Ultrasound Criteria Research Articles

Adenomyosis and obstetric complications: A retrospective case–control study

ObjectiveAdenomyosis is a uterine pathology affecting an increasing number of women of childbearing age. Its diagnosis is based upon histology or imaging [ultrasound or magnetic resonance imaging (MRI)]. Several studies have investigated the impact of adenomyosis on obstetric complications, with its diagnosis based on clinical symptoms, ultrasound or composite criteria. The aim of this study was to identify potential obstetric complications related to adenomyosis in women with an MRI-confirmed diagnosis. MethodsA single centre retrospective case–control study was undertaken in pregnant patients with an MRI-confirmed diagnosis of adenomyosis between January 2013 and December 2017 at the University Hospitals of Strasbourg. Controls were matched in a 4:1 ratio for age, parity and body mass index. Multivariate analysis was performed to identify obstetric complications. ResultsIn total, 291 women with an MRI-confirmed diagnosis of adenomyosis were identified during the study period. Of these, 89 patients achieved pregnancy after 24 weeks of gestation. The mean age of patients was 30.8 years. The adenomyosis group and the control group were comparable for matching criteria. Adenomyosis was found to be associated with increased risk of caesarean section [odds ratio (OR) 1.1, 95 % confidence interval (CI) 1.0–1.2; p = 0.03], intrauterine growth restriction (OR 1.3, 95 % CI 1.1–1.4; p < 0.001), postpartum haemorrhage (OR 1.2, 95 % CI 1.1– 1.4; p < 0.01), pre-eclampsia (OR 1.3, 95 % CI 1.0–1.6; p = 0.004) and previous spontaneous miscarriage (OR 2.09, 95 % CI 1.36–3.33; p < 0.001). Premature rupture of membranes, preterm delivery, severe intrauterine growth restriction and the risk of placenta praevia were not significantly higher in the adenomyosis group compared with the control group on multivariate analysis. ConclusionThis study demonstrates increased risk of several obstetric complications (caesarean section, intrauterine growth restriction, postpartum haemorrhage, pre-eclampsia, history of spontaneous miscarriage) in women with adenomyosis. To the authors’ knowledge, this is the first study to use MRI as the sole criterion for diagnosis. These results could be complemented by larger-scale prospective studies in order to manage these patients more effectively during pregnancy.

Adenomyosis: A guide to ultrasonographic evaluation

Adenomyosis is a pathology that compromises the fertility and quality of life of women of reproductive age, with ultrasound being the most important tool for diagnosis, timely management.prognosis evaluation, and disease evolution. Hence the importance of knowing the ultrasonographic criteria of this disease that allows us to make an early diagnosis for timely management.

Clinical, laboratory and ultrasonographic criteria for reveaing inflammation of the appendix and its regression in children

Introduction. Because of the numerous studies on a possible regression of inflammation in the cecum appendix, the question of finding reliable criteria for preoperative verification of inflammation and of assessing its dynamics in children is relevant.Material and methods. In January 2017 – December 2021, case-histories of 92 children aged from 3 to 18 years – (Me (age median) = 12; Q1 (lower quartile) = 9; Q2 (upper quartile) = 14.5 – were analyzed in the Yaroslavl Children's Clinical Hospital. The researchers assessed diagnostic and management algorithms. All children had a high risk of appendicitis (PAS (Pediatrics appendicitis score) ≥ 6 points) because of changes in the appendix and findings of ultrasound examination, but due to the symptoms relief, no surgical interventions were performed.Results. 78 (84.8%) children were prescribed antibacterial therapy. The median duration of symptom regression was 2 days (Q1 = 1 day; Q2 =4 days). On days 5–8 (Q1–Q2) (Me = 6 days), relief of all symptoms of the disease was recorded. The average diameter dimensions of the vermiform process, by ultrasound findings at the initial examination, were 8.6 ± 1.47 (95% CI 8.31–8.92), wall thickness – 3.2 ± 0.39 (95% CI 3.12–3.28). After the symptom relief , these indicators were 6.3 ± 1.29 (95% CI 5.95–6.58) and 2.0 ± 0.63 (95% CI 1.18–1.88), respectively. The decrease in size was statistically significant (p 0.001), signs regressed in parallel (r = 0.63; p 0.0001).95% CI lower limit of ultrasonographic parameters at the initial examination exceeded the threshold values indicating inflammatory changes (8 mm and 2.7 mm, respectively). After regression of the disease symptoms, 95% CI upper limit returned to the normal state.Conclusion. The presented clinical observations may be considered as cases of appendix inflammation with regression. The selected clinical and ultrasonographic criteria can be used both for verifying inflammation and for assessing the regression of inflammatory process.

