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(1/57) Three dimensional ultrasound and power doppler in assessment of uterine and ovarian angiogenesis: a prospective study.

AIM: To determine whether three-dimensional power Doppler can improve the recognition of pelvic tumor morphology and angiogenesis. METHODS: Using this technique we analyzed 180 adnexal masses and 110 uterine lesions. Tumor volume, morphology, and vascularity were evaluated in each patient. Irregular and randomly dispersed vessels with complex branching depicted by comprehensive three dimensional display were suggestive of pelvic malignancy, while linear-like vascular morphology, single vessel arrangement and regular branching were typical for benign structures. RESULTS: Addition of qualitative analysis of vascular architecture of adnexal tumor to morphological parameters reached 96.15% sensitivity and 98.73% specificity. When endometrial lesions were prospectively analyzed, sensitivity and specificity were 91.67% and 98.49%, respectively. Because the lowest positive predictive value of 16.67% was obtained for myometrial lesions, this method should not be advised for their eva luation. CONCLUSION: Good results achieved by three dimensional ultrasound can be explained by improved recognition of the pelvic lesion anatomy, characterization of the surface features, detection of the tumor infiltration, and precise depiction of the size and volume. Three dimensional power Doppler imaging can detect structural abnormalities of the malignant tumor vessels, such as arteriovenous shunts, microaneurysms, tumoral lakes, disproportional calibration, coiling, and dichotomous branching. Therefore it enhances and facilitates the morphologic and functional evaluation of both benign and malignant pelvic tumors.  (+info)

(2/57) The prognostic role of salpingoscopy in laparoscopic tubal surgery.

The present study was designed to evaluate the prognostic value of salpingoscopy in patients undergoing tubal laparoscopic surgery for infertility due to periadnexal adhesion or distal tubal occlusion. In addition, the clinical value of salpingoscopy was compared with a current classification system of adnexal adhesions and distal tubal occlusion. A total of 51 patients with either adnexal adhesions (24 patients) or hydrosalpinx (27 patients) were prospectively evaluated. Salpingoscopy was performed concomitantly with salpingo-ovariolysis or salpingoneostomy at the time of operative laparoscopy. There was no significant correlation between salpingoscopic classes and the classification system used for both the salpingo-ovariolysis and the salpingoneostomy groups of patients. The patients had a mean follow-up of 33 months. Patients with a normal tubal mucosa (salpingoscopic classes I and II) had a 71% cumulative term pregnancy rate in the salpingo-ovariolysis group and a 64% cumulative term pregnancy rate in the salpingoneostomy group. No intrauterine pregnancies were obtained in patients with intratubal damage (salpingoscopic classes III to V). There was a statistically significant correlation between the occurrence of a term pregnancy and the salpingoscopic classes, but not with the classification system used. These results suggest that patients with tubal infertility should be offered operative laparoscopy with salpingoscopy as the first step of treatment.  (+info)

(3/57) What do contrast media add to three-dimensional power Doppler evaluation of adnexal masses?

AIM: To investigate the potential usefulness of contrast-enhanced three-dimensional (3D) power Doppler sonography in the differentiation of benign and malignant adnexal lesions. METHODS: Thirty one patients with complex adnexal lesions of uncertain malignancy at transvaginal B-mode and/or color Doppler sonography were prospectively evaluated with three-dimensional power Doppler sonography before and after injection of a contrast agent. Presence of a penetrating pattern and a mixed penetrating and/or peripheral pattern suggested adnexal malignancy. The results were compared with histopathologic findings. RESULTS: There were 10 cases of ovarian malignancy and 21 benign adnexal lesions. Of 10 ovarian cancers, 6 showed vascular distribution suggestive of malignancy at nonenhanced 3D power Doppler sonography. After injection of contrast agent, a penetrating vascular pattern and/or mixed penetrating and peripheral pattern were detected in all cases of ovarian malignancy as well as in 2 benign lesions (fibroma and cystadenofibroma), which were misdiagnosed as malignant. The use of contrast agent with three-dimensional power Doppler sonography showed diagnostic efficiency of 96.7%, superior to that of nonenhanced 3D power Doppler sonography (93.5%). CONCLUSION: Contrast-enhanced 3D power Doppler sonography provides better visualization of tumor vascularity in complex adnexal masses. If used together with 3D morphological ultrasound assessment, enhanced 3D power Doppler imaging may precisely discriminate benign from malignant adnexal lesions.  (+info)

(4/57) Transvaginal color Doppler assessment of venous flow in adnexal masses.

OBJECTIVE: To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses. MATERIAL AND METHODS: Ninety-one consecutive patients (mean age: 46.6 years, range: 16-81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut-off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was < or = 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was > or = the best cut-off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B-mode morphology (evaluation performed according to Sassone's scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated. RESULTS: Twenty-five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut-off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively. CONCLUSIONS: Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors.  (+info)

(5/57) The Filshie clip for laparoscopic adnexal surgery.

