Transvaginal Ultrasound Research Articles

3D Sonographic Diagnosis of Hydrosalpinx: Implications for the Non-Laparoscopy Confirmation of Pelvic Inflammatory Disease

Introduction: As Pelvic Inflammatory Disease (PID) has many clinical and radiographic features, the specific utility of sonographic imaging for its diagnostic confirmation may be helpful with its non-invasive approach, rather than the common reliance on the operative procedure of laparoscopy for this purpose. Since the presence of hydrosalpinx is commonly associated with PID, its associated three-dimensional transvaginal sonography (3DTVS) appearance may offer helpful diagnostic certainty. Although Timor-Tritsch introduced a sonographic technique for its display previously in 2005, the technique used in this current imaging project may be somewhat simpler to employ and possibly even more revealing. A case series was investigated for the possible diagnosis of deep invasive endometriosis (DIE), for which patients presented with pelvic pain presumed to represent DIE. A separate case series was investigated for the possible value of the O-RADS app for the diagnosis of ovarian malignancy. Since the sonographic diagnosis of hydrosalpinx was made in each dataset, and some of those patients underwent exploratory surgery, the veracity of the sonographic diagnosis could be calculated. As pelvic pain could also represent possible PID, the cases in which hydrosalpinx were found were specifically examined for it. The present investigation was performed in order to detail the value of 3D surface rendering imaging for hydrosalpinx and its ultimate diagnosis. Some patients underwent operative intervention and thus histologic confirmation, in addition to the sonographic evaluation which all patients had performed. It is the intent of this investigation to display the value of 3DTVS to diagnostically determine some cases of chronic pelvic pain as being due to PID. Methods: A series of 32 patients were sonographically evaluated with 3DTVS for complaints of pelvic pain, and when a hydrosalpinx was observed, a particular technique was employed (described below). Nine of those patients had a surgical intervention in addition to the ultrasound evaluation. The technique that was used can be described as follows. The 3D volume of the region of interest (ROI) was obtained, and it was manipulated to produce the best image of the hydrosalpinx. A large Ultrasound rendering box was created to demonstrate the external surface of the resultant 3D hydrosalpinx image. Results: A total of 32 patients underwent the described rendering imaging with 3DTVS. Of those patients, 9 (27 %) also underwent surgical exploration. 78 % of those cases revealed surgical findings consistent with the presurgical sonographic diagnosis. Conclusion: From the review of this case series, it appears that the sonographic diagnosis of chronic PID can virtually be relied upon with 3DTVS, rather than subject all patients to laparoscopy for whom this diagnosis may be considered. One can consider the described technique as a method of performing a partial “Virtual Laparoscopy”. After sonographically confirming the diagnosis of chronic PID, a gynecologist can confidently use the available medical therapeutic methods for its treatment, and if such treatment fails improvement of the patient’s symptoms, surgical extirpation can be considered (e.g. TAH-BSO). In this way, 3DTVS can be considered as an important gynecologic diagnostic tool for the described purpose. The rendered images increased the confidence in diagnosing hydrosalpinx.

Endometrial Thickness as Diagnostic Triage for Endometrial Cancer Among Black Individuals