Ultrasound predictors of difficult airways

The objectives was to evaluate the effectiveness of diagnosing predictors of difficult airways with ultrasound.Materials and methods. 70 patients were examined. Before the surgery, we assessed the risk of difficult intubation by the LEMON scale and ultrasound methods using the following criteria: tongue thickness, vertical distance from the highest point of the hyoid bone to the mandible, neck soft tissue thickness, and epiglottis thickness. The diagnostic ability of the LEMON scale and ultrasound diagnosis of difficult laryngoscopy was assessed by determining the sensitivity, specificity and cut-off point using the ROC-AUC analysis. Results. The analysis of the obtained data showed a higher sensitivity of ultrasound criteria for difficult airways compared with the LEMON scale. Conclusion. Ultrasound diagnostic methods are effective for assessing difficult laryngoscopy. Ultrasound diagnostic criteria for difficult laryngoscopy are more sensitive compared to the LEMON scale. Diagnostic criteria for difficult laryngoscopy are: tongue thickness &gt; 61 mm, vertical distance from the highest point of the hyoid bone to the mandible &gt; 12.85 mm, neck soft tissue thickness &gt; 5.15 mm, and epiglottis thickness &gt; 2.85 mm.

Update on Ultrasound Diagnostic Criteria and New Ultrasound Severity and Activity Scorings of Hidradenitis Suppurativa: Modified SOS-HS and US-HSA.

Hidradenitis suppurativa (HS) is a devasting autoimmune cutaneous disease that affects the hair follicles and can clinically present palpable nodules, abscesses, and tunnels (fistulas), usually in the intertriginous regions. It has been widely reported that color Doppler ultrasound can detect subclinical abnormalities and stage the severity of the disease more accurately. Nevertheless, the ultrasound diagnostic criteria were reported with 15 MHz 10 years ago, and now it is possible to detect early anatomical abnormalities in HS using 70 MHz. Thus, an update of the ultrasonographic diagnostic criteria is needed. The most widely used sonographic staging of severity of HS (SOS-HS) includes the number of affected regions, besides counting the number of key lesions like pseudocysts, fluid collections, and tunnels; however, the total number of affected regions may fit better in an activity scoring. Furthermore, a high number of tunnels or communicated tunnels can complicate the management and may indicate an even more urgent treatment, which should be considered in the severity classification. To date, no hidradenitis scoring of activity has been reported in the literature, making it difficult to track the degree of inflammation under treatment objectively. Therefore, two new scorings are proposed. The first is an updated sonographic scoring of severity called modified SOS-HS (mSOS-HS), and the second is an activity ultrasound scoring of HS called US-HSA. Both staging systems can provide better anatomical information for discriminating the categories and, therefore, selecting more appropriate treatments and supporting research and clinical trials by giving more objective anatomical tools in real-world settings.

