scholarly journals Ultrasound Assessment of Adnexal Pathology: Standardized Methods and Different Levels of Experience

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 708
Author(s):  
Indrė Tavoraitė ◽  
Laura Kronlachner ◽  
Gina Opolskienė ◽  
Daiva Bartkevičienė
Keyword(s):  
Transvaginal Ultrasound ◽  
Subjective Evaluation ◽  
Subjective Assessment ◽  
Ultrasound Images ◽  
Predictive Values ◽  
Ultrasound Assessment ◽  
Level I ◽  
Adnexal Pathology ◽  
Sensitivity Specificity ◽  
Different Levels

Background and objectives: An expert’s subjective assessment is still the most reliable evaluation of adnexal pathology, thus raising the need for methods less dependent on the examiner’s experience. The aim of this study was to evaluate the performance of standardized methods when applied by examiners with different levels of experience and to suggest the most suitable method for less-experienced gynecologists. Materials and methods: This single-center retrospective study included 50 cases of histologically proven first-time benign or malignant adnexal pathology. Three examiners evaluated the same transvaginal ultrasound images: an expert (level III), a 4th year resident in gynecology (level I), and a final year medical student after basic training (labeled as level 0). The assessment methods included subjective evaluation, Simple Rules (SR) with and without algorithm, ADNEX and Gynecologic Imaging Reporting and Data System (GI-RADS) models. Sensitivity, specificity, accuracy, positive and negative predictive values with 95% confidence interval were calculated. Results: Out of 50 cases, 33 (66%) were benign and 17 (34%) were malignant adnexal masses. Using only SR, level III could classify 48 (96%), level I—41 (82%) and level 0—40 (80%) adnexal lesions. Using SR and algorithm, the performance improved the most for all levels and yielded sensitivity and specificity of 100% for level III, 100% and 97% for level I, 94.4% and 100% for level 0, respectively. Compared to subjective assessment, ADNEX lowered the accuracy of level III evaluation from 97.9% to 88% and GI-RADS had no impact. ADNEX and GI-RADS improved the sensitivity up to 100% for the less experienced; however, the specificity and accuracy were notably decreased. Conclusions: SR and SR+ algorithm have the most potential to improve not only sensitivity, but also specificity and accuracy, irrespective of the experience level. ADNEX and GI-RADS can yield sensitivity of 100%; however, the accuracy is decreased.

scholarly journals Endometrial Volume Measured by VOCAL Compared to Office Hysteroscopy for Diagnosis of Endometrial Polyps in Premenopausal Women with Abnormal Uterine Bleeding

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Mohamed Laban ◽  
Sherif H. Hussain ◽  
Alaa S. Hassanin ◽  
Waleed M. Khalaf ◽  
Mohamed K. Etman ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Final Analysis ◽  
Uterine Bleeding ◽  
Endometrial Polyps ◽  
Predictive Values ◽  
Endometrial Volume ◽  
Sensitivity Specificity

The aim is to compare hysteroscopy, two-dimensional transvaginal ultrasound (2D TVUS), and three-dimensional (3D) Virtual Organ Computer-aided AnaLysis™ (VOCAL) to detect endometrial polyps (EPs) in premenopausal women with abnormal uterine bleeding (AUB). This prospective study was done at Ain Shams Maternity Hospital, Egypt, from March 5, 2015, to December 30, 2015, enrolling 118 premenopausal women with AUB. 2D TVUS, 3D VOCAL, and hysteroscopy were done. 109 patients reached final analysis. 36 women (33%) were diagnosed with EP by 2D TVUS. 50 (45.9%) had EP by hysteroscopy. Endometrial thickness was 10.1 mm by 2D TVUS and endometrial volume was 4.92 mL by VOCAL in women with EP by hysteroscopy compared to 9.9 mm and 3.50 mL in women with no EP, respectively (P=0.223;P=0.06). 2D TVUS has sensitivity, specificity, and positive and negative predictive values of 54%, 84.7%, 75%, and 68.5%, respectively. Endometrial thickness of >7.5 mm has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 82%, 37.3%, 52.6%, 71%, and 57.8%, respectively. Endometrial volume of >1.2 mL has sensitivity, specificity, positive and negative predictive values, and overall accuracy of 90%, 42.4%, 57%, 83.3%, and 64.2%, respectively. 3D VOCAL may be used as a noninvasive method for the diagnosis of EP in premenopausal women with AUB.

