ABSTRACT
A risk of malignancy index (RMI), based on menopausal status, ultrasound (US) findings, and serum CA125, has previously been described and validated in the primary evaluation of women with adnexal masses and is widely used in selective referral of women from local cancer units to specialized cancer centers. Additional imaging modalities could be useful for further characterization of adnexal masses in this group of women. A prospective cohort study was conducted of 196 women with an adnexal mass referred to a teaching hospital for diagnosis and management. Follow-up data was obtained for 180 women; 119 women had benign and 61 women malignant adnexal masses. The sensitivity and specificity of specialist US, magnetic resonance imaging (MRI), radioimmunoscintigraphy (RS), and the RMI were determined. We identified a subgroup of women with RMI values of 25-1000 where the value of further specialist imaging was evaluated. Sensitivity and specificity for specialist US were 100% and 57%, for MRI 92% and 86%, and for RS 76% and 87%, respectively. Analysis of 123 patients managed sequentially, using RMI cutoff values of > or =25 and <1000 and then US and MRI provided a sensitivity of 94% and a specificity of 90%. Using this RMI cutoff followed by specialist US and MRI, as opposed to the traditional RMI cutoff value of 250, can increase the proportion of patients with cancer appropriately referred in to a cancer center, with no change in the proportion of patients with benign disease being managed in a local unit.
Subject(s)
Genital Diseases, Female/diagnosis , Neoplasms, Adnexal and Skin Appendage/diagnosis , Adnexa Uteri/diagnostic imaging , Adnexa Uteri/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Diagnosis, Differential , Female , Genital Diseases, Female/diagnostic imaging , Genital Diseases, Female/pathology , Humans , Magnetic Resonance Imaging , Middle Aged , Neoplasms, Adnexal and Skin Appendage/diagnostic imaging , Neoplasms, Adnexal and Skin Appendage/pathology , Prospective Studies , Risk Factors , Sensitivity and Specificity , UltrasonographyABSTRACT
AIMS: To evaluate the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) in characterizing adnexal masses, and to determine which patients may benefit from MRI. METHODS: We prospectively studied 72 women (mean age 53 years, range 19 to 86 years) with clinically suspected adnexal masses. A single experienced sonographer performed transabdominal and transvaginal greyscale spectral and colour Doppler examinations. MRI was carried out on a 1.5T system using T1, T2 and fat-suppressed T1-weighted sequences before and after intravenous injection of gadolinium. The adnexal masses were categorized as benign or malignant without knowledge of clinical details, according to the imaging features which were compared with the surgical and pathological findings. RESULTS: For characterizing lesions as malignant, the sensitivity, specificity and accuracy of MRI were 96.6%, 83.7% and 88.9%, respectively, and of US were 100%, 39.5% and 63.9%, respectively. MRI was more specific (p<0.05) than US. Both MRI and US correctly diagnosed 17 (24%) cases with benign and 28 (39%) cases with malignant masses. MRI correctly diagnosed 19 (26%) cases with benign lesion(s), which on US were thought to be malignant. The age, menopausal status and CA-125 levels in these women made benign disease likely, but US features were suggestive of malignancy (large masses and solid-cystic lesions with nodules). CONCLUSION: MRI is more specific and accurate than US and Doppler assessment for characterizing adnexal masses. Women who clinically have a relatively low risk of malignancy but who have complex sonographic features may benefit from MRI.
Subject(s)
Adnexal Diseases/diagnosis , Magnetic Resonance Imaging , Ultrasonography, Doppler, Color , Adnexal Diseases/diagnostic imaging , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Middle Aged , Patient Selection , Prospective Studies , Sensitivity and SpecificitySubject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Carcinoma in Situ/therapy , Carcinoma, Ductal, Breast/therapy , Hemangiosarcoma/diagnosis , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Second Primary/diagnosis , Aged , Breast Neoplasms/etiology , Combined Modality Therapy , Female , Follow-Up Studies , Hemangiosarcoma/etiology , Humans , Magnetic Resonance Imaging , Middle Aged , Neoplasms, Radiation-Induced/etiology , Neoplasms, Second Primary/etiologyABSTRACT
Deep vein thrombosis with pulmonary embolus is a frequent event, which is usually treated by anticoagulant drug therapy alone. Caval filters tend to be used infrequently in most centres in the UK. This article intends to help hospital doctors make use of these devices appropriately.
Subject(s)
Vena Cava Filters , Vena Cava, Inferior/surgery , Venous Thrombosis/surgery , Humans , Pulmonary Embolism/etiology , Pulmonary Embolism/prevention & control , Recurrence , Vena Cava Filters/adverse effects , Venous Thrombosis/complicationsABSTRACT
A new type of enchondromatosis is described with a symmetrical distribution but not involving the spine and characterised by severe ankle deformity, shortening of metacarpals and phalanges, and cone-shaped phalangeal epiphyses.
Subject(s)
Enchondromatosis/diagnostic imaging , Fingers/diagnostic imaging , Child , Epiphyses/diagnostic imaging , Humans , Male , RadiographyABSTRACT
The background philosophy, structure and training experience offered by a new free-standing clinic set up purely to facilitate orthopaedic post-graduate training is described. Emphasis is placed on the ethical issues involved. The educational programme, which includes involvement in all local and national activities, is summarized. The registrars' operative experience is recorded using log-sheet criteria. This venture has predated the major restructuring of the health care system in Auckland, which is anticipated in the next few years, and will therefore allow the training programme to evolve appropriately, employing the educational opportunities of all sectors of health care.
