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Prediction of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm Abstract Objective To build mathematical models for evaluating the individual risk of endometrial malignancy in women with postmenopausal bleeding and sonographic endometrial thickness ≥ 4.5 mm using clinical data, sonographic endometrial thickness and power Doppler ultrasound findings. Methods Of 729 consecutive patients with postmenopausal bleeding, 261 with sonographic endometrial thickness ≥ 4.5 mm and no fluid in the uterine cavity were included. They underwent transvaginal two‐dimensional gray‐scale and power Doppler ultrasound examination of the endometrium. The ultrasound image showing the most vascularized section through the endometrium as assessed by power Doppler was frozen, the endometrium was outlined and the percentage vascularized area (vascularity index) was calculated using computer software. The ultrasound examiner also estimated the color content of the endometrial scan on a visual analog scale (VAS) graded from 0 to 100 (VAS score). A structured history was taken to collect clinical information. Multivariate logistic regression analysis was used to create mathematical models to predict endometrial malignancy. Results There were 63 (24%) malignant and 198 (76%) benign endometria. Women with a malignant endometrium were older (median age 74 vs. 65 years; P = 0.0005) and fewer used hormone replacement therapy and warfarin. Women with a malignant endometrium had a thicker endometrium (median thickness 20.8 vs. 10.2 mm; P = 0.0005) and higher values for vascularity index and VAS score. When using only clinical data to build a model for estimating the risk of endometrial malignancy, a model including the variables age, use of warfarin and use of hormone replacement therapy had the largest area under the receiver–operating characteristics curve (AUC), with a value of 0.74 (95% confidence interval (CI), 0.67–0.81). A model including age, use of warfarin and endometrial thickness had an AUC of 0.82 (95% CI, 0.76–0.87), and one including age, use of hormone replacement therapy, endometrial thickness and vascularity index had an AUC of 0.91 (95% CI, 0.87–0.95). Using a risk cut‐off of 11%, the latter model had sensitivity 90%, specificity 71%, positive likelihood ratio 3.14 and negative likelihood ratio 0.13. Conclusions The diagnostic performance of models predicting endometrial cancer increases substantially when sonographic endometrial thickness and power Doppler information are added to clinical variables. The models are likely to be clinically useful but need to be prospectively validated. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Wiley - Tập 37 Số 2 - Trang 232-240 - 2011
Applying the right statistics: analyses of measurement studies Abstract The study of measurement error, observer variation and agreement between different methods of measurement are frequent topics in the imaging literature. We describe the problems of some applications of correlation and regression methods to these studies, using recent examples from this literature. We use a simulated example to show how these problems and misinterpretations arise. We describe the 95% limits of agreement approach and a similar, appropriate, regression technique. We discuss the difference vs. mean plot, and the pitfalls of plotting difference against one variable only. We stress that these are questions of estimation, not significance tests, and show how confidence intervals can be found for these estimates. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
Wiley - Tập 22 Số 1 - Trang 85-93 - 2003
Prognostic factors in severe twin–twin transfusion syndrome treated by endoscopic laser surgery Abstract Objective The aim of this study was to investigate clinical and sonographic parameters, in particular Doppler blood flow measurements, in severe second‐trimester twin–twin transfusion syndrome before and after endoscopic laser coagulation of the placental vascular anastomoses, to correlate these data with fetal outcome and to determine whether fetal blood flow measurements could help to estimate the probability of fetal survival. Methods In 121 cases of severe twin–twin transfusion syndrome examined between 17 and 26 weeks of gestation, the following investigations were performed: fetal biometry, placental location, deepest pool of amniotic fluid, echocardiography and Doppler sonography of the umbilical arteries and the ductus venosus of both twins before and after fetoscopic laser ablation of the placental anastomoses. Results The overall survival rate was 64% (156/242). Both fetuses survived in 48% (58/121) and one fetus survived in 33% (40/121), resulting in 81% (98/121) of pregnancies with at least one survivor. Gestational age at the time of the procedure and placental location had no significant influence on fetal survival. The amniotic fluid volume drained after laser coagulation correlated significantly (p = 0.038) with the risk of miscarriage or extremely premature delivery within 4 weeks of the procedure. Intertwin discrepancy in abdominal circumference showed a significant negative correlation (p = 0.004) with the probability for survival of donor fetuses. Before the procedure, 19% (23/121) of donor twins and 5% (6/121) of recipient