Utilization of ultrasound as a diagnostic tool in the preoperative assessment of patients with adnexal masses.

PURPOSE: To evaluate the reliability of ultrasound scan (US) findings in the preoperative assessment of the nature of adnexal masses in females. METHODS: After detailed history, a preoperative US examination was performed in all women. Tumor diameter, localization, the presence of solid, cystic and multilocular components, excrescences, metastasis and free fluid were assessed. Doppler scan was done and pulsatility (PI) and resistance indices (RI) were determined. These data were compared with postoperatively obtained histopathological findings and statistically analyzed. RESULTS: The study included 609 women out of which 20.7% had malignant, 73.7% benign, and 5.6% border-line tumors. Patients with malignant tumors were oldest (p<0.001). There were significantly more positive US parameters in malignant than in benign tumors (p<0.001). Also, there were significant differences (p<0.001) between malignant, benign and borderline tumors regarding all examined US and Doppler parameters except tumor multilocularity. RI had sensitivity 75%, specificity 61.2%, positive predictive value (PPV) 42.70% and negative predictive value (NPV) 96.16%. PI had sensitivity 50%, specificity 35.3%, PPV 8.37% and NPV 25.93%. Sensitivity of US characteristics was 94.34%, specificity 30.62%, PPV 22.27% and NPV 96.25%. CONCLUSIONS: US pattern characteristics and Doppler parameters were found to be moderately reliable in discriminating malignant, benign and borderline adnexal tumors. Tumor of solid or mixed consistency, presence of ascites and excrescences were the best predictors of malignancy.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

OBJECTIVE: The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS: Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS: The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS: Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.

Influence of red clover-derived isoflavones on serum lipid profile in postmenopausal women.

AIM: Menopause is associated with adverse metabolic changes, especially in plasma lipoprotein and cholesterol levels. Estrogens have beneficial effects on lipid metabolism. Phytoestrogens are plant substances that are structurally and functionally similar to 17beta-estradiol and are capable of producing estrogenic effects. The goal of the present study was to estimate the effects of red clover-derived isoflavones on serum lipid levels in postmenopausal women. METHODS: The study comprised 40 healthy postmenopausal women with an average age of 56 years. The women were divided into two groups: 22 were allocated to a red clover-derived isoflavone medication group, and 18 were allocated to a non-medication group. Total blood cholesterol, cholesterol fractions and triglycerides in the women of both groups were investigated before treatment and at 4-month intervals over the following 12 months. RESULTS: Both total serum cholesterol and low-density lipoprotein (LDL) cholesterol levels, as well as triglyceride levels, were decreased significantly in the group receiving phytoestrogens. However, high-density lipoprotein (HDL) cholesterol showed a significant increase. CONCLUSION: Red clover phytoestrogen supplementation in postmenopausal women had favorable metabolic effects on serum lipids. Furthermore, red clover phytoestrogens have no side-effects and can be considered safe.