Transvaginal Ultrasound Research Articles

Predictive values of cervix length measurement based on transvaginal ultrasonography

BACKGROUND: Pregnancy is an important process in women’s life, which is widely concerned by women. In recent years, the incidence of premature delivery (PTD) becomes more and more higher due to the development of auxiliary reproduction and ovulation induction technologies and the changes of pregnant women’s lifestyle and physical quality. PTD not only affects postpartum recovery and causes great physical pains, but it also has adverse effects on the birth state of neonates and even leads to neonatal death OBJECTIVE: The predictive values of cervix length (CL) measurement based on transvaginal ultrasonography (TVUS) and pathological examination of placenta for premature delivery (PTD) were investigated and the correlation between PTD and infection was analyzed. METHODS: 120 pregnant women with PTD or high-risk factors for PTD admitted to The Affiliated Hospital of Southwest Medical University between February 2020 and March 2022 were included as the subjects and underwent pathological examination of placenta and TVUS for CL measurement. The final gestational age was set as the standard for the evaluation on the predictive values of pathological examination of placenta and TVUS. What’s more, 36 subjects in PTD group and 84 in normal delivery group (control group) underwent pathological examination of placenta for the analysis of the correlation between PTD and infection. RESULTS: The joint inspection method showed significantly better sensitivity, specificity, PPV, and NPV compared to single CL or pathological examination of the placenta (P< 0.05). Among pregnant women, those with CL ⩽ 30 mm and positive placental pathology had a higher proportion compared to those with CL > 30 mm and negative placental pathology (P< 0.05). Furthermore, the incidence of Ureaplasma Urealyticum (UU), Chlamydia Trachomatis (CT), and Chorioamnionitis (CA) in vaginal discharge of the preterm delivery (PTD) group was significantly higher than that of the control group (P< 0.05). CONCLUSION: The combination of CL ⩽ 30 mm and positive placental pathology could effectively predict PTD and placental infection was notably correlated with the occurrence of PTD.

The Role of Peripheral Blood Inflammation Indices in Patients with a Diagnosis of Endometrial Hyperplasia and Cancer

Purpose: Endometrial cancer (EC) is an important problem with its increasing incidence, especially in developed countries. There is no generally accepted screening program yet. The management of endometrial hyperplasia (EH), which is the most important risk factor, is complex because it is an invasive process. Methods: A retrospective study was conducted with a total of 72 patients. Patients between the ages of 35-65 with abnormal uterine bleeding, and increased endometrial thickness on transvaginal sonography were evaluated with pathology results. Sociodemographic characteristics of the patients and laboratory values at hospital admission were obtained from hospital records. White blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils, basophils, and thrombocyte counts (x10⁹/L); plateletcrit (%), hemoglobin (Hb) (g/dL), and hematocrit (Htc) (%) values were recorded. Neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and thrombocyte lymphocyte ratio (TLR) were obtained. Systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and pan-immune-inflammation value (PIV) were obtained. Results: Thirty-seven patients diagnosed with EH and 35 patients diagnosed with endometrial malignancy were included. The mean age of the EH was 45.5 years and the mean age of the malignant group was 50.5 years (p=0.027). The sociodemographic characteristics of the patients were found to be similar. There was no significant difference in complete blood count parameters between two groups. Mean values of NLR were 2.33 and 2.52 in EH and EC groups, respectively, p = 0.448. Mean values of MLR were 0.20 and 0.21, respectively, p = 0.498. Mean values of TLR were 0.16 and 0.15, respectively, p = 0.811. Mean values of SII were 720.1 and 812.4 (x10⁹/L), respectively, p = 0.456. Mean values of SIRI were 943.1 and 1095.6 (x10⁹/L), respectively, p = 0.257. Mean values of PIV were 312753.6 and 352975.1 (x10⁹/L), respectively, p = 0.514. Conclusion: Peripheral blood inflammation indices have recently been used in cancer diagnosis and follow-up. We did not find any statistically significant differences in the investigated parametrers between the EH and EC patient groups. Close follow-up is necessary in the presence of additional risk factors in women with EH.