twins showed absent or reversed end‐diastolic flow in the umbilical artery (p = 0.001). This finding had no significant influence on the survival rate of donors. An increase of waveform indices in the umbilical artery 1 day after the procedure compared to immediately after the procedure correlated significantly with a lower probability for survival of donors (p = 0.042) and recipients (p = 0.018). Before the procedure, 37% (45/121) of recipient twins and 9% (10/113) of donor twins showed absent or reversed flow during atrial contraction in the ductus venosus (p < 0.0001). This finding had a significant negative influence on the survival rate of recipient fetuses (p = 0.02). Furthermore, an increase of waveform indices in the ductus venosus 1 day after the procedure compared to immediately after the procedure correlated significantly with a lower probability of survival in recipients (p = 0.005). Conclusions Fetoscopic laser coagulation of the placental vascular anastomoses in severe mid‐trimester twin–twin transfusion is a potentially corrective and effective, minimally invasive procedure. Doppler investigation of the umbilical and fetal circulations provides important information on the fetal condition, prognosis and therapeutic effects of the intervention. Signs of congestive heart failure in the recipient may reduce the probability of survival, whereas increased placental resistance in the donor before the procedure is not necessarily associated with a reduction in the probability of survival after laser coagulation. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Wiley - Tập 14 Số 6 - Trang 380-387 - 1999
Increased nuchal translucency thickness at l0–14 weeks of gestation as a predictor of severe twin‐to‐twin transfusion syndrome Abstract This study examines a possible association between increased nuchal translucency thickness at 10–14 weeks of gestation in monochorionic twin pregnancies and the subsequent development of severe twin‐to‐twin transfusion syndrome (TTS). In 132 monochorionic twin pregnancies, including 16 that developed severe TTS at 15–22 weeks of gestation and 116 that did not develop TTS, crown‐rump length, nuchal translucency thickness and fetal heart rate were measured at 10–14 weeks. In those that developed severe TTS, the prevalence of nuchal translucency thickness above the 95th centile of the normal range and the inter‐twin difference in nuchal translucency thickness and fetal heart rate were significantly higher than in the non‐TTS group; there were no significant differences between the groups in the inter‐twin difference in crown‐rump length. For fetal nuchal translucency above the 95th Gentile, the positive and negative predictive values for the development of TTS were 38% and 91%, respectively; the likelihood ratios of nuchal translucency above or below the 95th centile for the development of severe TTS were 4.4 (1.8–9.7) and 0.7 (0.4–0.9), respectively. These findings demonstrate that the underlying hemodynamic changes associated with TTS may manifest as increased fetal nuchal translucency thickness at 10–l4 weeks of gestation. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Wiley - Tập 10 Số 2 - Trang 86-89 - 1997
Increased fetal nuchal translucency: possible involvement of early cardiac failure Abstract The ultrasonographic measurement of nuchal translucency thickness at 10–23 weeks of gestation is accepted as an efficient method of screening for chromosomal abnormalities. However, the underlying mechanism producing increased nuchal translucency thickness is still poorly understood. The purpose of this study was to investigate the possible contribution of impaired cardiac function to such an increase, by studying the venous return in the ductus venosus, using Doppler ultrasound. In a total of 6.5 fetuses, nuchal translucency thickness was measured at 10–13 weeks of gestation by means of a transvaginal probe. Color‐coded and pulsed Doppler ultra‐sound were also used to evaluate different hemodynamic parameters in the ductus venosus: maximum systolic and diastolic velocities, pulsatility index, lowest forward velocity during atria1 contraction and fetal heart rate. Fetal nuchal translucency thickness of ≥ 3 mm was found in 17 cases; in five of them there were chromosomal anomalies: four trisomy 21 and one trisomy 18. Of interest is the finding that in the five chromosomally abnormal fetuses with increased nuchal translucency thickness, the forward velocity during atria1 contraction was consistently less than 2 cm/s (p < 0.001). This impairment of atria1 contraction may well implicate cardiac failure and/or heart defects in the pathogenesis of increased nuchal translucency thickness in the first trimester of pregnancy. Furthermore, nuchal translucency may prove to be a sensitive marker of the early identification of fetal cardiac anomalies. Copyright © 1997 International Society of Ultrasound in Obstetrics and Gynecology
Wiley - Tập 10 Số 4 - Trang 265-268 - 1997
