Placental 11B-Hydroxysteroid Dehydrogenase Type 2 mRNA Levels in Intrauterine Growth Restriction versus Small-for-Gestational-Age Fetuses.

INTRODUCTION: The objective of this study was to evaluate placental 11B-hydroxysteroid dehydrogenase type 2 (11B-HSD-2) mRNA levels in intrauterine growth-restricted fetuses (IUGR) as compared with small-for-gestational-age (SGA) fetuses according to clinical criteria. MATERIAL AND METHODS: Placental levels of 11B-HSD-2 mRNA levels were measured in SGA (birth weight <10th centile) and gestational-age-matched, appropriate-for-gestational-age (AGA) births. SGA was classified as IUGR (birth weight <3rd centile or <10th percentile with abnormal uterine artery Doppler or cerebroplacental ratio) or non-IUGR SGA. After RNA extraction, mRNA levels were determined by reverse transcription and quantitative PCR. RESULTS: A total of 38 placentas were analyzed (20 AGA and 18 SGA). Among the SGA pregnancies, 13 qualified as IUGR. The activity of 11B-HSD-2 in IUGR pregnancies [0.105 (SD 0.328)] was significantly reduced compared to non-IUGR SGA [0.304 (SD 0.261); p = 0.018] and AGA [0.294 (SD 0.328); p = 0.001]. These differences remained significant after adjusting for potential confounders (such as smoking or maternal cortisol levels). Activity levels did not significantly differ between non-IUGR SGA and AGA. DISCUSSION: IUGR fetuses had reduced 11B-HSD-2 activity in comparison with SGA and normally grown fetuses. This finding provides opportunities to develop new placental biomarkers for the phenotypic characterization of fetal smallness.

Diagnostic performance of IOTA simple rules for adnexal masses classification: a comparison between two centers with different ovarian cancer prevalence.

OBJECTIVE: The aim of this study was to compare the diagnostic performance of the IOTA simple rules for classifying adnexal masses when used in two centers with different ovarian cancer prevalence. STUDY DESIGN: A prospective study was performed between June 2012 and December 2013 at two different centers with different ovarian cancer prevalence. Center A had high ovarian malignancy prevalence and Center B had low malignancy rates. Eligible patients were all women diagnosed as having a persistent adnexal mass. Examiners had to analyze the masses according to IOTA simple rules (SR) providing a diagnosis of malignant, benign or inconclusive. Those cases classified as inconclusive were then examined by an expert examiner (the same examiner in center A, a different examiner in center B), who had to classify the mass as malignant, benign or uncertain according to his subjective impression (SI). Definitive histologic diagnosis from tumors removed surgically was used as gold standard. The diagnostic performance was assessed by calculating the sensitivity and specificity, positive and negative likelihood ratios, for SR and SR+SI assessments. McNemar test was used for comparing sensitivity and specificity. RESULTS: During this period, 247 women were eligible for this study. The rate of inconclusive masses was 18.4% and 18.0% for centers A and B, respectively (p>0.05). Ovarian malignancy rate was significantly higher in center A as compared with center B (27.2% versus 11.3%), (p=0.001). When analyzing only cases classifiable by SR, sensitivity in center A was significantly higher (100% versus 84.6% p=0.001), but specificity was similar in both centers (93.9% and 95.8% respectively). When analyzing SR plus SI, sensitivity in center A was significantly higher (100% versus 86.7% p=0.001), but specificity was similar in both centers (89.9% and 88.8%, respectively). CONCLUSIONS: The diagnostic performance in terms of sensitivity of IOTA rules is higher in a center with higher prevalence of ovarian malignancy.