Machine learning models in evaluating the malignancy risk of ovarian tumors: a comparative study

ObjectivesThe study aimed to compare the diagnostic efficacy of the machine learning models with expert subjective assessment (SA) in assessing the malignancy risk of ovarian tumors using transvaginal ultrasound (TVUS).MethodsThe retrospective single-center diagnostic study included 1555 consecutive patients from January 2019 to May 2021. Using this dataset, Residual Network(ResNet), Densely Connected Convolutional Network(DenseNet), Vision Transformer(ViT), and Swin Transformer models were established and evaluated separately or combined with Cancer antigen 125 (CA 125). The diagnostic performance was then compared with SA.ResultsOf the 1555 patients, 76.9% were benign, while 23.1% were malignant (including borderline). When differentiating the malignant from ovarian tumors, the SA had an AUC of 0.97 (95% CI, 0.93–0.99), sensitivity of 87.2%, and specificity of 98.4%. Except for Vision Transformer, other machine learning models had diagnostic performance comparable to that of the expert. The DenseNet model had an AUC of 0.91 (95% CI, 0.86–0.95), sensitivity of 84.6%, and specificity of 95.1%. The ResNet50 model had an AUC of 0.91 (0.85–0.95). The Swin Transformer model had an AUC of 0.92 (0.87–0.96), sensitivity of 87.2%, and specificity of 94.3%. There was a statistically significant difference between the Vision Transformer and SA, and between the Vision Transformer and Swin Transformer models (AUC: 0.87 vs. 0.97, P = 0.01; AUC: 0.87 vs. 0.92, P = 0.04). Adding CA125 did not improve the diagnostic performance of the models in distinguishing benign and malignant ovarian tumors.ConclusionThe deep learning model of TVUS can be used in ovarian cancer evaluation, and its diagnostic performance is comparable to that of expert assessment.

Endometrial Atypical Hyperplasia and Risk of Endometrial Cancer

Endometrial atypical hyperplasia (EAH) is a premalignant condition with a substantial risk of progression to endometrial cancer (EC), with the endometrioid subtype being the most common. EAH is characterized by abnormal endometrial gland proliferation and cellular atypia, often resulting from prolonged unopposed estrogen exposure. This review aims to explore the clinical significance of EAH, its risk of progression to EC, and the current approaches to management. The risk of EAH progressing to EC ranges from 20 to 50%, influenced by factors such as histopathology and genetic mutations including PTEN and KRAS. Key risk factors include obesity, polycystic ovary syndrome, and postmenopausal status. Abnormal uterine bleeding is a hallmark symptom of EAH and early-stage EC, necessitating diagnostic evaluation through endometrial biopsy and transvaginal ultrasonography. Therapeutic management strategies depend on patient risk and fertility considerations. Hormonal therapy, particularly progestins, is the mainstay for fertility preservation, while hysterectomy is preferred for higher-risk patients. Regular monitoring with biopsies is essential for those undergoing conservative treatment. Recent advancements in the management of EAH and EC have shifted towards incorporation of molecular diagnostics and targeted therapies, enabling better risk stratification and individualized care. Biomarkers and minimally invasive surgical techniques are emerging as promising approaches in improving outcomes for women with EAH. This review underscores the importance of early diagnosis and personalized management in preventing the progression of EAH to EC, highlighting current clinical practices and potential future developments in this field.

Detection of Ovarian Tumors Using TVUS Imaging and Segmentation Techniques

Ovarian most cancers remains a giant health subject due to its regularly asymptomatic development until superior stages, where treatment options are confined. Early detection is critical for enhancing affected person outcomes and survival costs. This observe proposes a comprehensive technique leveraging superior photograph processing techniques for the early detection and category of ovarian tumors the usage of trans vaginal ultrasound (TVUS) snap shots. The method starts with preprocessing steps which include median filtering to do away with noise artifacts inclusive of salt and pepper noise from ultrasound photos. Ultimately, picture enhancement techniques are applied to enhance contrast and intensity, observed through binary sample evaluation to signify texture features vital for tumor identification. Photo segmentation is performed the use of okay- manner clustering and gray degree Co-prevalence Matrix (GLCM) analysis to isolate and analyze areas of interest within the ovarian photos. A Convolutional Neural community (CNN) is then hired for correct classification of ovarian tumors as regular, benign, or malignant primarily based on the extracted functions. This approach not handiest enhances the diagnostic accuracy but also minimizes affected person publicity to ionizing radiation, making it appropriate for ordinary medical applications. The proposed methodology represents a considerable advancement within the discipline of ovarian cancer detection, presenting a non-invasive and green way to evaluate ovarian health and facilitate timely intervention. Destiny research directions include refining the set of rules’s performance with large datasets and exploring additional imaging modalities for complete ovarian fitness evaluation.

A Multicenter Cohort Study on DNA Methylation for Endometrial Cancer Detection in Cervical Scrapings.