Poor performance of the transvaginal ultrasonography triage strategy has been suggested as a contributor to racial disparity between Black individuals and White individuals in endometrial cancer (EC) stage at diagnosis in population-level simulation analyses. To examine the false-negative probability using ultrasonography-measured endometrial thickness (ET) thresholds as triage for EC diagnosis among Black individuals and assess whether known risk factors of EC modify ET triage performance. This retrospective diagnostic study of merged abstracted electronic health record data and secondary administrative data (January 1, 2014, to December 31, 2020) from the Guidelines for Transvaginal Ultrasound in the Detection of Early Endometrial Cancer sample assessed Black individuals who underwent hysterectomy in a 10-hospital academic-affiliated health care system and affiliated outpatient practices. Data analysis was performed from January 31, 2023, to November 30, 2023. Pelvic ultrasonography within 24 months before hysterectomy. Ultrasonography performed before hysterectomy as well as demographic and clinical data on symptom presentation, endometrial characterization, and final EC diagnosis were abstracted. Endometrial thickness thresholds were examined for accuracy in ruling out EC diagnosis by using sensitivity, specificity, and negative predictive value. False-negative probability was defined as 1 - sensitivity. Accuracy measures were stratified by risk factors for EC and by factors hypothesized to influence ET measurement quality. A total of 1494 individuals with a uterus (median [IQR] age, 46.1 [41.1-54.0] years) comprised the sample, and 210 had EC. Fibroids (1167 [78.1%]), vaginal bleeding (1067 [71.4%]), and pelvic pain (857 [57.4%]) were the most common presenting diagnoses within 30 days of ultrasonography. Applying the less than 5-mm ET threshold, there was an 11.4% probability that someone with EC would be classified as not having EC (n = 24). At the 4-mm (cumulative) threshold, the probability was 9.5%, and at 3 mm, it was 3.8%. False-negative probability at the 5-mm threshold was similar among EC risk factor groups: postmenopausal bleeding (12.4%; 95% CI, 7.8%-18.5%), body mass index greater than 40 (9.3%; 95% CI, 3.1%-20.3%); and age 50 years or older (12.8%; 95% CI, 8.4%-18.5%). False-negative probability was also similar among those with fibroids on ultrasonography (11.8%; 95% CI, 6.9%-18.4%) but higher in the setting of reported partial ET visibility (26.1%; 95% CI, 10.2%-48.4%) and pelvic pain (14.5%; 95% CI, 7.7%-23.9%). These findings suggest that the transvaginal ultrasonography triage strategy is not reliable among Black adults at risk for EC. In the presence of postmenopausal bleeding, tissue sampling is strongly recommended.

Twin fetuses associated with double amniotic sacs diagnosed using transvaginal ultrasonography: A case report

BACKGROUND Conjoined twins are a rare twin malformation commonly presenting as single amniotic sac twinning, with double amniotic sac twinning being extremely rare and poorly reported. Most conjoined twins are females. CASE SUMMARY A woman of childbearing age conceived naturally, and at 8 wk of gestation, transvaginal ultrasonography showed an embryo and cardiac tube pulsation in both amniotic sacs. On dynamic observation, the two embryos were connected in the lower abdomen, with restricted movement. A repeat transvaginal ultrasound at 11 wk showed that the intestinal tubes of both fetuses were connected in the lower abdomen. The pregnancy was terminated and labor was induced. CONCLUSION Transvaginal ultrasound may detect conjoined twin malformations in an early stage. Our case provides diagnostic insights for ultrasonographers and can help develop early therapeutic interventions.

The use of transvaginal ultrasound alters physiologic uterine peristalsis in gynecologic participants

To study whether transvaginal ultrasound (TVUS) affected the uterine peristalsis (UP) patterns in nonpregnant participants. Institutional review board-approved, prospective observational cohort study. The noninvasive UP imaging (UPI) system uses electrode patches placed on the patient's skin just above the pubic bone and on the low back to quantify the 3-dimensional electrical activation pattern during UP by calculating peristalsis frequency, duration, magnitude, and activation ratio. A 20-minute UPI scan was completed without TVUS followed by a 10-minute UPI scan acquired simultaneously during TVUS examination as a comparison. University medical center. Twenty-eight participants with regular menstrual cycles not taking hormonal medication and with a normal uterus were included in analysis. Subjects were imaged longitudinally during the four phases of the menstrual cycle (menses, proliferative, periovulatory, and secretory) with a UPI scan followed by concurrent TVUS and UPI scan. Serum hormone levels (estradiol and progesterone) and TVUS evaluating follicular development were obtained during each visit to confirm menstrual cycle phase. Duration, frequency, magnitude, and activation ratio of the UP waves. With the use of simultaneous TVUS, UP waves had a change in at least one of the outcomes measured in all visits. The frequency, magnitude, and duration were significantly higher with TVUS use in all phases of the menstrual cycle. The activation ratio was higher with TVUS during all phases except the periovulatory phase. This study demonstrated that TVUS may inherently affect UP waves. Therefore, noninvasive technology may more accurately measure physiologic peristalsis waves.

A prospective study on risk factors associated with the development of isthmocele after caesarean section.

