesions of women managed surgically. Ultrasound characteristics were analyzed, and masses were classified by subjective assessment of the ultrasonographer (SA) and other ultrasound scores (IOTA Simple Rules Risk Assessment SRRA, ADNEX model, and O-RADS). RESULTS: Of a total of 187 adnexal masses studied, 134 were benign (71.7%) and 53 were malignant (28.3%). SA, IOTA SRRA, ADNEX model with or without CA125 and O-RADS had high levels of sensitivity (93.9%, 81.1%, 94.3%, 88.7%, 98.1%) but lower specificity (80.2%, 82.1%, 82.8%, 77.6%, 73.1%) with similar AUC (0.87, 0.87, 0.92, 0.90, 0.86). Ultrasound features significantly related with malignancy were the presence of irregular contour, absence of acoustic shadowing, vascularized solid areas, ≥1 papillae, vascularized septum, and moderate-severe ascites. CONCLUSION: IOTA SRRA, ADNEX model, and O-RADS can help in the classification of benign and malignant masses. Certain ultrasound characteristics studied in ultrasound scores are associated with malignancy.

Comparison of Ultrasound Scores in Differentiating between Benign and Malignant Adnexal Masses.

Subjective ultrasound assessment by an expert examiner is meant to be the best option for the differentiation between benign and malignant adnexal masses. Different ultrasound scores can help in the classification, but whether one of them is significantly better than others is still a matter of debate. The main aim of this work is to compare the diagnostic performance of some of these scores in the evaluation of adnexal masses in the same set of patients. This is a retrospective study of a consecutive series of women diagnosed as having a persistent adnexal mass and managed surgically. Ultrasound characteristics were analyzed according to IOTA criteria. Masses were classified according to the subjective impression of the sonographer and other ultrasound scores (IOTA simple rules -SR-, IOTA simple rules risk assessment -SRRA-, O-RADS classification, and ADNEX model -with and without CA125 value-). A total of 122 women were included. Sixty-two women were postmenopausal (50.8%). Eighty-one women had a benign mass (66.4%), and 41 (33.6%) had a malignant tumor. The sensitivity of subjective assessment, IOTA SR, IOTA SRRA, and ADNEX model with or without CA125 and O-RADS was 87.8%, 66.7%, 78.1%, 95.1%, 87.8%, and 90.2%, respectively. The specificity for these approaches was 69.1%, 89.2%, 72.8%, 74.1%, 67.9%, and 60.5%, respectively. All methods with similar AUC (0.81, 0.78, 0.80, 0.88, 0.84, and 0.75, respectively). We concluded that IOTA SR, IOTA SRRA, and ADNEX models with or without CA125 and O-RADS can help in the differentiation of benign and malignant masses, and their performance is similar to the subjective assessment of an experienced sonographer.

Cribado combinado para la detección de trisomía 21 en el primer trimestre de la gestación. Impacto sobre la tasa de procedimientos invasivos de diagnóstico prenatal tras 5 años de implementación / First-trimester combined screening for trisomy 21. Impact on the rate of invasive prenatal diagnostic procedures after 5 years of use

Objetivo. Evaluar la efectividad del cribado combinado del primer trimestre para la detección prenatal del síndrome de Down tras 5 años de implantación en nuestro hospital y su repercusión en la disminución de pruebas diagnósticas invasivas. Material y métodos. Se evaluó el riesgo de anomalía cromosómica fetal en 10.669 gestaciones mediante cribado combinado del primer trimestre entre mayo de 2006 y diciembre de 2010. El punto de corte para indicar una técnica invasiva diagnóstica fue de 1/270. Asimismo se analizaron las amniocentesis realizadas entre los años 2005 y 2010. Resultados. La tasa de detección del cribado para trisomía 21 fue del 90% y la tasa de falsos positivos del 3,56%. En gestantes de 35 o más años, la tasa de detección fue del 96,7%. En el año 2005 se realizaron 496 amniocentesis. En el año 2010, tras 5 años de la implementación del cribado, se realizaron 148 amniocentesis, lo que implica una reducción de técnicas invasivas del 70%. Conclusiones. La implantación del cribado combinado en nuestro medio ha demostrado su eficacia para la detección de trisomía 21 y ha supuesto una importante reducción en el número de procedimientos invasivos de diagnóstico prenatal. La edad materna avanzada como criterio aislado de indicación de técnicas invasivas para el estudio del cariotipo fetal debe cuestionarse si se ofrece un cribado universal y de calidad (AU)

Objective. To assess the effectiveness of first-trimester combined screening in the prenatal detection of Down syndrome after 5 years of use in our hospital and its impact in reducing invasive diagnostic tests. Material and methods. The risk of fetal chromosomal anomalies was assessed in 10,669 pregnancies with first-trimester combined screening between May 2006 and December 2010. The cut-off to indicate an invasive diagnostic test was 1/270. The amniocenteses performed between 2005 and 2010 were also analyzed. Results. The detection rate of screening for trisomy 21 was 90% and the false-positive rate was 3.56%. In pregnant women aged 35 years or more, the detection rate was 96.7%. In 2005 there were 496 amniocenteses. In 2010, 5 years after the introduction of screening, 148 amniocenteses were performed, representing a 70% reduction in invasive procedures. Conclusions. The introduction of combined screening in our environment has proven effective for the detection of trisomy 21 and has substantially reduced the use of invasive prenatal diagnostic procedures. The use of advanced maternal age as an isolated criterion to indicate invasive techniques to study fetal karyotype should be questioned if high-quality universal screening is to be offered (AU)