Ultrasound for the diagnosis of gout—the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 239-249
Author(s):  
Sara Nysom Christiansen ◽  
Mikkel Østergaard ◽  
Ole Slot ◽  
Viktoria Fana ◽  
Lene Terslev
Keyword(s):  
Outcome Measures ◽  
Predictive Value ◽  
Reference Standards ◽  
Secondary Outcome ◽  
Predictive Values ◽  
Ultrasound Findings ◽  
Ultrasound Assessment ◽  
Sensitivity Specificity ◽  
Ultrasound Group ◽  
Msu Crystals

Abstract Objective To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions. Methods Ultrasound was performed in patients with clinically suspected gout. Joints (28) and tendons (26) were binarily evaluated for the Outcome Measures in Rheumatology gout lesions—double contour (DC), tophus, aggregates and erosions. Ultrasound assessment was compared with two reference standards: (i) presence of MSU crystals in joint/tophus aspirate (primary outcome) and (ii) ACR/EULAR 2015 gout classification criteria (secondary outcome). Both reference standards were evaluated by rheumatologists blinded to ultrasound findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each ultrasound lesion against both reference standards were determined. Results Eighty-two patients (70 men), mean age 62.4 (range 19–88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77–0.95). DC and tophus showed high specificities (0.88–0.95), positive predictive values (0.94–0.98) and accuracies (0.82–0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32–0.59). Ultrasound of MTP joints for DC or tophus, knee joint for DC and peroneus tendons for tophus was sufficient to identify all MSU-positive patients with ultrasound signs of gout at any location. Conclusion Ultrasound-visualized DC and tophus, as defined by the Outcome Measures in Rheumatology ultrasound group, show high specificities, positive predictive values and accuracies for diagnosing gout and are therefore valid tools in clinical practice.

scholarly journals LEVER SIGN TEST FOR CHRONIC ACL INJURY: A COMPARISON WITH LACHMAN AND ANTERIOR DRAWER TESTS

2021 ◽  
Vol 29 (3) ◽  
pp. 132-136
Author(s):  
MARCEL FARACO SOBRADO ◽  
MARCELO BATISTA BONADIO ◽  
GABRIEL FERNANDES RIBEIRO ◽  
PEDRO NOGUEIRA GIGLIO ◽  
CAMILO PARTEZANI HELITO ◽  
...  
Keyword(s):  
Predictive Value ◽  
Cruciate Ligament ◽  
Outpatient Setting ◽  
Sign Test ◽  
Level Of Evidence ◽  
Acl Injuries ◽  
Predictive Values ◽  
Anterior Drawer ◽  
Sensitivity Specificity ◽  
Different Levels

ABSTRACT Objective: This study aims to evaluate the sensitivity and specificity of the lever sign test in patients with and without chronic Anterior Cruciate Ligament (ACL) injuries in an outpatient setting and the inter-examiner agreement of surgeons with different levels of experience. Methods: 72 consecutive patients with a history of previous knee sprains were included. The Lachman, anterior drawer, and Lever Sign tests were performed for all subjects in a randomized order by three blinded raters with different levels of experience. Sensitivity, specificity, positive predictive value, negative predictive value, and inter-rater agreement were estimated for all tests. Results: Among the 72 patients, the prevalence of ACL injuries was 54%. The lever test showed sensitivity of 64.1% (95% CI 0.47-0.78) and specificity of 100% (95% CI 0.87-1.00) for the senior examiner. For the less experienced examiner the sensitivity was 51.8% and the specificity was 93.7%. Positive predictive values (PPV) and negative predictive values (NPV) were 100% and 70.2%, respectively. Conclusion: Lever Sign test shows to be a maneuver of easy execution, with 100% specificity and 100% PPV. Moderate agreement between experienced examiners and low agreement among experienced and inexperienced examiners was found. This test may play a role as an auxiliary maneuver. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test.

scholarly journals Validation of the mTICCS Score as a Useful Tool for the Early Prediction of a Massive Transfusion in Patients with a Traumatic Hemorrhage

2020 ◽  
Vol 9 (4) ◽  
pp. 945 ◽  
Author(s):  
Klemens Horst ◽  
Rachel Lentzen ◽  
Martin Tonglet ◽  
Ümit Mert ◽  
Philipp Lichte ◽  
...  
Keyword(s):  
Massive Transfusion ◽  
Early Stage ◽  
Scoring Systems ◽  
Clinical Score ◽  
Predictive Values ◽  
Emergency Situations ◽  
Severe Hemorrhage ◽  
Patients At Risk ◽  
Level I ◽  
Sensitivity Specificity