The increasing incidence of endometrial cancer (EC) has highlighted the need for improved early detection methods. This study aimed to develop and validate a novel DNA methylation classifier, EMPap, for EC detection using cervical scrapings. EMPap incorporated the methylation status of BHLHE22 and CDO1, along with age and body mass index (BMI), into a logistic regression model to calculate the endometrial cancer methylation (EM) score for identifying EC in cervical scrapings. We enrolled 1297 patients with highly suspected EC, including 196 confirmed EC cases, and assessed the EMPap performance in detecting EC. EMPap demonstrated robust diagnostic accuracy, with an area under the curve of 0.93, sensitivity of 90.3%, and specificity of 89.3%. It effectively detected EC across various disease stages, grades, and histological subtypes, and consistently performed well across patient demographics and symptoms. EMPap correctly identified 87.5% of the type II ECs and 53.8% of premalignant lesions. Notably, compared with transvaginal ultrasonography (TVS) in patients with postmenopausal bleeding, EMPap exhibited superior sensitivity (100% vs. 82.0%) and specificity (85.2% vs. 38.5%). In asymptomatic postmenopausal women, EMPap maintained high sensitivity (89.5%) and negative predictive value (NPV) (98.3%). This study demonstrated the potential of EMPap as an effective tool for EC detection. Despite the limited sample size, EMPap showed promise for identifying type II EC and detecting over 50% of premalignant lesions. As a DNA methylation classifier, EMPap can reduce unnecessary uterine interventions and improve diagnosis and outcomes.

Risk-stratified CA125 screening integrating CA125 trajectories, trajectory-specific progression and transvaginal ultrasound for ovarian cancer

BackgroundsCancer antigen 125 (CA125) is widely used for screening ovarian cancer (OC), yet its effectiveness remains debated. Potential factors may include ineffective cut-off value for CA125 in screening, as well as a lack of consideration for CA125 trajectories and trajectory-specific progression.MethodsBased on data from multiple rounds of CA125 tests and transvaginal ultrasound (TVU) examinations conducted on 28,456 women in the PLCO Trial, time-dependent receiver-operating-characteristic curves (ROCs) and area-under-the-curves (tdAUCs) analyses were employed to identify the optimal CA125 cut-off values for OC screening. Participants were categorized into four CA125 trajectories: stable negative CA125 (CA125SN), loss of positive CA125 (CA125LP), stable positive CA125 (CA125SP), and gain of positive CA125 (CA125GP). The associations between different CA125 trajectories, trajectory-specific progression indicators, and OC risk were explored. The effectiveness of risk-stratified CA125 screening, incorporating CA125 trajectories, trajectory-specific progression, and TVU, was evaluated using hazard ratio and 95% confidence intervals [HR (95%CIs)], with adjustments for potential confounders.ResultsAfter a median follow-up of 14.8 years for OC incidence and 23.8 years for OC mortality, 250 OC cases and 218 OC deaths were identified. The tdAUC for 10-year OC incidence with CA125 was 0.663, with an optimal cut-off value of 13.00 U/ml. Trajectory analyses showed that both CA125SP and CA125GP were significantly associated with increased risks of OC incidence [HRs (95%CIs): 2.00(1.47–2.73) and 3.06(2.25–4.16)] and mortality [HRs (95%CIs):1.58(1.13–2.21) and 2.60(1.87–3.62)] compared to CA125SN. Trajectory-specific progression analyses identified relative velocity as the optimal progression indicators for both CA125SP and CA125GP (tdAUCs: 0.712 and 0.767), with optimal cut-off values of 9% and 32% per year, respectively. Positive progression was associated with significantly increased risks of OC incidence [HRs (95%CI): 7.26(4.00-13.17) and 3.83(1.96–7.51) CA125GP and CA125SP] and mortality [HRs (95%CI): 8.03(4.15–15.56) and 6.04(2.78–13.14)] compared to negative progression. Optimized risk-stratified CA125 screening, which integrated CA125 trajectories, trajectory-specific progression, and TVU, reduced missed OC by 3.6% and improved accuracy compared to traditional screening methods.ConclusionsIncorporating CA125 trajectories and trajectory-specific progression into screening protocols enhances the identification of the population at high-risk of OC. An optimized screening strategy, which includes these factors along with TVU, is recommended to improve the effectiveness of OC screening.

Routine Transvaginal Ultrasound at the Time of the Anatomy Scan: To Do or Not To Do?

