Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems.

BACKGROUND: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. AIM: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. MATERIAL AND METHODS: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. RESULTS: The median age was 60.3 years (range ± 10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71-0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65-0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70-0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73-0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. CONCLUSIONS: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

The use of sonographic subjective tumor assessment, IOTA logistic regression model 1, IOTA Simple Rules and GI-RADS system in the preoperative prediction of malignancy in women with adnexal masses.

BACKGROUND: Sonography based methods with various tumor markers are currently used to discriminate the type of adnexal masses. OBJECTIVE: To compare the predictive value of selected sonography-based models along with subjective assessment in ovarian cancer prediction. MATERIAL AND METHODS: We analyzed data of 271 women operated because of adnexal masses. All masses were verified by histological examination. Preoperative sonography was performed in all patients and various predictive models includ¬ing IOTA group logistic regression model LR1 (LR1), IOTA simple ultrasound-based rules by IOTA (SR), GI-RADS and risk of malignancy index (RMI3) were used. ROC curves were constructed and respective AUC's with 95% CI's were compared. RESULTS: Of 271 masses 78 proved to be malignant including 6 borderline tumors. LR1 had sensitivity of 91.0%, specificity of 91.2%, AUC = 0.95 (95% CI: 0.92-0.98). Sensitivity for GI-RADS for 271 patients was 88.5% with specificity of 85% and AUC = 0.91 (95% CI: 0.88-0.95). Subjective assessment yielded sensitivity and specificity of 85.9% and 96.9%, respectively with AUC = 0.97 (95% CI: 0.94-0.99). SR were applicable in 236 masses and had sensitivity of 90.6% with specificity of 95.3% and AUC = 0.93 (95% CI 0.89-0.97). RMI3 was calculated only in 104 women who had CA125 available and had sensitivity of 55.3%, specificity of 94% and AUC = 0.85 (95% CI: 0.77-0.93). CONCLUSIONS: Although subjective assessment by the ultrasound expert remains the best current method of adnexal tumors preoperative discrimination, the simplicity and high predictive value favor the IOTA SR method, and when not applicable, the IOTA LR1 or GI-RADS models to be primarily and effectively used.

[Pregnancy and possible complications in a patient with Sjögren's syndrome--a case report]. / Przebieg ciazy oraz mozliwe powiklania u pacjentki z zespolem Sjögrena--opis przypadku.

This article presents a case of a 29-year-old pregnant woman with Sjögren's syndrome, regardless of her first pregnancy loss, conceived and delivered a healthy baby. The authors have also reviewed available medical literature and have indicated problems that typically occur in such patients. Diagnostic methods, therapeutic possibilities, and common complications that obstetrician have to deal with while taking care of pregnant women with Sjögren's syndrome have been shown.

[Pregnancy and possible complications in a patient with systemic sclerosis--a case report]. / Przebieg ciazy oraz mozliwe powiklania u pacjentki z twardzina ukladowa--opis przypadku.

The report describes a case of a 28-year-old woman who, despite many problems with scleroderma, was able to conceive and deliver a healthy baby The main symptoms, problems, treatment and consequences of the disease that the patient experienced were presented. The authors paid attention to interdisciplinary medical care that such a patient should get. Apart from a gynecologist, a rheumatologist and a dermatologist should be involved in medical treatment. Although our patient did not demonstrate intensified symptoms of the main disease and did not need drugs, the authors showed problems, possible difficulties of treatment and consequences of sclerosis that every obstetrician can encounter in such cases. To increase the value of this article the authors included data from available literature to lay emphases on problems with scleroderma that can be met with a patient who needs treatment with a preconception, during pregnancy and afterwards, during lactation.

[Splenic artery aneurysms in pregnancy as a life threatening disorder]. / Tetniak tetnicy sledzionowej u ciezarnej jako stan zagrozenia zycia.

Splenic artery aneurysms (SAA) is very rare and uncommon condition what makes it difficult in diagnosis and treatment. We report a rare case of 27-year old patient in 24th week of pregnancy with rupture of SAA. This article reviews the etiology, clinical features, diagnosis of this potentially lethal condition. Although there is prompt treatment, rupture during pregnancy is associated with a very high maternal and fetal mortality rate. The aim of the report is to draw attention of early diagnosis of this condition to achieve good materno-fetal outcome.