The modified Trauma-Induced Coagulopathy Clinical Score (mTICCS) presents a new scoring system for the early detection of the need for a massive transfusion (MT). While validated in a large trauma cohort, the comparison of mTICCS to established scoring systems is missing. This study therefore validated the ability of six scoring systems to stratify patients at risk for an MT at an early stage after trauma. A dataset of severely injured patients (ISS ≥ 16) derived from the database of a level I trauma center (2010–2015) was used. Scoring systems assessed were Trauma-Associated Severe Hemorrhage (TASH) score, Prince of Wales Hospital (PWH) score, Larson score, Assessment of Blood Consumption (ABC) score, Emergency Transfusion Score (ETS), and mTICCS. Demographics, diagnostic data, mechanism of injury, injury pattern (graded by AIS), and outcome (length of stay, mortality) were analyzed. Scores were calculated, and the area under the receiver operating characteristic curves (AUCs) were evaluated. From the AUCs, the cut-off point with the best relationship of sensitivity-to-specificity was used to recalculate sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). A total of 479 patients were included; of those, blunt trauma occurred in 92.3% of patients. The mean age of patients was 49 ± 22 years with a mean ISS of 25 ± 29. The overall MT rate was 8.4% (n = 40). The TASH score had the highest overall accuracy as reflected by an AUC of 0.782 followed by the mTICCS (0.776). The ETS was the most sensitive (80%), whereas the TASH score had the highest specificity (82%) and the PWH score had the lowest (51.83%). At a cut-off > 5 points, the mTICCS score showed a sensitivity of 77.5% and a specificity of 74.03%. Compared to sophisticated systems, using a higher number of weighted variables, the newly developed mTICCS presents a useful tool to predict the need for an MT in a prehospital situation. This might accelerate the diagnosis of an MT in emergency situations. However, prospective validations are needed to improve the development process and use of scoring systems in the future.

scholarly journals Performance Characteristics of the Ultrasound Strategy during Incidence Screening in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 858
Author(s):  
Jatinderpal Kalsi ◽  
Aleksandra Gentry-Maharaj ◽  
Andy Ryan ◽  
Naveena Singh ◽  
Matthew Burnell ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Transvaginal Ultrasound ◽  
Annual Incidence ◽  
Stage I ◽  
Cancer Trial ◽  
Predictive Values ◽  
Epithelial Cancers ◽  
Line Test ◽  
One Year ◽  
Sensitivity Specificity

Randomised controlled trials of ovarian cancer (OC) screening have not yet demonstrated an impact on disease mortality. Meanwhile, the screening data from clinical trials represents a rich resource to understand the performance of modalities used. We report here on incidence screening in the ultrasound arm of UKCTOCS. 44,799 of the 50,639 women who were randomised to annual screening with transvaginal ultrasound attended annual incidence screening between 28 April 2002 and 31 December 2011. Transvaginal ultrasound was used both as the first and the second line test. Participants were followed up through electronic health record linkage and postal questionnaires. Out of 280,534 annual incidence screens, 960 women underwent screen-positive surgery. 113 had ovarian/tubal cancer (80 invasive epithelial). Of the screen-detected invasive epithelial cancers, 37.5% (95% CI: 26.9–49.0) were Stage I/II. An additional 52 (50 invasive epithelial) were diagnosed within one year of their last screen. Of the 50 interval epithelial cancers, 6.0% (95% CI: 1.3–16.5) were Stage I/II. For detection of all ovarian/tubal cancers diagnosed within one year of screen, the sensitivity, specificity, and positive predictive values were 68.5% (95% CI: 60.8–75.5), 99.7% (95% CI: 99.7–99.7), and 11.8% (95% CI: 9.8–14) respectively. When the analysis was restricted to invasive epithelial cancers, sensitivity, specificity and positive predictive values were 61.5% (95% CI: 52.6–69.9); 99.7% (95% CI: 99.7–99.7) and 8.3% (95% CI: 6.7–10.3), with 12 surgeries per screen positive. The low sensitivity coupled with the advanced stage of interval cancers suggests that ultrasound scanning as the first line test might not be suitable for population screening for ovarian cancer. Trial registration: ISRCTN22488978. Registered on 6 April 2000.

TO SEPARATELY ASSESS THE DIAGNOSTIC POTENTIAL OF TVS & MRI IN THE TERMS OF SENSITIVITY AND SPECIFICITY BY CORRELATING THE IMAGING FINDINGS WITH HISTOPATHOLOGY

2020 ◽  
Vol 4 (6) ◽  
Author(s):  
Suraj Mathur
Keyword(s):  
Transvaginal Ultrasound ◽  
High Sensitivity ◽  
Imaging Evaluation ◽  
Medical College ◽  
Conventional Mri ◽  
Diagnostic Potential ◽  
Adc Mapping ◽  
Malignant Lesions ◽  
Sensitivity Specificity

This prospective study was done in the Department of Radio diagnosis Govt. Medical College, Kozhikode. A total of 65 patients who were referred to our department with clinical suspicion of endometrial lesions and incidentally detected endometrial lesions on ultrasonography underwent transvaginal ultrasound and subsequent Imaging evaluation of pelvis MRI has very high sensitivity (95%) and specificity (98%) and is almost as accurate (97%) as histopathology in differentiating benign from malignant lesions. Addition of DWI with ADC mapping to conventional MRI increases its accuracy even more. However there is inherent limitation to MRI in detecting carcinoma in situ and micrometastasis. Keywords: TVS, MRI, Sensitivity, Specificity, Histopathology.