There are no universal guidelines for transvaginal ultrasound (TVUS) at the time of the anatomy scan. TVUS can provide information on placental location and cervical length (CL) but may lead to more interventions. As a quality assurance initiative, a universal TVUS (UTVUS) protocol at the time of the anatomy scan was started at our institution. This study was conducted to assess whether there was a decrease in preterm birth (PTB), postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission once UTVUS was implemented. This was a retrospective cohort study performed on singleton gestations from February 2021 to January 2022. In the first 6 months of the study period, patients only had TVUS based on risk factors (pre group). In the second half of the study period, UTVUS was implemented at the time of the anatomy scan (post group). A total of 2,118 patients were included in the study. There were 1,037 patients in the pre group, of which 161 underwent TVUS based on high-risk factors (history of the cervical procedure, history of prior PTB, and placenta appearing low lying or cervix appearing short on abdominal ultrasound). The post group/UTVUS included 1,081 patients. Patients in the pre group had statistically significantly earlier gestational age at first TVUS (p < 0.0001), were less likely to have had a prior PTB <36 weeks (p = 0.03), and were more likely to have a history of cervical procedure (p = 0.0006) than patients in the post group. There was an increased use of vaginal progesterone in the UTVUS with 33 patients (as opposed to 10 patients in the pre group; p = 0.0007). The proportion of patients with PTB, PPH, or NICU admission did not significantly differ between the two groups even after adjusting for cofounders (p > 0.05). Our data show that UTVUS did not decrease the adverse pregnancy outcomes. In addition, the implementation of UTVUS adds more discomfort for a patient, more time to the patient's scan, and is an additional cost. Therefore, surveillance by abdominal ultrasound and adding TVUS based on risk factors may be a reasonable alternative. · UTVUS showed no difference between CLs.. · There is not sufficient evidence to conclude a difference between PTB or PPH in the two groups.. · There was significantly more placenta previa diagnosed in the post group, yet most resolved..

The impact of bowel preparation on MRI scans for confirming rectosigmoid endometriosis detected by transvaginal ultrasonography.

The study aims to assess the impact of bowel preparation on MRI scans in diagnosing rectosigmoid endometriosis (RSE) and to examine the level of agreement among investigators, including radiologists and clinicians with varying levels of MRI experience. Fifty-eight patients underwent MRI scans, with 34 showing RSE and 24 without involvement, according to TVUS as the reference standard. The scans were conducted both with and without a bowel preparatory protocol (BPP). The highest concordance was observed in the group 4, which included patients with RSE and BPP, with a Kappa value of 0.47-0.52. In contrast, for groups with MRI scans without the BPP, there was no consistency among the investigators (Kappa <0.20). The sensitivity, specificity, positive predictive value, and negative predictive value were 0.72, 0.47, 0.72, and 0.47 without BPP, and increased to 0.82, 0.74, 0.85, and 0.74, respectively, after BPP. The results reveal that the concordance between investigators in detecting RSE via MRI scan improves with the use of BPP. Additionally, the success rate of MRI and TVUS for detecting RSE can be comparable, but only if bowel preparatory techniques are utilized during MRI scans.

Embryonic and Fetal Heart Development Before 12 Weeks of Gestation.

To assess embryonic and fetal cardiac growth and development using transvaginal 2-dimensional sonography before 12 weeks of gestation. Transvaginal scans for first-trimester dating were performed for 131 normal fetuses at 8-11 + 6 weeks of gestation. The basal-apical length (BAL), transverse length (TL), cardiac circumference (ECC), embryonic cardiac area (ECA), global sphericity index (GSI), and cardio-thoracic area ratio (CTAR) were able to be obtained in 105 normal embryos and fetuses. Nomograms for several cardiac parameters including BAL, TL, ECC, ECA, GSI, and CTAR were constructed. BAL, TL, ECC, and ECA increased curvilinearly with advancing gestation (R2 = 0.97406, 0.980396, 0.978359, and 0.920705, respectively, P < .001). GSI (mean, 1.14; SD, 0.10) and CTAR (mean, 15.7%; SD, 3.3%) values were constant at 8-11 + 6 weeks of gestation. There were significant curvilinear correlations between BAL, TL, ECC, and ECA, and crown-rump length (CRL) (R2 = 0.975976, 0.983482, 0.980673, and 0.929936, respectively, P < .001). GSI and CTAR values were not changed with the increase of CRL during this period. Our results provide nomograms for several cardiac parameters which may improve the understanding of embryonic and fetal cardiac growth and development prior to 12 weeks of gestation.

Transvaginal sonographic screening of abnormal intra-amniotic structure around internal cervical os at 18-21+6 weeks of gestation.

