Ultrasound criteria and CA 125 as predictive variables of ovarian cancer in women with adnexal tumors.

OBJECTIVES: To evaluate the capacity to predict malignancy in women with adnexal tumors using CA 125 measurement and ultrasound criteria. METHODS: This was a cross-sectional study including 103 women with a total of 110 adnexal tumors. CA 125 level was measured in a sample of peripheral blood. Lesions were classified by ultrasound, using standardized predetermined criteria, as benign (B) or malignant (M). Those that could not be classified by these criteria were assessed subjectively. Histopathologic examination of surgical specimens was used as the gold standard. RESULTS: Of 110 tumors, 79 (71.8%) were benign and 31 (28.2%) were malignant on histopathology. Ultrasound criteria could be applied to 91 (82.7%) tumors, resulting in a sensitivity of 90%, specificity of 87%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 97%. In tumors not classifiable according to ultrasound criteria, subjective sonographic assessment gave a sensitivity of 67%, specificity of 80%, PPV of 75% and NPV of 73%. At a cut-off point of 37.4 U/mL, CA 125 had a sensitivity of 69%, a specificity of 87.8%, a PPV of 69% and a NPV of 88% for detection of malignancy. When CA 125 was associated with age and ultrasound criteria in a logistic regression model, the sensitivity and specificity increased in the subset of sonographically malignant tumors. CONCLUSION: The majority of tumors were correctly classified using ultrasound criteria. CA 125 alone performed worse than did ultrasound in discriminating malignant from benign adnexal tumors. CA 125 measurement contributed to the diagnosis of malignancy, improving overall specificity, only in sonographically malignant tumors.

Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy.

The objective was to determine the cross-sectional area of the umbilical cord, its diameter and the diameter of its vessels to establish a reference curve for these parameters during pregnancy, through a prospective cross-sectional study, including 2,310 low-risk pregnancies between 12 and 40 weeks' gestation. Means and standard deviations (SDs), plus the 10th, 50th and 90th percentiles for each measurement were calculated using polynomial regression analysis. Mann-Whitney, Kruskal-Wallis and Wilcoxon tests were used for statistical analysis. These parameters increased significantly with gestational age. The area of the cord also varied significantly with parity. Their new reference curves for low risk pregnancies were calculated using polynomial regression, and an almost linear increase in values was found up to 32 weeks of pregnancy, tending to stabilise from then onwards. The regression equation of the umbilical cord area according to gestational age (GA) was: -1.417 + 0.3026*GA-0.008*GA(2) + 0.000007*GA(3) and the degree of adjustment (R(2)) was 0.89.

Fetal thigh volumetry by three-dimensional ultrasound: comparison between multiplanar and VOCAL techniques.

OBJECTIVES: To evaluate the agreement between multiplanar and Virtual Organ Computer-aided AnaLysis (VOCAL()) techniques for the measurement of total fetal thigh volume and to assess the repeatability and reproducibility of measurements performed using these methods; to derive birth weight-predicting models for both methods and to compare their accuracies. METHODS: This was a cross-sectional study of 150 singleton pregnancies at 30-42 weeks of gestation in which ultrasound volumes of the fetal thigh were obtained within 48 hours of delivery and measured using multiplanar and VOCAL techniques. Bland-Altman analyses were performed to determine the agreement between the two methods, and to evaluate intraobserver and interobserver variability in a subset of 40 patients. Birth weight-predicting models were derived using total fetal thigh volumes obtained using the VOCAL (ThiV) and multiplanar (ThiM) methods as independent variables. The accuracies of these formulas were compared. RESULTS: The mean percentage difference between measurements performed using the VOCAL technique and the multiplanar technique was -0.04 and the 95% limits of agreement were -8.17 and 8.09. The mean percentage difference and 95% limits of agreement between paired measurements in the assessment of intraobserver and interobserver variability were -1.10 (-7.67 to 5.47) and 0.61 (-7.68 to 8.91) for the VOCAL technique and 1.03 (-6.35 to 8.41) and -0.68 (-11.42 to 10.06) for the multiplanar method, respectively. The best-fit formulas for predicting birth weight (BW) were: BW = 1025.383 + 12.775x ThiV; and BW = 1033.286 + 12.733x ThiM. There was no significant difference between the accuracies of these formulas. CONCLUSIONS: There is good agreement between the VOCAL and multiplanar techniques for assessment of total fetal thigh volume. Measurements performed using both methods are repeatable and reproducible. For prediction of birth weight, the formulas generated in this study can be used interchangeably.

Birth-weight prediction by two- and three-dimensional ultrasound imaging.