The primary objective was to detect the number of women developing isthmocele following lower segment caesarean section. The secondary objectives included analysing the risk factors associated with developing isthmocele and measuring the agreement between Transvaginal Ultrasonography (TVS) and Saline infusion Sonohysterography (SIS) in diagnosing Isthmocele. This study was conducted in the Department of Obstetrics and Gynecology and focused on women who had undergone Lower Segment cesarean Section (LSCS). The study aimed to detect any indentation of at least 2mm in the scar site, known as isthmocele, using Transvaginal Ultrasound (TVS) and Saline Infusion Sonography (SIS) between 6weeks and 6months after delivery. Along with the primary objective, the study also evaluated several secondary outcomes such as maternal comorbidities, closure techniques, and labor details. The evaluation of isthmocele followed the 2019 modified Delphi consensus approach. In our study, we found that 30% of our study population had isthmocele. We also observed that the number of previous caesarean deliveries, maternal BMI, duration of surgery, and characteristics of the previous CD scar were significantly associated with the development of isthmocele. When we compared the diagnostic methods, we found that TVS and SIS had similar limits of agreement for clinically important isthmocele parameters. However, we noticed a difference in the length and distance of isthmocele from the internal os, which we observed through Bland Altman plots. Our research has shown that women who have undergone multiple caesarean deliveries, have a higher maternal body mass index (BMI), and experienced longer surgery duration are at a significantly higher risk of developing isthmocele. To prevent its development, it is recommended to promote vaginal birth after caesarean delivery whenever feasible, manage maternal obesity early on, and provide adequate surgical training to medical professionals. Additionally, transvaginal ultrasound (TVS) is an effective method for detecting isthmocele and can be used interchangeably with saline-infused sonography (SIS).

Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus.

To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. Twenty-seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29-45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18-50) mm. Echogenicity was non-uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color- or power-Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) of the lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non-uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power-Doppler examination. The ultrasound finding of a parametrial, unilateral, solid, non-uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Role of Ovarian Volume in Fertile and Infertile Women by Sonography at Swabi

Background: The measurement of ovarian volume via sonography is an important parameter in assessing ovarian aging and defining fertility potential in women. In the Swabi region, where advanced medical facilities are limited, measuring ovarian volume could be particularly useful for diagnosing fertility issues. This cross-sectional study investigates the relationship between ovarian size and female fertility among women in Swabi. Objective: To evaluate the role of ovarian volume in distinguishing between fertile and infertile women in the Swabi district using ultrasound. Methods: A cross-sectional study was conducted at the Department of Radiology, Mahaban Medical and Research Hospital, Swabi, Khyber-Pakhtunkhwa, Pakistan. A total of 101 participants were recruited from community health clinics using convenience sampling. Data on demographic characteristics, medical history, and menstrual cycle regularity were collected via standardized questionnaires. Ovarian dimensions were measured by trained personnel using transvaginal sonography (TVUS), which provided accurate and reproducible results. Descriptive statistics, including means, standard deviations, and percentages, were calculated for variables such as age, ovarian measurements, and fertility status. Cross-tabulation was used to classify participants based on fertility status and menstrual cycle regularity. Correlation tables were generated to examine the interrelationship between fertility status and cycle regularity. Data analysis was performed using the Statistical Software for Social Sciences (SPSS version 25.0). Results: The average age of participants was 28.52 years (SD = 5.08). The mean ovarian volumes for the right and left ovaries were 6.66 cm³ (SD = 3.28) and 7.46 cm³ (SD = 4.26), respectively. Among the participants, 62 were fertile, and 39 were infertile. Fertile participants had slightly higher mean ovarian measurements (right ovary: 6.90 cm³, left ovary: 7.19 cm³) compared to infertile participants (right ovary: 6.29 cm³, left ovary: 7.89 cm³). The regularity of menstrual cycles did not significantly differ between fertile and infertile women, with 31 fertile participants having regular cycles and 31 having irregular cycles. Conclusion: The study found that fertile women had slightly higher ovarian volumes compared to infertile women. However, menstrual cycle regularity did not differ significantly between the two groups. These findings suggest that while ovarian volume may be a useful indicator of fertility, menstrual cycle regularity alone is not a reliable predictor of fertility status in this cohort.