To detect an abnormal intra-amniotic structure around the internal cervical os using transvaginal sonography at 18-21+6 weeks of gestation. In this cohort study, during a 12-month period from July 2022 to June 2023, 395 transvaginal scans were performed for second-trimester cervical-length screening in singleton pregnancies at 18-21+6 weeks of gestation. Nine abnormal intra-amniotic structures (AIAS), 87 low-lying placentas (LLP, second-trimester placenta previa or placental margin within 2 cm from internal cervical os), and 299 controls (not LLP and no abnormal finding around internal cervical os) were diagnosed. Sonographic features of AIAS and delivery outcomes in the three groups were compared. Sonographic features of nine AIAS cases were: two single bands, one single broad band, one multiple bands, one single tubular, and one multiple tubulars. Blood flow was noted in seven cases. Seven AIAS had disappeared by 26 weeks, one was resolved at 34 weeks, and one (vasa previa and parachute placenta) remained until delivery. Incidences of emergency cesarean section, abnormal placenta and umbilical cord, and abnormal deliveries in AIAS were significantly higher than those in LLP and control groups (P = 0.031). Blood losses during delivery in AIAS and LLP groups were significantly greater than in the control group (P = 0.004), but there was no significant difference in blood loss between AIAS and LLP groups. The incidence of AIAS around the internal cervical os in the second trimester was 2.28% (9/395 fetuses). Mid-second-trimester transvaginal sonographic screening for the detection of AIAS around the internal cervical os including vasa previa may be essential to reduce perinatal morbidity.

Comparing Cesarean Scar Defect Incidence After Locked and Unlocked Repair Methods Among Primiparous Patients: A Randomized Double-Blinded Trial.

To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques. We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis. All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04). We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques.

Concordance between Preoperative #ENZIANi Score and Postoperative #ENZIANs Score Classification-Why Do We Choose #ENZIAN and How Does It Impact the Future Classification Trend?

Objectives: To assess the concordance of the preoperative application of the #ENZIAN classification (#ENZIANi) with the postoperative result (#ENZIANs) using surgical findings as the reference standard. Methods: This retrospective study included 282 consecutive patients with deep endometriosis undergoing surgical treatment. Preoperative assessment with transvaginal sonography and magnetic resonance imaging was compared with postoperative assessment. Concordance and diagnostic test evaluation were calculated. Results: The highest concordance was observed in the F (abdominal wall endometriosis) with k Cohen of 0.837, following the values for pelvic locations, with 0.795 for T left, 0.791 for T right, 0.776 for F (adenomyosis), 0.766 for C (rectum), and 0.75 and 0.72 for O right k and O left, respectively. The highest sensitivity was demonstrated for the P compartment *(98%), T compartment (both sides 97%), and A, B, C (94-96%), corresponding with deep endometriosis. Conclusions: Preoperative assessment using TVS/TAS + MRI with the ENZIANi score correlates well with the ENZIANs postoperative score and demonstrates good concordance in the detection and localization of deep endometriosis, thereby minimizing false negative results and ensuring accurate preoperative staging. The ENZIAN classification is well-suited to surgeon needs and benefits from continuous development. Future improvements, such as adding the expanded C module, may be considered in the next edition.

7426 Tamoxifen-Induced Ovarian Hyperstimulation in a Pre-Menopausal Patient with Breast Cancer History: Spontaneous Resolution with Conservative Management