Threat of premature birth: psycho-social aspects

2016 ◽  
pp. 86-89
Author(s):  
S. Zhuk ◽  
◽  
O. Schurevska ◽  
Keyword(s):  
Pregnant Women ◽  
Physical Functioning ◽  
Premature Birth ◽  
Defense Mechanisms ◽  
Subjective Evaluation ◽  
Clinical Signs ◽  
Subjective Assessment ◽  
Psychological Status ◽  
Stress Load ◽  
Mandatory Participation

The objective: to study the psychological characteristics of women’s status in one of the most common complications of pregnancy - the threat of termination of pregnancy, depending on the level of stress load. Patients and methods. We have studied the psychological status (the Holmes-Rahe level of psychosocial stress, the Spielberg-Hanin level of anxiety, V.I.Dobryakov’s related to a pregnancy test, diagnosis of psychological defense mechanisms, assessment of quality of life) 60 pregnant women with threat of premature birth in the third trimester of pregnancy. Surveyed women were divided into 2 groups: group 1 included 30 pregnant women – forced migrant of Donetsk and Lugansk area and 2 group – 30 pregnant women who resided in Kiev. Results. At the same clinical picture of the threat of premature birth we detected discrepancy between the subjective assessment of their condition in women – forced migrants: a high level of situational and personal anxiety, decrease in physical (physical functioning, role-physical functioning) and psychological (social functioning, role emotional functioning) health, doubtful and pathological subtypes of gestational dominant. This creates prerequisites for complications of pregnancy, childbirth and postpartum future period and requires the participation of psychologists in the work with this category of patients. Conclusion. So, revealed a discrepancy between the objective clinical signs similar obstetric pathology (on the example of threatened abortion) in pregnant women with different levels of stress load and their subjective evaluation of their condition that affects their psychological status. This should be reflected in individually tailored therapy and be mainstreamed into the work of obstetricians and gynecologists with these patients, and requires mandatory participation of psychologists in the work with this category of patients. Key words: pregnancy, the threat of premature birth, stress, psychological status.

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

scholarly journals The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

2020 ◽  
Author(s):  
Carmelo Saraniti ◽  
Enzo Chianetta ◽  
Giuseppe Greco ◽  
Norhafiza Mat Lazim ◽  
Barbara Verro
Keyword(s):  
White Light ◽  
Diagnostic Tool ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Resection Margins ◽  
Predictive Values ◽  
White Light Endoscopy ◽  
Laryngeal Lesions ◽  
Sensitivity Specificity ◽  
The Impact

Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points

scholarly journals Bi-caudate ratio as a MRI marker of white matter atrophy in multiple sclerosis and ischemic leukocencephalopathy

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Dena Serag ◽  
Eman Ragab
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Surrogate Marker ◽  
Normal Subjects ◽  
Subjective Assessment ◽  
Linear Measurement ◽  
Control Group ◽  
Imaging Science ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Background Brain atrophy measurement is now a cornerstone in basic neuro-imaging science. While assessment of white matter atrophy by visual inspection is subjective, volumetric approaches are time-consuming and not often feasible. Bi-caudate ratio represents a linear surrogate parameter of brain volume that can be derived from standard imaging sequences. This study highlights the value of the bi-caudate ratio (BCR) as a MRI marker of white matter atrophy in patients with multiple sclerosis and ischemic leukoencephalopathy and set a cut-off value to differentiate between patients with white matter atrophy and normal subjects. Results A total of 115 patients (54 males and 61 females) diagnosed with white matter leukoencephalopathy (MS in 51 patients and ischemic leukoencephalopathy in 64 patients) were included. Another group of 60 subjects with a normal white matter signal was recruited as a control group. BCR for the patient group ranged from 0.13 to 0.27 (mean (± SD) = 0.16 ± 0.02), while for the control group, it ranged from 0.05 mm to 0.13 (mean (± SD) = 0.09 ± 0.01). The difference between the two groups was statistically significant (P value < 0.001). A cut-off value of 0.13 was used to differentiate between the BCR in both patients and control groups with sensitivity, specificity, and accuracy of 99.2%, 100%, and 99%, respectively. The difference in BCR for patients diagnosed with MS and ischemic leukoencephalopathy was also statistically significant (P value < 0.001). Conclusion The bi-caudate ratio represents a linear measurement of subcortical atrophy that can be useful as a surrogate marker of global supra-tentorial white matter atrophy instead of the usually performed visual and therefore subjective assessment. It is an easily obtained measure that can be performed without complex time-consuming volumetric studies. Our findings also revealed that the BCR is higher in patients with ischemic leukoencephalopathy than in patients with MS.

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