Clinical outcomes of post-placental insertion of Copper T380A and Multiload 375 contraceptive devices during cesarean section: a randomized clinical trial

BackgroundTo compare two types of intrauterine devices, namely Cu T380A IUD and Multiload 375 IUD, inserted immediately post-placental during cesarean section, with regard to expulsion rates and side effects.MethodsA randomized comparative clinical trial was carried out over 200 patients with 100 patients in each group. Transabdominal ultrasonography (US) was done on all patients before discharge to ensure the adequate position of the IUD in addition to casco speculum examination to assess the IUD threads, and then women were requested to attend a follow-up appointment at 6 weeks after delivery; gynecological examinations in addition to transvaginal sonography were done to measure the top-fundal distance that reflects the position of the IUD. The participants were instructed to report the pattern of bleeding during the puerperium, fever, or vaginal discharge.ResultsThe ultrasonographic assessment of IUD position before patient discharge (1st assessment) revealed that 18% of Cu T380A IUD users were displaced in comparison to 24% of Multiload 375 IUD, and such difference between both groups was not statistically significant (P = 0.3); furthermore, the ultrasonographic assessment of IUD position after 6 weeks (2nd assessment) revealed that 19% of Cu T380A IUD users were displaced in comparison to 30% of Multiload 375 IUD, and such difference between both groups was statistically significant (P = 0.047). In addition, none of the included patients in both groups suffered from fever after IUD insertion.ConclusionThe present study demonstrated that post-placental insertion of Multiload 375 IUCD results in significantly higher displacement compared to post-placental insertion of Cu T380A IUCD, as well as significantly more bleeding problems with Cu T380A IUCD as compared with Multiload 375 IUCD.Trial registrationThe study was registered prospectively on clinical trial.gov with trial registeration number NCT05624411 (Registered 22-October-2022, https://clinicaltrials.gov/study/NCT05624411).

Chitinase-3-like protein 1, matrix metalloproteinase-9, and monocyte chemoattractant protein-1 as potential biomarkers and treatment targets of adenomyosis.

This study aimed to investigate the levels of chitinase-3-like protein-1 (CHI3L1), matrix metalloproteinase-9 (MMP-9), and monocyte chemoattractant protein-1 (MCP-1) in adenomyosis, as compared to normal myometrial tissue. These biomarkers may be useful for determining potential treatment targets. This was a correlative, analytical, and observational study with a cross-sectional design. Participants with a diagnosis of moderate-to-severe adenomyosis, as determined through transvaginal ultrasonography and histological examination, and who underwent laparotomy or laparoscopic surgery for the treatment of adenomyosis, were enrolled in the study. Unlike other studies that recruited healthy women as controls, our study used adenomyotic and healthy nonadenomyotic myometria obtained from the same individual. The levels of CHI3L1, MMP-9, and MCP-1 in the biopsy samples were determined using enzyme-linked immunoassay kits, according to the manufacturer's protocol. A highly significant increase in the levels of CHI3L1, MMP-9, and MCP-1 was found in adenomyotic tissues compared to non-adenomyotic tissues (P<0.001). A significant positive correlation was found between CHI3L1 and MMP-9 levels (r=0.463; P=0.008), CHI3L1 and MCP-1 levels (r=0.594; P<0.001), and MCP-1 and MMP-9 levels (r=0.680; P<0.001) in adenomyotic tissues. CHI3L1 may play a role in the pathogenesis of adenomyosis via the regulation of the MCP-1 and MMP-9 pathways. Therefore, these molecules may serve as biomarkers and potential therapeutic targets for adenomyosis.

Is there a relationship between the psychological state of infertile patient and ovarian reserve indicators?