Abstract Disclosure: S. Gondi: None. M. Contento: None. A. Leiter: None. Background: Tamoxifen is a selective estrogen receptor modulator (SERM) that competitively binds to estrogen receptors (ER) on tumors and inhibits the effect of estrogen, which is used in the treatment and prevention of ER-positive breast cancer. Tamoxifen therapy has been reported to increase serum estrogens and cause ovarian hyperstimulation in premenopausal women, but knowledge on how to manage these conditions is limited. Clinical Case: A 36-year-old pre-menopausal female with history of malignant neoplasm of the right breast (ER positive) who completed neoadjuvant chemotherapy, lumpectomy, and radiation, on tamoxifen for seven years presented with new-onset oligomenorrhea. Laboratory testing done by the patient’s gynecologist revealed total estrogen 2,723 pg/mL (reference range [RR] 34-501), testosterone 132 ng/dL (RR 8-60), anti-Mullerian hormone 12.7 ng/mL (RR for age 0.66-8.75), ovulation-phase follicle stimulating hormone 11.5 mIU/mL (RR 4.7-21.5) and luteinizing hormone (LH) 63.3 mIU/mL (RR 14-95.6). Further workup revealed that ovarian tumor markers alpha-fetoprotein and serum human chorionic gonadotropin and other labs including dehydroepiandrosterone sulfate, progesterone 17-OH, lactate dehydrogenase, prolactin, and thyroid stimulating hormone were normal. Transvaginal ultrasound (TVUS) showed a new 2.8 x 1.9 x 2.3 cm complex left ovarian cyst, which, along with the elevated estrogen level, was concerning for ovarian hyperstimulation. Treatment with LH-releasing hormone (LHRH) agonists, surgical consultation, and discontinuation of tamoxifen were offered as potential management strategies, but the patient opted for observation and continued tamoxifen. Two months later, estradiol was 989 pg/mL (RR 85-498), and then three months later decreased to 152 pg/mL with repeat TVUS showing resolution of the left ovarian cyst. The patient’s oligomenorrhea resolved with resumption of regular menstrual cycles. Conclusion: While it is well-known that tamoxifen causes elevated serum estrogen levels and can lead to ovarian hyperstimulation, there is limited research on the management of these side effects. Treatment strategies in past cases have included oophorectomy or medical management with LHRH agonists or gonadotropin-RH agonists. However, this case demonstrates that a tamoxifen-induced ovarian cyst and high estrogen levels can resolve on its own with continued tamoxifen treatment. Conservative management with monitoring via imaging and repeat estrogen levels may be sufficient in management of pre-menopausal women with tamoxifen-induced ovarian hyperstimulation. Presentation: 6/1/2024

7696 Ovarian Steroid Cell Tumor Presenting as Non-classical Adrenal Hyperplasia

Abstract Disclosure: V. Reddy: None. A. Gowda: None. V. Vattipally: None. D. Kunduru: None. IntroductionSteroid cell tumors(SCT) of the ovary make up less than 0.1% of all ovarian tumors. The three subtypes are stromal luteoma, Leydig cell tumor, and steroid cell tumor-not otherwise specified (NOS) which is the commonest subtype. Androgen excess is seen in 75% tumors and presents with virilization. Tumors are usually benign but maybe malignant in 25-43% cases. Factors predicting malignancy include size &amp;gt;7 cm, mitotic activity, necrosis, hemorrhage, and nuclear atypia. Case ReportA 29 y/o Caucasian female presented with secondary amenorrhea and hirsutism. History includes DM2,hypothyroidism,depression and morbid obesity. She reported early pubarche by age 8,menarche at age 13 and developed hirsutism and irregular menstrual cycles from age 15. No workup due to poor follow up until she saw PCP at age 21.She was diagnosed with PCOS and started on Metformin. Eventually referred to endocrinology at age 27, since amenorrhea and hirsutism persisted. On exam she had significant male pattern hair loss and hirsutism over face and body.She reported three first trimester miscarriages.Labs showed testosterone 370 ng/dl, 17 OHP 808 ng/dl, DHEAS 47 ng/dl, Estradiol 117 pg/ml, FSH 2.2 mIU/ml, LH 2.5 mIU/ml, androstenedione 319 ng/dl.Transvaginal US was unremarkable. She was diagnosed with non classical adrenal hyperplasia (NCAH) and started on treatment with prednisone 5 mg daily, drospirenone and spironolactone 100 mg daily.3 months later, labs showed 50% lowering of testosterone to 199 ng/dl and 17 OHP to 407 ng/dl.There was continued biochemical and clinical improvement at the next visit with 17 OHP 73 ng/dl and testosterone 55 ng/dl. Labs done 21 months after initial presentation, showed sudden dramatic rise in 17 OHP to 1148 ng/dl and testosterone to 639 ng/dl. Normal AFP, HCG, CEA, CA125, CA19-9, Inhibin A. CT showed 10.4 cm solid right ovarian mass and underwent right salpingo-oophorectomy. Pathology showed steroid cell tumor, NOS. Labs 1 month postoperatively showed complete normalization of testosterone to &amp;lt;3 ng/dl, 17 OHP to 11 ng/dl and DHEAS 0.66 ng/dl. Steroid therapy was tapered and discontinued. DiscussionWe present the case of a patient with ovarian SCT presenting as NCAH.SCTs are very rare accounting for only 0.1% of all ovarian tumors. Since they commonly secrete androgens, they present similarly to CAH or PCOS and may rarely even co-exist with CAH. Differentiating between NCAH and SCT is difficult especially when there is initial response to steroid therapy and imaging is unremarkable as with our patient. It is important to consider SCT in patients with hyperandrogenism even in the setting of elevated 17 OHP levels. Care should be taken to follow up both clinical and metabolic metrics closely and investigate if any change is noticed. Early diagnosis can prevent irreversible symptoms of hyperandrogenism. Presentation: 6/1/2024