Comparative Study between the use of Ultrasonic Criteria of Weaning versus the Conventional Criteria of Weaning in Post-traumatic Acute Respiratory Distress Syndrome Patients who were Ventilated for a long Time

Introduction: Failure to wean and re-ventilation is a major problem in the intensive care unit (ICU). Thirty percent of ventilated patients experience weaning failure and are re-ventilated, especially patients who are ventilated for long durations. Ultrasound provides reliable data on lung parenchyma inflammation resolution and diaphragmatic contraction power, thereby assisting in deciding if the patient should be weaned and consequently reducing the percentage of weaning failure. Aim of the Work: To compare the ultrasonic criteria for weaning with the conventional criteria of weaning in patients with post-traumatic acute respiratory distress syndrome (ARDS) who were ventilated for a long time and assess their effect on the ICU stay duration. Materials and Methods: This was a prospective, double-blind study performed on 200 participants who were weaned from the ventilator after being ventilated for &gt; 1 week due to respiratory failure. Respiratory failure in the patients was either due to severe lung contusion or post-traumatic ARDS. The patients were randomly and equally allocated in two groups of 100 patients each. Groups A and B comprised patients who were weaned from the ventilator using the conventional and ultrasound weaning criteria, respectively. All patients weaned from both groups were followed up for 6 days for signs of weaning failure and post-extubation respiratory failure. The number of patients who were re-ventilated and discharged from the ICU was recorded and compared in both groups. Results: Group A had a significantly higher number of patients who experienced deterioration in consciousness, tachypnea, desaturation, tachycardia, and hypertension in addition to showing chest X-ray infiltration and being re-ventilated than group B. Moreover, group A patients had a significantly longer ICU duration than group B patients. Conclusion: The use of the ultrasonic criteria for weaning reduces re-intubation, re-ventilation, and post-extubation respiratory failure. Additionally, its use also decreases the ICU stay in patients with post-traumatic ARDS who were ventilated for a long time.

ЭКТОПИЧЕСКАЯ БЕРЕМЕННОСТЬ В РУБЦЕ НА МАТКЕ ПОСЛЕ КЕСАРЕВА СЕЧЕНИЯ

The localization of the ovum in the postoperative scar on the uterus is considered as a variant of ec-topic pregnancy with a high risk of maternal morbidity and mortality. A clinical case of diagnosis and treatment of a patient with ectopic pregnancy in the uterine scar after caesarean section, complicated by uterine bleeding, is described in the article. The clinical features and ultrasound diagnostic criteria are provided. Justification of the treatment tactics with hysterectomy is provided, taking into account the status of the patient, changes in the postoperative uterine scar, concomitant gynecological patholo-gy and willingness of the patient to accomplish the childbearing function.

Preoperative prediction of microvascular invasion in hepatocellular carcinoma using ultrasound features including elasticity.

Microvascular invasion (MVI) is an important predictor of poor prognosis in patients with hepatocellular carcinoma (HCC). Accurate preoperative prediction of MVI in HCC would provide useful information to guide the choice of therapeutic strategy. Shear wave elastography (SWE) plays an important role in hepatic imaging, but its value in the preoperative prediction of MVI in HCC has not yet been proven. To explore the value of conventional ultrasound features and SWE in the preoperative prediction of MVI in HCC. Patients with a postoperative pathological diagnosis of HCC and a definite diagnosis of MVI were enrolled in this study. Conventional ultrasound features and SWE features such as maximal elasticity (Emax) of HCCs and Emax of the periphery of HCCs were acquired before surgery. These features were compared between MVI-positive HCCs and MVI-negative HCCs and between mild MVI HCCs and severe MVI HCCs. This study included 86 MVI-negative HCCs and 102 MVI-positive HCCs, including 54 with mild MVI and 48 with severe MVI. Maximal tumor diameters, surrounding liver tissue, color Doppler flow, Emax of HCCs, and Emax of the periphery of HCCs were significantly different between MVI-positive HCCs and MVI-negative HCCs. In addition, Emax of the periphery of HCCs was significantly different between mild MVI HCCs and severe MVI HCCs. Higher Emax of the periphery of HCCs and larger maximal diameters were independent risk factors for MVI, with odds ratios of 2.820 and 1.021, respectively. HCC size and stiffness of the periphery of HCC are useful ultrasound criteria for predicting positive MVI. Preoperative ultrasound and SWE can provide useful information for the prediction of MVI in HCCs.