This study explored the relationship between reduced ovarian reserve and the psychological state of infertile women. This cross-sectional, single-center study was conducted with 106 infertile women. The Beck Depression Inventory (BDI) was used to assess patients' propensity for depression. The data relating to infertility, such as causes of infertility, type of infertility (primary or secondary), duration of infertility, and treatment status [previous assisted reproductive technologies (ART) treatment and ART treatment failure] were recorded for each patient. The ovarian reserve was determined using laboratory tests [anti-Mullerian hormone (AMH); follicle-stimulating hormone (FSH)] and transvaginal ultrasonography to measure the antral follicle count (AFC) in each ovary. There was no significant relationship between the total score obtained from the Beck depression scale and AFC, AMH, thyroid-stimulating hormone, FSH, estradiol, and prolactin measurements (p>0.05). There was no significant difference between the groups regarding depression levels based on the cause of infertility (p=0.412). Additionally, the type of infertility (primary, secondary) did not differ between the groups (p=0.586). There were no differences on the BDI scale regarding the level of depression between patients who underwent in vitro fertilization (IVF) treatment (history of previous IVF treatment failure) and those who did not. There was no significant association between AFC and AMH levels and the depression state of infertile patients.

Feasibility of Predicting Surgical Duration in Endometriosis Using Numerical Multi-Scoring System of Endometriosis (NMS-E).

Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.

Accuracy of sonographic lower segment thickness and prediction of vaginal birth after caesarean in a resourced-limited setting; Prospective study.

To assess the accuracy of ultrasound measurement of the lower uterine segment (LUS) thickness against findings at laparotomy, and to investigate its correlation with the success rate of vaginal birth after one previous caesarean delivery (CD) in a resource-limited setting. Prospective study. Obstetrics and Gynaecology department in a tertiary hospital in Ghana. Women with one previous CD undergoing either a trial of labour (TOLAC) or elective CD. Myometrial lower uterine segment thickness (mLUS) and full lower uterine segment thickness (fLUS) were measured with transvaginal ultrasound (TVUS). The women were managed according to local protocols with the clinicians blinded to the ultrasound measurements. The LUS was measured intraoperatively for comparison with ultrasound measurements. Lower uterine segment findings at laparotomy, successful vaginal birth. A total of 311 pregnant women with one previous CD were enrolled; 147 women underwent elective CD and 164 women underwent a TOLAC. Of the women that underwent TOLAC, 96 (58.5%) women had a successful vaginal birth. The mLUS was comparable to the intraoperative measurement in the elective CD group with LUS thickness <5 mm (bias of 0.01, 95% CI -0.10 to 0.12 mm) whereas fLUS overestimated LUS <5 mm (bias of 0.93, 95% CI 0.80-1.06 mm). Successful vaginal birth rate correlated with increasing mLUS values (odds ratio 1.30, 95% CI 1.03-1.64). Twelve cases of uterine defect were recorded. LUS measurement ≤2.0 mm was associated with an increased risk of uterine defects with a sensitivity of 91.7% (95% CI 61.5-99.8%) and specificity of 81.8% (95% CI 75.8-86.8%). Accurate TVUS measurement of the LUS is technically feasible in a resource-limited setting. This approach could help in making safer decisions on mode of birth in limited-resource settings.

Association of a polygenic risk score with risk of abnormal ultrasound findings and ovarian cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

10542 Background: Several susceptibility loci have been identified in genome-wide association studies (GWAS) of single nucleotide polymorphisms (SNPs) that are associated with ovarian cancers. Polygenic risk scores (PRS) combining certain loci have shown limited performance at predicting ovarian cancer risk. However, the utilization of PRS with ovarian cancer screening tests, like transvaginal ultrasound (TVU), warrants further evaluation. This study investigated the association between a polygenic risk score and ovarian cancer risk and abnormal TVU screening in a large-scale randomized controlled ovarian cancer screening trial. Methods: A polygenic risk score was constructed using weighted sums of risk alleles of 15 ovarian cancer SNPs identified in previous GWAS to evaluate the association with abnormal TVU screening results and ovarian cancer outcomes in female participants of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Complete genotyping information, TVU results, and ovarian cancer outcomes were available for 15722 females (mean age 62.2 years +/- 5.3) with European ancestry, including 116 ovarian cancer cases. Abnormal TVU was defined as ovarian volume or cyst volume &gt; 10 cm3, any solid/cystic component within a cystic ovarian tumor, or any solid area or papillary projection extending into the cavity of a cystic ovarian tumor. Polygenic risk scores were categorized as quartiles and odds ratios (OR) were calculated to assess risk of ovarian cancer or abnormal TVU result using the lowest PRS quartile as reference category. Results: TVU screening results were abnormal for 732 (732/15722, 4.66%) participants and normal for 14990 (14990/15722, 95.3%) participants at trial baseline. PRS within the fourth quartile demonstrated increased risk of ovarian cancer with reference to the lowest quartile (OR 1.77, 95% confidence interval: 1.04-3.08). Similarly, women in the highest quartile of the PRS had increased odds of an abnormal TVU screening result (OR 1.46, 95% confidence interval: 1.17-1.83) compared to women in the lowest PRS quartile. Conclusions: A polygenic risk score including 15 loci previously shown to be associated with ovarian cancer risk showed an association with increased ovarian cancer risk in the PLCO trial. Furthermore, the PRS was also associated with abnormal ultrasound results. Our findings support further evaluation of polygenic risk scores and transvaginal ultrasound for ovarian cancer risk stratification and screening approaches.