Cardiac defects in chromosomally normal fetuses with abnormal ductus venosus blood flow at 10–14 weeks Abstract Objective To assess a possible relationship between ductus venosus blood flow abnormalities and cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness at 10–14 weeks of gestation. Methods Ductus venosus Doppler ultrasound blood flow velocity waveforms were obtained at 10–14 weeks' gestation immediately before fetal karyotyping in 200 consecutive singleton pregnancies with increased nuchal translucency. Fetal echocardiography was subsequently carried out in those with normal fetal karyotype. Results Reverse or absent flow during atrial contraction was observed in 11 of the 142 chromosomally normal fetuses with increased nuchal translucency. Major defects of the heart and/or great arteries were present in seven of the 11 with abnormal ductal flow and increased nuchal translucency, but in none of the 131 with normal flow. Conclusion These preliminary results suggest that abnormal ductus venosus blood flow in chromosomally normal fetuses with increased nuchal translucency identifies those with an underlying major cardiac defect. Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Wiley - Tập 14 Số 5 - Trang 307-310 - 1999
Screening for chromosomal abnormalities at 10–14 weeks: the role of ductus venosus blood flow Abstract Objective To assess the possible role of Doppler ultra‐sound assessment of ductus venosus blood flow in screening for chromosomal abnormalities at 10–14 weeks of gestation. Methods Ductus venosus flow velocity waveforms were obtained immediately before fetal karyotyping in 486 consecutive singleton pregnancies at 10–14 weeks of gestation. All cases were screened for chromosomal defects by a combination of maternal age and fetal nuchal translucency thickness. The peak systolic and diastolic velocities, the velocity during atrial contraction and the pulsatility index were measured. Results There were 63 chromosomal defects (38 cases of trisomy 21, 12 cases of trisomy 18, seven cases of trisomy 13, three cases of Turner's syndrome and three cases of triploidy). In 57 (90.5%) cases there was reverse or absent flow during atrial contraction. Abnormal ductus venosus flow was also observed in 13 (3.1%) of the 423 chromosomally normal fetuses. In the chromosomally abnormal group, compared to the normal group, the median heights of the S and D waves were significantly lower and the pulsatility index was significantly higher. However, multivariate regression analysis demonstrated that only the height of the A wave provided a significant independent contribution in distinguishing between the chromosomally normal and abnormal groups. Conclusion These preliminary results suggest that assessment of ductus venosus blood flow in pregnancies considered to be at high risk for chromosomal defects may result in a major reduction in the need for invasive testing, with only a small decrease in sensitivity. Copyright © 1998 International Society of Ultrasound in Obstetrics and Gynecology
Wiley - Tập 12 Số 6 - Trang 380-384 - 1998
Discordance in nuchal translucency thickness in the prediction of severe twin‐to‐twin transfusion syndrome Abstract Objective To examine in monochorionic pregnancies the possible value of intertwin discordance in nuchal translucency (NT) thickness in the prediction of early fetal death or severe twin–twin transfusion syndrome (TTTS). Methods In 512 monochorionic twin pregnancies NT was measured at 11 to 13 + 6 weeks' gestation and regression analysis was used to determine the significance of the association between the intertwin discordance in NT and subsequent early fetal death or development of severe TTTS requiring endoscopic laser surgery. Results In 412 (80.5%) pregnancies there was a normal outcome, in 58 (11.3%) there was severe TTTS requiring endoscopic laser surgery at 18–24 weeks, in 19 (3.7%) there was death of one or both fetuses at 13–18 weeks and in 23 (4.5%) there was fetal death at 21–38 weeks. In the four outcome groups the median discordance in NT was 11%, 22%, 35% and 7%, respectively. Significant prediction of early fetal death and severe TTTS was provided by the discordance in fetal NT, which was not significantly improved by including the discordance in crown–rump length. If the discordance in NT was 20% or more, the false positive rate was 20%, the detection rate of early fetal death was 63% and the detection rate of severe TTTS was 52%. Conclusions Discordance in NT of 20% or more is found in about 25% of monochorionic twins and in this group the risk of early fetal death or development of severe TTTS is more than 30%. If the discordance is less than 20% the risk of complications is less than 10%. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.
Wiley - Tập 29 Số 5 - Trang 527-532 - 2007
Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group
Wiley - Tập 46 Số 3 - Trang 284-298 - 2015
Consensus on revised definitions of Morphological Uterus Sonographic Assessment (<scp>MUSA</scp>) features of adenomyosis: results of modified Delphi procedure ABSTRACT Objectives To evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions. Methods A modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two‐dimensional (2D) video recordings (four recordings also included three‐dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts. Results Of 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan‐shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis. Conclusion Consensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Wiley - Tập 60 Số 1 - Trang 118-131 - 2022
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