7696 Ovarian Steroid Cell Tumor Presenting As Non-classical Adrenal Hyperplasia

Abstract Disclosure: V. Reddy: None. A. Gowda: None. V. Vattipally: None. D. Kunduru: None. Ovarian Steroid Cell Tumor Presenting as Non-classical Adrenal Hyperplasia IntroductionSteroid cell tumors(SCT) of the ovary make up less than 0.1% of all ovarian tumors. The three subtypes are stromal luteoma, Leydig cell tumor, and steroid cell tumor-not otherwise specified (NOS) which is the commonest subtype. Androgen excess is seen in 75% tumors and presents with virilization. Tumors are usually benign but maybe malignant in 25-43% cases. Factors predicting malignancy include size &amp;gt;7 cm, mitotic activity, necrosis, hemorrhage, and nuclear atypia. Case ReportA 29 y/o Caucasian female presented with secondary amenorrhea and hirsutism. History includes DM2,hypothyroidism,depression and morbid obesity. She reported early pubarche by age 8,menarche at age 13 and developed hirsutism and irregular menstrual cycles from age 15. No workup due to poor follow up until she saw PCP at age 21.She was diagnosed with PCOS and started on Metformin. Eventually referred to endocrinology at age 27, since amenorrhea and hirsutism persisted. On exam she had significant male pattern hair loss and hirsutism over face and body.She reported three first trimester miscarriages.Labs showed testosterone 370 ng/dl, 17 OHP 808 ng/dl, DHEAS 47 ng/dl, Estradiol 117 pg/ml, FSH 2.2 mIU/ml, LH 2.5 mIU/ml, androstenedione 319 ng/dl.Transvaginal US was unremarkable. She was diagnosed with non classical adrenal hyperplasia (NCAH) and started on treatment with prednisone 5 mg daily, drospirenone and spironolactone 100 mg daily.3 months later, labs showed 50% lowering of testosterone to 199 ng/dl and 17 OHP to 407 ng/dl.There was continued biochemical and clinical improvement at the next visit with 17 OHP 73 ng/dl and testosterone 55 ng/dl. Labs done 21 months after initial presentation, showed sudden dramatic rise in 17 OHP to 1148 ng/dl and testosterone to 639 ng/dl. Normal AFP, HCG, CEA, CA125, CA19-9, Inhibin A. CT showed 10.4 cm solid right ovarian mass and underwent right salpingo-oophorectomy. Pathology showed steroid cell tumor, NOS. Labs 1 month postoperatively showed complete normalization of testosterone to &amp;lt;3 ng/dl, 17 OHP to 11 ng/dl and DHEAS 0.66 ng/dl. Steroid therapy was tapered and discontinued. DiscussionWe present the case of a patient with ovarian SCT presenting as NCAH.SCTs are very rare accounting for only 0.1% of all ovarian tumors. Since they commonly secrete androgens, they present similarly to CAH or PCOS and may rarely even co-exist with CAH. Differentiating between NCAH and SCT is difficult especially when there is initial response to steroid therapy and imaging is unremarkable as with our patient. It is important to consider SCT in patients with hyperandrogenism even in the setting of elevated 17 OHP levels. Care should be taken to follow up both clinical and metabolic metrics closely and investigate if any change is noticed. Early diagnosis can prevent irreversible symptoms of hyperandrogenism. Presentation: 6/1/2024

A comparative study between modified Bishop score and transvaginal sonography to predict successful induction of labor

ABSTRACT Background: Modified Bishop score (MBS) and cervical length determination by transvaginal sonography (TVS) are the two methods for predicting successful vaginal delivery based on pre-induction favourability of the cervix. Aims and Objectives: This study compared both methods for predicting successful vaginal delivery. The primary objective was to compare the predictive value of MBS and TVS in predicting successful induction of labor. The secondary objective was to obtain the cut-off score of MBS and TVS for successful induction of labor. Methods: A prospective study was done involving 100 pregnant women admitted for induction of labor. TVS was done to measure the cervical length before induction of labor. MBS was also calculated for all the patients. Labor was induced with prostaglandins. Labor induction was considered successful if there was an onset of uterine contractions and cervical dilatation within 24 h of induction. Results: For successful induction of labor, the cutoff of cervical length by TVS and MBS was 2.5 cm and 6, respectively. Cervical length assessment by TVS performed better than the MBS (sensitivity 61.8% vs. 28.9%, Specificity 95.8% vs. 100%). Conclusion: MBS and cervical length measurement by sonography both are good predictors of successful induction of labor. Cervical length measurement by TVS provides a better prediction of the likelihood of vaginal delivery.