Presence of Adenomyosis Impairs Clinical Outcomes in Women Undergoing Frozen Embryo Transfer: A Retrospective Cohort Study.

(1) Background: The presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) was investigated in several studies and demonstrated a potentially detrimental effect on live birth rates following IVF, most of them were small studies in which the adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. (2) Methods: 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Among them, 140 women had a confirmed diagnosis of adenomyosis based on the MUSA criteria. (3) Results: Adenomyosis patients were more likely to proceed with deferred FET compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 months) (p < 0.001). The presence of adenomyosis significantly decreased the clinical pregnancy rates (aOR 0.62, 95% CI: 0.39-0.98, p = 0.040) and live birth rates (aOR 0.46, 95% CI: 0.27-0.75, p = 0.003) and significantly increased the miscarriage rates (aOR 2.13, 95% CI: 0.98-4.37, p = 0.045). Multivariable logistic regression adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis demonstrated that the use of the GnRH agonist protocol did not decrease or increase the miscarriage rate, clinical pregnancy rate, or live birth rate. (4) Conclusions: The presence of adenomyosis had a significant negative impact on the clinical outcomes of patients undergoing FET and was associated with higher miscarriage, lower clinical pregnancy, and live birth rates. GnRH agonist pre-treatment does not appear to improve clinical outcomes.

Pre-Operative Evaluation of Color Doppler Ultrasonography to Predict Malignancy in Ovarian Masses at Ain-Shams University

Background Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries. This cancer is characterized by high malignancy, difficult early detection, low survival rate, and high fatality rate. Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass. Aim of the Work The aim of the study is to determine predictive value of pre-operative resistance index (RI) of color Doppler of ovarian vessels in identifying potential ovarian malignancy at Ain Shams maternity hospital between May 2015 and May 2020. Methods this retrospective observational study, was done on total 379 patients who underwent laparotomy for adnexal masses at Ain Shams University hospitals over five years period between May 2015 and May 2020 with inclusion and exclusion criteria. Medical records of the study population were revised to assess demographic data, ultrasound criteria and histopathological result Results Thin wall and clear content are negatively correlated with ovarian malignancy and these correlators statistically significant. While presence of papillae and septation are positively correlated with ovarian malignancy and these findings were statistically highly significant. Masses proved to be ovarian malignancy were mostly unilateral, more than 5 cm size, thick wall, with turbid content, solid consistency, unilocular with papillae and septation. RI in our study was lower in malignant lesions ranging between (0.22–0.60) and the Mean±SD of resistance index values in the ovarian cancer (0.48±0.07). Resistance index at cut off value ≤0.54 had high specificity and negative predictive value but moderate sensitivity and positive predictive value in diagnosing ovarian malignancy. Conclusion As evident from the current study, thick wall, turbid content, solid consistency, papillae and septations were significantly most frequent in ovarian cancer. Resistance index was significantly highest in ovarian malignancy. In current study RI was lower in malignant lesions. From the results of current study we can conclude that the pre-operative resistance index (RI) of color Doppler of ovarian vessels had significant high diagnostic performance in predicting ovarian cancer. Resistance index at cut off value≤0.54 in diagnosis of ovarian cancer has sensitivity (85.2%), specificity (91.6%), accuracy (90.2%), positive predictive value (73.4%) and negative predictive value (95.8%).

Characterization of breast lumps locations using high-frequency ultrasound: Correlation between Doppler vascularity and BI-RADS