Novel liquid biopsy assay to distinguish benign from malignant pelvic masses.

e17563 Background: Despite not ranking among the top ten most common cancers in women in the United States, ovarian cancer stands as the fifth leading cause of cancer-related deaths in this population. According to the American Cancer Society, only 20% of ovarian cancers are found at stages I-II, when 94% of patients are expected to live longer than five years after diagnosis. Instead, the majority of ovarian cancers are detected at stages III-IV, when long term survival is 20% or less. Early identification of ovarian cancer is challenging due to the wide range of symptoms with which a patient may present, most of which lack specificity for ovarian cancer. Even in cases where a physician may want to rule in or out ovarian cancer, the available methods for screening have a low positive predictive value. These methods include bimanual exams, transvaginal ultrasounds, and CA-125 blood tests. In a screening capacity, the sensitivity for a bimanual exam finding ovarian cancer is only about 44%, transvaginal ultrasound is approximately 85%, and CA-125 testing registers at 77%. The need for better tools to detect ovarian cancer is clear. Genece Health has developed an assay utilizing a proprietary algorithm that leverages deep learning to analyze cfDNA fragment size, end motif, and coverage patterns, along with other genomic features, to detect the presence of ctDNA in blood originating from ovarian cancer. The data presented herein demonstrate that the Genece Health assay has the ability to detect ctDNA in a single tube of blood using low pass whole genome sequencing in a cost-effective way to distinguish between malignant and benign pelvic masses. Methods: Blood was prospectively collected from 56 females with pelvic masses in advance of removal and histopathology (approximately 32 cancer and 24 benign masses) in Streck cfDNA BCT Devices. Additionally, healthy female donor blood from 50 individuals procured through the San Diego Blood Bank were collected in Streck cfDNA BCT Devices. cfDNA was extracted from double-spun plasma and low-pass whole genome sequencing (2X – 5X coverage) was performed. Data were analyzed with the Genece Health Algorithm. Results: The Genece Health Algorithm demonstrated the ability to distinguish between pelvic masses that were deemed benign versus malignant via histopathology. There was a significant (P&lt;0.01) difference between the classifier assigned to the malignant and benign and presumed normal groups. Conclusions: The investigational assay described herein shows progress toward the ability to use non-invasive molecular testing to identify ovarian cancer in a blood sample. A blood test to differentiate between a benign and malignant pelvic mass will enhance the ability of physicians to detect ovarian cancer at earlier stage, improving clinical outcomes for women. The cost-effective low-pass whole genome sequencing approach taken by Genece will be further explored in expanded cohorts.

Hysteroscopic evaluation of endometrial changes and fallopian tubal functions in women using progestin-only contraceptives

The purpose of this prospective study was to investigate whether office hysteroscopy (OH) can be used to assess the mechanisms of action of progestogen-only contraceptives (POCs), diagnose possible local causes of abnormal uterine bleeding (AUB), and support the treatment plan of symptomatic patients using POCs compared with those who do not use hormones. The study included 140 women who were divided into two groups. Group A consisted of 70 women who used POCs, whereas group B consisted of 70 women who did not use hormones. They were successively examined using transvaginal ultrasonography (TVS), OH, and endometrial sampling. The TVS results were consistent with those of OH and histopathology. The changes in endometrial thickness and vasculature, as well as fallopian tube (FT) functions, were significantly more pronounced in POC users than in non-POC users. There was a significant reduction in the peristalsis of the proximal part of the FT, as well as a reduction in the bubble flow test in group A compared with group B. In addition, the combination of peristalsis and the bubble flow test (Darwishscope test) was significantly lower in group A. It was concluded that using OH as a simple diagnostic tool in women with POCs would contribute to a better understanding of the mechanisms of endometrial and FT effects and explain some local endometrial causes of AUB. This ensures that the combination of TVS and OH would limit routine endometrial sampling in POCs users.