Performance of transvaginal ultrasound in evaluation of endometrioid versus non-endometrioid cancers.

401 Background: Measurement of endometrial thickness by transvaginal ultrasound (TVUS) is the standard of care for evaluation of patients with postmenopausal bleeding, the most common presenting symptom of endometrial cancer. However, the sensitivity of TVUS has not been clearly established in the setting of non-endometrioid histology, which is more aggressive and does not arise from endometrial hyperplasia. This study aims to evaluate the endometrial stripe (EMS) detection rate and sensitivity of TVUS in non-endometrioid compared to endometrioid endometrial cancers. Methods: In this retrospective cohort study, we included endometrial cancer cases diagnosed at a single institution from 01/01/2019 to 04/01/2024 who were enrolled in the Discovery and Evaluation of Testing for Endometrial Cancer in Tampons (DETECT) study who had TVUS during their initial clinical evaluation. Demographic characteristics and results from TVUS reports were obtained from the electronic medical record. Endometrial stripe thickness of less than 5mm is considered a negative result, whereas endometrial thickness of 5mm or greater (5mm+) is considered positive. The primary outcomes were the ability to measure EMS and the sensitivity of TVUS at a cutoff of 5mm+ for endometrial cancer detection, overall and by race and histology. We assessed differences using chi-squared tests. Results: Of the 349 patients included in our analysis, 247 (71%) had endometrioid histology, and 102 (21%) had non-endometrioid histology. There were 98 (28%) Black patients (49% non-endometrioid) and 242 (69%) White patients (22% non-endometrioid). The EMS was adequately measured in 98% of patients with endometrioid histology compared to 91% of patients with non-endometrioid histology (p=0.001). When stratified by race, EMS was visualized in 100% of Black patients with endometrioid histology but 89% of Black patients with non-endometrioid histology (p=0.02). This difference was seen but not significant in White patients with 98% measurable endometrial stripes in endometrioid cancer and 92% in non-endometrioid cancer (p=0.05). The ability to measure EMS was not different when compared by race alone. The sensitivity of TVUS (EMS of 5mm+) was higher in patients with endometrioid histology (99%) than patients with non-endometrioid histology (94%; p=0.03). Conclusions: In one of the largest and most diverse studies of TVUS performance in endometrial cancer patients to date, TVUS was more effective at visualizing the EMS and had higher sensitivity in patients with endometrioid compared to non-endometrioid endometrial cancers. While performance did not vary by race, the prevalence of non-endometrioid cancers was twice as high among Black compared to White patients. Our findings suggest that TVUS may be less accurate for diagnosing non-endometrioid endometrial cancer, which disproportionately affects Black women.

Correlation between ultrasound features and histopathological finding in cases of adenomyosis: a cross-sectional study

Background Adenomyosis is a gynecological disorder characterized by hypertrophy and hyperplasia of the surrounding myometrium and the presence of ectopic endometrial glands and stroma inside the myometrium. Aims To compare the accuracy of preoperative ultrasound (US) features with the histopathological results for the diagnosis of adenomyosis, and to determine its sensitivity for diagnosis. Patients and methods A total of 100 perimenopausal and postmenopausal patients (aged 40 to 60 years old) presented with abnormal uterine bleeding. Every patient underwent a thorough history taking, general examination, and pelvic examination. The selected patients were subjected to all laboratory investigations, abdominal and vaginal US, and abdominal or vaginal hysterectomy followed by histopathological examination. Results 45 (45%) patients had adenomyosis by transvaginal US and 52 (52%) patients had adenomyosis by histopathology with a P value of 0.105 which means that there is no significant difference between transvaginal US and histopathology in the diagnosis of adenomyosis. Transvaginal US had an 89.0% diagnostic accuracy for adenomyosis, with 82.7% sensitivity, 95.8% specificity, 95.6% positive predictive value, and 83.6% negative predictive value. Conclusion Transvaginal US is an important diagnostic technique for adenomyosis, and there is no significant difference between ultrasound and histology in the diagnosis of the condition.

Comparison of Diagnostic Accuracy of Saline Infusion Sonohysterography, Transvaginal Sonography and Hysteroscopy

Comparison of Diagnostic Accuracy of Saline Infusion Sonohysterography, Transvaginal Sonography and Hysteroscopy