BackgroundA breast lump is a major concern, and it is critical for every clinician to diagnose and manage patients with breast lumps. High-frequency ultrasound (U/S) is the first imaging technique for evaluating a breast lump and classifying it as benign or malignant based on many ultrasound criteria; Breast imaging-reporting and data system (BI-RADS) and Doppler vascularity also contribute important information for identification. The main aim of the current study was to characterize breast lesions using high-frequency ultrasound with grayscale and Doppler as well as correlate Doppler vascularity and BI-RADS features. Materials and methodsA retrospective study was conducted in Madinah–Saudi Arabia at Al-Madinah General Hospital from November 2021 to March 2022. The sampling included 124 females' breast ultrasound reports and was analyzed (by radiologist) to demonstrate the features of breast masses shown through ultrasound. ResultsMost study samples were aged 18–38 years (66.1%). The most common complaints were lump and pain (31.45% and 9.68%, respectively). About (31.3%) and most of lumps located in upper outer quadrant UOQ, (42.2%), hypoechoic and anechoic (71.1%, 34.9%, respectively), well-defined (45.2%), oval (68.6%) and a vascular (85.5%). Most lumps had a BIRADS feature of 0–3, and there was no significant correlation between female age and complaints (p-value> 0.05). ConclusionThe study concluded among the study sample most breast lesions were scattered and located in UOQ, and most of them were hypoechoic and anechoic, well-defined, and a vascular, most of them have BI-RADs characteristics 0–3, there is a significant correlation between breast lumps’ BI-RADS features and Doppler vascularity.

The Role of "Critical" Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules.

Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5-15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, "taller than wide" shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93-0.98); sensitivity 0.70 IC95% (0.59-0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80-0.94); specificity 0.75 CI95% (0.72-0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.

Diagnostic accuracy of B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography in differentiation between benign and malignant lymphadenopathy

BackgroundConventional ultrasound is used as an imaging modality for differentiation between benign and malignant lymph nodes, but with different accuracy, sensitivity, and specificity between different studies. A biopsy is the gold standard diagnosis modality but has a drawback due to its invasive nature. In general, metastatic lymph nodes present with a higher stiffness than benign lymph nodes, so ultrasound elastography could be used as an imaging modality for lymphadenopathy differentiation based on its ability to assess tissue stiffness. However, more studies should be done to assess its accuracy. Therefore, we aimed to assess the accuracy of B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria in differentiation between benign from malignant lymph nodes.MethodsA cross-sectional study included 60 patients with lymphadenopathy. B-mode, Doppler ultrasound, strain elastography, and 2D shear wave elastography criteria were assessed for accuracy, sensitivity, and specificity compared to the final histopathological diagnosis, whether by core biopsy, fine needle aspiration, or excision biopsy.ResultsWe assessed 60 patients in our study (20 benign and 40 malignant). Of these ultrasound criteria that achieved statistical significance, the highest accuracy was for elasticity ratio 88.9%, followed by strain ratio 83.8%. Also, the highest specificity was for an elasticity ratio of 80%, followed by strain score and strain ratio of 75% and 70%, respectively. Cortical asymmetry achieved the highest sensitivity, 100%, followed by strain ratio and elasticity ratio, with a sensitivity of 90% and 87.5%, respectively. However, cortical asymmetry had an extremely low specificity of 25%.ConclusionsUltrasound elastography criteria achieved higher accuracy compared to conventional ultrasound. So it can be used as an effective imaging modality to differentiate between benign and malignant lymph nodes.