Systematic, noninvasive endometriosis diagnosis in transvaginal sonography by the Swiss Society of Ultrasound in Medicine.

We present a new systematic, comprehensive, checklist-based sonographic assessment of endometriosis in the female true pelvis. Emphasis is placed on practical skills teaching. The newly introduced White Sliding Line (WSL) is the core structure. The WSL separates five compartments (anterior, central, posterior, and lateral right and left) containing dedicated endometriosis signs of mobility and morphology to be checked. This approach relies on the 2016 IDEA Consensus and further developments. It directly connects to the 2021 #ENZIAN Classification Standard. In practice, evaluation follows the proposed checklist in all compartments, judging first sliding mobility between organs and structures in a highly dynamic investigation. A rigorous search for deep endometriosis (DE) is then performed. We treat adhesions due to their great clinical importance and possible, reliable diagnosis by TVS as the fifth endometriosis unit, next to endometrioma, DE, adenomyosis, and superficial endometriosis. Including superficial (peritoneal) endometriosis is a future goal.

Diagnostic Accuracy of Color and Spectral Doppler in Identifying Endometrial Cancer in Post-Menopausal Menometrorrhagial Patients with Histopathology as Gold Standard

Background: Endometrial cancer is the most common gynecological malignancy in postmenopausal women, often presenting with postmenopausal hemorrhage. Traditional diagnostic methods are invasive, prompting the need for less intrusive, accurate alternatives. Objective: To evaluate the efficacy of Doppler ultrasonography in diagnosing endometrial cancer in postmenopausal women presenting with hemorrhage, using histopathology as the gold standard. Methods: This cross-sectional study was conducted at the University of Lahore Teaching Hospital from September 2023 to March 2024, involving 140 postmenopausal women. Participants underwent transvaginal and transabdominal ultrasonography, including color and spectral Doppler assessments. Doppler findings were compared with histopathological outcomes following biopsy. Results: Doppler ultrasonography demonstrated a sensitivity of 78.63%, specificity of 65.22%, positive predictive value of 92.00%, negative predictive value of 37.50%, and overall diagnostic accuracy of 76.43%. Stratification analysis further indicated that the accuracy exceeded 90% in detecting endometrial cancer. Conclusion: Doppler ultrasonography is a valuable non-invasive diagnostic tool for detecting endometrial cancer in postmenopausal women with hemorrhage. It offers high sensitivity and specificity, reducing the necessity for invasive diagnostic procedures.

An interpretable clinical ultrasound-radiomics combined model for diagnosis of stage I cervical cancer

ObjectiveThe purpose of this retrospective study was to establish a combined model based on ultrasound (US)-radiomics and clinical factors to predict patients with stage I cervical cancer (CC) before surgery.Materials and methodsA total of 209 CC patients who had cervical lesions found by transvaginal sonography (TVS) from the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, patients were divided into the training set (n = 146) and internal validation set (n = 63), and 52 CC patients from Anhui Provincial Maternity and Child Health Hospital and Nanchong Central Hospital were taken as the external validation set. The clinical independent predictors were selected by univariate and multivariate logistic regression analyses. US-radiomics features were extracted from US images. After selecting the most significant features by univariate analysis, Spearman’s correlation analysis, and the least absolute shrinkage and selection operator (LASSO) algorithm, six machine learning (ML) algorithms were used to build the radiomics model. Next, the ability of the clinical, US-radiomics, and clinical US-radiomics combined model was compared to diagnose stage I CC. Finally, the Shapley additive explanations (SHAP) method was used to explain the contribution of each feature.ResultsLong diameter of the cervical lesion (L) and squamous cell carcinoma-associated antigen (SCCa) were independent clinical predictors of stage I CC. The eXtreme Gradient Boosting (Xgboost) model performed the best among the six ML radiomics models, with area under the curve (AUC) values in the training, internal validation, and external validation sets being 0.778, 0.751, and 0.751, respectively. In the final three models, the combined model based on clinical features and rad-score showed good discriminative power, with AUC values in the training, internal validation, and external validation sets being 0.837, 0.828, and 0.839, respectively. The decision curve analysis validated the clinical utility of the combined nomogram. The SHAP algorithm illustrates the contribution of each feature in the combined model.ConclusionWe established an interpretable combined model to predict stage I CC. This non-invasive prediction method may be used for the preoperative identification of patients with stage I CC.