BACKGROUND: Gynecologic endoscopic procedures are increasingly common and require the ability to control large vascular structures. METHOD: The Filshie clip is a silicone-lined, titanium occlusive device, originally designed and Food and Drug Administration (FDA) approved for surgical contraception. This device also has the potential for occluding vascular structures during laparoscopic surgery. EXPERIENCE AND RESULTS: We describe a salpingectomy, an excision of bilateral hydrosalpinges, and a salpingo-oopherectomy. We performed all procedures laparoscopically using this device as the primary modality for assuring hemostasis. CONCLUSION: The Filshie clip is a useful and economical device for assuring hemostasis during gynecologic endoscopic surgery.  (+info)

(6/57) Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study.

BACKGROUND: The objective of this study was to assess the safety and efficacy of a 0.5% ferric hyaluronate gel, in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy. METHODS: The study was a randomized (by computer-generated schedule), third party blinded, placebo-controlled, parallel-group design conducted at five centres in Europe. Females aged 18-46 years received 300 ml ferric hyaluronate (n = 38) or lactated Ringer's (n = 39) as an intraperitoneal instillate at the completion of surgery. At second-look 6-12 weeks later, the presence of adhesions was evaluated at 24 abdominal sites. RESULTS: Patients treated with ferric hyaluronate had significantly fewer adhesions compared with controls. When adhesions formed, they were significantly less extensive and less severe in the treated group. The American Fertility Society score for adnexal adhesions was reduced by 69% in the treatment group compared with controls. The safety profile of ferric hyaluronate-treated patients was comparable with those treated with lactated Ringer's solution. CONCLUSIONS: In conclusion, ferric hyaluronate was safe and highly efficacious in reducing the number, severity and extent of adhesions throughout the abdomen following peritoneal cavity surgery.  (+info)

(7/57) Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation.

OBJECTIVE: To determine the spectrum of sonographic findings on gray scale and color Doppler sonography in a series of pathologically proven cases of ovarian and adnexal torsion. METHODS: The study population included 15 patients with surgical confirmation of ovarian or adnexal torsion, or both, who underwent sonographic examination before surgery. All sonograms were reviewed retrospectively. RESULTS: Gray scale abnormalities included the following: complex masses in 11 (73%) of 15 patients, cystic masses in 3 (20%), and a solid mass in 1 (7%). Cul-de-sac fluid was present in 13 (87%) of 15 patients. Adnexal neoplasms were present in 4 (27%) of 15 (1 granulosa cell tumor and 3 dermoid cysts) on pathologic examination. Doppler findings were abnormal in 14 (93%) of 15 patients and normal in 1 (7%). Abnormal Doppler findings included no arterial and no venous flow in 6 (40%) of 15, decreased venous flow with no arterial flow in 5 (33%), decreased venous flow and decreased arterial flow in 2 (13%), and decreased arterial flow with no venous flow in 1 (7%). Small amounts of cul-de-sac fluid were present in 13 (87%) of 15 patients. CONCLUSIONS: The diagnosis of ovarian and adnexal torsion remains challenging. It cannot be based solely on the absence or presence of flow on color Doppler sonography, because the presence of arterial or venous flow does not exclude the diagnosis of adnexal torsion. Comparison with the morphologic appearance and flow patterns of the contralateral ovary will aid in diagnosis.  (+info)

(8/57) Complex pelvic mass as a target of evaluation of vessel distribution by color Doppler sonography for the diagnosis of adnexal malignancies: results of a multicenter European study.

OBJECTIVE: To compare the diagnostic accuracy of gray scale sonography and color Doppler imaging in the differential diagnosis of adnexal malignancies from benign complex pelvic masses in a multicenter prospective study. METHODS: The study was performed as a collaborative work at 3 European university departments of obstetrics and gynecology. A total of 826 complex pelvic masses on which transvaginal sonography and evaluation of cancer antigen 125 plasma concentrations were performed before surgical exploration were included in the study. The scanning procedure was the same in the 3 institutions. An adnexal mass was first studied in gray scale sonography, and a probable histologic type was predicted. Second, solid excrescences or solid portions of the tumor were evaluated for vascular flow with color Doppler sonography (conventional or power). A mass was graded malignant if flow was shown within the excrescences or solid areas and benign if there was no flow. The overall agreement between the test result and the actual outcome was calculated by kappa statistics. RESULTS: Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with gray scale sonography (kappa = 0.82 and 0.65, respectively) because of significantly higher specificity (0.94 versus 0.84; P < .001). The evaluation of the cancer antigen 125 plasma concentration did not seem to increase the accuracy of either method. CONCLUSIONS: The evaluation of vessel distribution by color Doppler sonography in complex adnexal cysts seems to increase the diagnostic accuracy of gray scale sonography in the detection of adnexal malignancies in a large study population.  (+info)