Current Diagnostic Possibilities for the Initial Forms of External Endometriosis

Background. Routine use of ultrasound methods does not always allow detecting endometriosis in the early stages. It is necessary to develop more accurate criteria for the diagnosis of endometriosis in its initial stages of development. Objective: to assess ultrasound and biological markers of endometriosis “small” forms of different localization in infertile women.Material and methods. Ultrasound examination of 208 infertile patients with initial stages of external endometriosis (1–15 points by revised American Fertility Society (rAFS) classificatoon) was performed (main group). The control group consisted of 195 healthy women of childbearing age. To verify the diagnosis, it is suggested to use a panel of biomarkers, including interleukins (IL) 1β and 6, CA125, HE4 as well as the ROMA (Risk of Ovarian Malignancy Algorithm) index in the dynamics of the menstrual cycle.Results. On ultrasound scans, 56 (94.9%) patients had small one- and two-sided ovarian cysts corresponding to endometriosis stage 1–2 (rAFS), and in 3 (5.4%) of them, the ultrasound result was questionable. Detectability during the initial ultrasound examination in the Douglas space was 76.9%, in the rest of cases the ultrasound picture was doubtful. Peritoneal endometriosis was detected only in 5 patients. In the remaining cases (88.9%), additional studies were necessary, including surgical (laparoscopy). The average content of CA125 in the main group on days 3–5 of the menstrual cycle was 42.6 (2.1) U/ml, on days 21–23 – 39.6(2.2) U/ml (p=0.32); in the control group, 5.1 (0.4) and 4.8 (0.7) U/ml, respectively (p = 0.71). The increase in CA125 in the main group was almost 8 times higher than in the control group, however, according to the indicators of HE4 and the ROMA index, statistically significant differences in the groups were not obtained. In the dynamics of the menstrual cycle, the content of ILs in the main group significantly decreased by days 21–23 of the cycle, while the content of CA125 and HE4 remained practically unchanged. Such sharp fluctuations of the considered biomarkers were not detected in the control group. However, even on days 21–23 of the cycle, the average content of ILs and CA125 in women of the main group remained statistically significantly higher than in the control group.Conclusion. In infertile women with dubious ultrasound criteria of external endometriosis, the use of IL1β and IL-6, which stimulate the immune inflammatory response, as well as tumor markers CA125, HE4 and ROMA index allows to differentiate the disease in the initial stages.

Diagnostic effectiveness of intraoperative express histological examination as a tool to take decisions on the extent of surgery for papillary thyroid cancer

Background. In case of the screening use of high-resolution ultrasound, the level of detecting thyroid neoplasms is about 25 % in the population. Ultrasound criteria are not enough to detect carcinoma. The following methods are used for the differential diagnosis of malignant thyroid neoplasms: ultrasound scans, computed tomography, fine-needle aspiration (FNA) biopsy, intraoperative express histological and histopathological examination. Some authors consider FNA to be the standard method for primary morphological diagnosis of thyroid nodes. It is not always possible to conduct FNA safely. Also, FNA cannot be a method of 100% morphological identification of a primary tumor. In such cases, the extent of the surgery will depend on the data obtained from the intraoperative express histological examination. Analysis of the diagnostic effectiveness of the express histological examination will help to take a decision on the need for it when choosing the extent of a surgery on the thyroid gland. Aim of the study: to evaluate the diagnostic efficiency of the intraoperative express histological method in the detection of papillary thyroid cancer on solitary nodes (Bethesda IV, V) and metastases of papillary thyroid cancer during surgery. Materials and methods. The results of intraoperative express histological and pathohistological examinations performed at the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues from 2018 to 2021 were analyzed. The sample included materials of surgeries on the thyroid gland in case of papillary cancer T1ab-2N0–1 and solitary nodes (Bethesda IV and Bethesda V) according to data obtained using FNA. The sample size in the study of regional metastasis included 220 examinations, 845 examinations in the “gray zone” (Bethesda IV — 465, Bethesda V — 380). Cases of discrepancy between the results of intraoperative express histological and final histopathological examinations were considered. The data was processed using the EZR v. 3.4.1 statistical analysis program. Results. The sensitivity of the express histological examination in case of detecting metastases of thyroid cancer is 72.2 % with the method specificity of 99.9 %. The diagnostic efficiency in detecting metastases of thyroid cancer is 89.1 %. When the express histological examination is used for Bethesda IV nodes, the sensitivity of the method is 8 % with a specificity of almost 100 %. The diagnostic efficiency of the express histological examination is even higher in case of Bethesda V: sensitivity of 47 % with the method specificity of almost 100 %. The values obtained correlate with international data. This testifies to the need for further improvement of the of intraoperative diagnosis method. Conclusions. The diagnostic efficiency of the intraoperative express histological examination for detecting metastases of papillary thyroid cancer in the selected group is 89.1 % with sensitivity of 72.2 % and specificity of 99.9 %. The diagnostic efficiency of intraoperative express histological examination for verification of thyroid cancer in case of Bethesda IV nodes is 63.9 % with sensitivity of 8.2 % and specificity of 99.6 %. The diagnostic efficiency of intraoperative express histological examination for verification of thyroid cancer in Bethesda V nodes is 63.4 % with sensitivity of 47.3 % and specificity of 99.2 %. The intraoperative express histological examination method makes it possible to take decisions on surgical tactics during surgery within the determined limits, so we believe it reasonable to further use and improve it.