OBJECTIVES: To compare the accuracies of birth-weight predicting models derived from two-dimensional (2D) ultrasound parameters and from total fetal thigh volumes measured by three-dimensional (3D) ultrasound imaging; and to compare the performances of these formulae with those of previously published equations. METHODS: A total of 210 patients were evaluated to create a formula-generating group (n = 150) and a prospective-validation group (n = 60). Polynomial regression analysis was performed on the first group to generate one equation based on 2D ultrasound measurements, one based on fetal thigh volume measured by the multiplanar technique (ThiM) and one based on fetal thigh volume obtained by the Virtual Organ Computer-aided AnaLysis (VOCAL()) method (ThiV). Paired-samples t-tests with Bonferroni adjustments were used to compare the performances of these equations in the formula-finding and the prospective-validation groups. The same approach was used to compare the accuracies of the new 2D and 3D formulae with those of both original and modified 2D equations from previous publications, as well as the 3D model reported by Chang et al. RESULTS: The formulae with the best fit for the prediction of birth weight were: estimated fetal weight (EFW) = - 562.824 + 11.962x AC x FDL + 0.009 x BPD(2)x AC(2) (where AC is abdominal circumference, FDL is femur diaphysis length and BPD is biparietal diameter), EFW = 1033.286 + 12.733 x ThiM, and EFW = 1025.383 + 12.775 x ThiV. For both the formula-generating and the prospective-validation groups, there were no significant differences between the accuracies of the new 2D and 3D models in the prediction of birth weight. When applied to our population, the performances of the modified and original versions of the previously published 2D equations and the performance of the original 3D formula reported by Chang et al. were all significantly worse than our models. CONCLUSIONS: We believe that the greatest sources of discrepancy in estimation of birth weight are the phenotypic differences among patients used to create each of the formulae mentioned in this study. Our data reinforce the need for customized birth-weight prediction formulae, regardless of whether 2D or 3D measurements are employed.

[Curve of normal fetal weight values estimated by ultrasound according to gestation age]. / Curva dos valores normais de peso fetal estimado por ultra-sonografia segundo a idade gestacional.

OBJECTIVE: to evaluate the evolution of estimated fetal weight in normal pregnancies in Campinas, Brazil, between 20 to 42 weeks. DESIGN AND METHODS: A descriptive study was performed, including 2,874 normal pregnant women studied through routine obstetric ultrasound with fetal biometry, using the Hadlock (1991) formula for fetal weight estimation. Data were evaluated by fitting a curve with the 10th, 50th, and 90th percentiles of fetal weight for gestational age, subsequently submitted to a smoothing procedure by quadratic polynomial adjustment. RESULTS: the 50th percentile was 368g at 20th week, 1,512g at 30th, and 3,417g at 42nd week. There was a mean weight increase of 200g per week from the 27th to 38th week, when the gain decreased. CONCLUSIONS: The availability of a Brazilian curve of normal estimated fetal weight will allow for prenatal ultrasound diagnosis of deviations.

Evolution of cystic and adnexal tumors identified by echography.

The authors present their experience in detecting volume and echostructure alterations of the ovary in 14,525 women examined echographically and clinically. They analyzed 499 adnexal tumors and observed after clinical follow-up and echography that 60.6% of the cystic-septa tumors had involuted spontaneously. Percentage of spontaneous resolution was higher in small-diameter tumors, avoiding unnecessary surgery.

Aleitamento materno e cancer de mama.Estudo caso-controle desenvolvido em Campinas - Sao Paulo. / Breast feeding and breast cancer. Case-control study carried out in Campinas - Sao Paulo

Foi avaliada a relacao entre cancer de mama e aleitamento materno em um estudo caso-controle de 174 mulheres com cancer de mama e 325 controles. As mulheres que amamentaram e aquelas que deram aleitamento exclusivo ate 12 meses, tiveram a metade do risco de apresentar cancer de mama do que as que nunca deram de mamar ou nunca deram aleitamento exclusivo. O risco de cancer de mama foi 0,4 nas mulheres com 1 a 12 meses de amenorreia por lactacao, diminuindo para 0,2 nas mulheres com 13 ou mais meses. Ao controlar pelo numero de ciclos menstruais ovulatorios, observou-se que as associacoes descritas acima desapareceram nas mulheres que haviam tido ate 299 ciclos; mantiveram-se, entretanto, no grupo das mulheres com 300 ou mais ciclos

Cancer de mama e gravidez. Perspectivas do uso da ecografia no diagnostico. / Breast cancer and pregnancy.Perspectives of the use of echography in the diagnosis

Os autores reveem a literatura sobre a associacao de cancer de mama e gravidez. Embora a incidencia nao seja alta, entendem que uma maior atencao deve ser dada ao problema. Alem de entenderem que se deve examinar mais adequadamente as mamas durante o ciclo gravidopuerperal, propoem a ecografia como um metodo diagnostico auxiliar importante

Perspectivas iniciais do diagnostico subclinico dos tumores ovarianos atraves da ecografia bidimensional. / Initial perspectives of the subclinical diagnosis of ovarian tumors by bidimensional echography

Os autores apresentam a experiencia com a avaliacao pelvica ecografica em 12.000 exames (5.000 pacientes) e a correlacionam com o toque ginecologico e diagnostico cirurgico nos casos operados. Atraves dessa correlacao, os autores afirmam que existem boas perspectivas para o diagnostico subclinico dos tumores ovarianos atraves do emprego da ecografia