Combined oral contraceptive utilization and uterine fibroid incidence: A prospective study in a cohort of African-American women.

Published associations between combined oral contraceptive use and uterine fibroid development have lacked prospective imaging with ultrasound to distinguish between incident and prevalent fibroids. The Study of Environment, Lifestyle, and Fibroids prospectively followed fibroid-free, African-American women (the group with the highest disease burden in the U.S.) to identify incident cases. We examined associations between combined oral contraceptive use and the 40-month cumulative risk of fibroids. History of hormonal contraceptive use was collected via telephone interview at enrollment. Fibroid identification was performed using transvaginal ultrasonography at enrollment, and at 20 and 40-months of follow-up. Inverse probability weights for exposures and censoring were used to construct weighted risk ratios (wRR) and weighted risk different (wRD) estimators which control for differences in fibroid risk factors between exposure groups. In addition, unweighted fully adjusted log-binomial regression models (aRR) were run for comparison. Of the 1,308 participants in the analysis sample, 70% had used combined oral contraceptives and 17% developed fibroids by 40 months. We observed an inverse association between ever use of combined oral contraceptives and cumulative fibroid incidence (wRR: 0.78; 95% Confidence Interval (CI): 0.60, 1.00; wRD: -0.05, 95% CI: -0.11, 0; aRR: 0.76, 95% CI: 0.60, 0.98). Fibroid incidence was greater in participants who started using combined oral contraceptives after age 17 years than among younger initiators, though the restriction to ever-users made this estimate less precise (wRR: 1.25; 95% CI: 0.89, 1.76; wRD: 0.04, 95% CI: -0.02, 0.10). No consistent patterns of fibroid incidence were seen among ever-users for duration of, or years since, last combined oral contraceptives use.

The Effect of Ajwa Dates (Phoenix dactylifera L) Consumption to Antral Ovarium Imaging by with Ultrasonography (USG) Transvaginal of Perimenopausal Women

Objectives: Perimenopause is a transition from the reproductive period to the menopause stage with a decrease in the number and function of oocytes. Transvaginal ultrasound is a reliable alternative method for detecting ovarian reserve. Ajwa dates contain phenolic and other flavonoid components which are considered to have the potential to improve the ovarian condition of perimenopausal women which can be assessed by increasing the number of antral follicles as measured by transvaginal ultrasound. This study aims to determine the effect of consuming ajwa dates (Phoenix dactylifera L.) on the appearance of ovarian follicles using transvaginal ultrasound in perimenopausal women. Methods: This research is a quasi-experimental study with a pre-post control design carried out at RSIA Sitti Khadijah I Muhammadiyah Makassar, South Sulawesi, Indonesia, from May to September 2023. This research involved 44 perimenopausal subjects aged 42-48 years who were divided into 2 groups randomly (28 intervention groups, 16 control groups). Subjects in the intervention group consumed seven pieces of ajwa dates (60-70 grams each seven pieces) every morning before having breakfast for eight weeks. The transvaginal USG was performed twice, the first was on day three of the menstrual cycle of each subject and the second was after eight weeks of intervention. A comparison of changes in ovarian follicles was analyzed using the Mann-Whitney U test. Results: This study showed a significant decrease in the number of antral follicles in the intervention group and an increase in the number in the control group (p&lt;0.05). Meanwhile, the size of the antral follicles showed a significant increase in the intervention group and a significant decrease in the size of the antral follicles in the control group (p&lt;0.05). Conclusion: Consuming Ajwa dates as an exogenous antioxidant can affect the number and size of antral follicles, which is an indicator of improving the condition of perimenopausal women's ovaries.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S66