Diagnosis of Mild-to-moderate Idiopathic Median Neuropathy at the Carpal Tunnel Based on Signs and Symptoms is Discordant From Diagnosis Based on Electrodiagnostic Studies and Ultrasound.

Although idiopathic median neuropathy at the carpal tunnel (IMNCT) is objective and verifiable, distinction of normal and abnormal nerves is imprecise and probabilistic. The associated symptoms and signs (carpal tunnel syndrome [CTS]) vary, particularly for nonsevere (mild and moderate) median neuropathy. Discordance between diagnosis of mild or moderate median neuropathy at the carpal tunnel using symptoms and signs and diagnosis based on objective tests is a measure of the potential for overdiagnosis and overtreatment. What is the difference in the estimated prevalence of mild-to-moderate IMNCT using nonsevere signs and symptoms compared with the estimated prevalence using electrodiagnostic studies (EDS) and ultrasound (US)? We used data from an existing cross-sectional data registry. To create this registry, between January 2014 and January 2019, we considered all new adult English-speaking people who had an EDS that included the median nerve or people with a diagnosis of CTS who did not have surgery yet. A small and unrecorded number of people declined participation. The cross-sectional area of the median nerve at the distal wrist crease using US in people who already had EDS was measured. People with a diagnosis of CTS underwent both EDS and US. The six signs and symptoms of Carpal Tunnel Syndrome 6 (CTS-6, a validated tool to estimate the probability of IMNCT using ratings of symptoms and signs of CTS) were recorded. This resulted in a registry of 185 participants; we excluded 75 people for obvious, severe IMNCT (defined as nonrecordable nerve conduction velocity, thenar atrophy, or greater than 5 mm 2-point discrimination). Three of the 110 qualifying patients had missing information on ethnicity or race, but we accounted for this in our final analysis. Without a reference standard, as is the case with IMNCT, latent class analysis (LCA) can be used to establish the probability that an individual has specific pathophysiologic findings. LCA is a statistical method that identifies sets of characteristics that tend to group together. This technique has been used, for example, in diagnosing true scaphoid fractures among suspected fractures based on a combination of demographic, injury, examination, and radiologic variables. The prevalence of mild-to-moderate IMNCT was estimated in two LCAs using four signs and symptoms characteristic of mild-to-moderate IMNCT, as well as EDS and US measures of median neuropathy. The estimated prevalence of mild-to-moderate IMNCT based on signs and symptoms was 73% (95% CI 62% to 81%), while the estimated prevalence using EDS and US measurements was 51% (95% CI 37% to 65%). The notable discordance of 22% between the estimated prevalence of mild-to-moderate IMNCT using signs and symptoms and prevalence based on EDS and US criteria, and the overlapping CIs of the probability estimations, indicate considerable uncertainty and a corresponding notable potential for underdiagnosis or overdiagnosis. When signs and symptoms suggest mild-to-moderate median neuropathy and surgery is being considered, patients and clinicians might consider additional testing, such as EDS or US, to increase the probability of actual median neuropathy that can benefit from surgery. We might benefit from a more accurate and reliable diagnostic strategy or tool for mild-to-moderate IMNCT; this might be the focus of a future study. Level III, diagnostic study.

Global variation and outcomes of expectant management of CSP.

The incidence of Cesarean scar pregnancies (CSPs) is rising globally. Ultrasound criteria for the diagnosis of CSPs have been described by the International Society of Ultrasound in obstetrics and gynecology and appear to be well used in various centers around the world. There is no guidance on best practices for expectant management of CSP, and there is considerable variation in how this is offered globally. Many studies have reported significant maternal morbidity in cases of CSP with fetal cardiac activity managed expectantly, largely relating to hemorrhage and cesarean hysterectomy from placenta accreta spectrum. However, high live birth rates are also reported. Literature describing the diagnosis and expectant management of CSP in low-resource settings is lacking. Expectant management in selected cases where no fetal cardiac activity is present is a reasonable option and can be associated with good maternal outcomes. Standardization in reporting different types of CSPs and correlating these with pregnancy outcomes will be an important next step in developing guidance for expectant management of this high-risk pregnancy with a high burden of complications.

Management of late-onset fetal growth restriction: pragmatic approach.

There is limited prospective evidence to guide the management of late-onset fetal growth restriction (FGR) and its differentiation from small-for-gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37 weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol. This was a prospective study of women with a non-anomalous singleton pregnancy at ≥ 32 weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW) ≤ 10th centile, or EFW > 10th centile in addition to a decrease in fetal abdominal circumference of ≥ 50 centiles compared with a previous scan, umbilical artery Doppler pulsatility index > 95th centile or cerebroplacental ratio < 5th centile. Women were classified as low or high risk based on ultrasound and Doppler criteria. Women in the low-risk group were delivered by 41 weeks of gestation, unless they subsequently met high-risk criteria, whereas women in the high-risk group (EFW < 3rd centile, umbilical artery Doppler pulsatility index > 95th centile or EFW between 3rd and 10th centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37 weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1-min Apgar score < 7, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5-min Apgar score < 7, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise. Over 18 months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low-risk compared with the high-risk group (45% vs 58%; adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.9); P = 0.022). There was no significant difference in the rate of adverse maternal outcome (18% vs 24%; aOR, 0.7 (95% CI, 0.4-1.2); P = 0.142) or severe adverse neonatal outcome (3.8% vs 8.5%; aOR, 0.5 (95% CI, 0.2-1.3); P = 0.153) between the low- and high-risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low-risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% vs 58%; aOR, 0.6 (95% CI, 0.4-0.9); P = 0.026). Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low-risk pregnancies. In clinical practice, a policy of expectantly managing women with a low-risk late-onset FGR pregnancy at term could improve neonatal and long-term development. Randomized controlled trials are needed to assess the effect of an evidence-based conservative management protocol for late FGR on perinatal morbidity and mortality and long-term neurodevelopment. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt

IntroductionThyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).ObjectiveThis study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.Material and methodsA total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.ResultsThere were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.ConclusionThe application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.

O-268 Presence of adenomyosis impairs clinical outcomes in women undergoing frozen embryo transfer

Abstract Study question Does the presence of adenomyosis impact the clinical outcomes of patients undergoing frozen embryo transfer (FET)? Summary answer Presence of adenomyosis is associated with higher miscarriage and lower clinical pregnancy and live birth rates. GnRH agonist pre-treatment does not increase clinical outcomes. What is known already Presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) has been investigated in several studies demonstrating a potential detrimental effect on live birth rates following IVF, most of them were small studies in which adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. Considering the fragmented evidence up to date, we decided to perform a large retrospective study including women with adenomyosis undergoing FET which has been confirmed based on solid ultrasonographic criteria. Study design, size, duration Retrospective cohort study of 3503 patients undergoing their first cycle of blastocyst frozen transfer in a university-affiliated fertility center between January 2017 and December 2021. Participants/materials, setting, methods Overall, 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Patients were categorized as adenomyosis when fulfilling to the Morphological Uterus Sonographic Assessment (MUSA) criteria and as non-adenomyosis when no-adenomyosis was identified. Among them 140 women had a confirmed diagnosis of adenomyosis based on MUSA criteria. Clinical information was retrospectively collected from medical records. Main results and the role of chance Comparisons between adenomyosis and non-adenomyosis groups revealed similar baseline characteristics in terms of patients’ weight, parity, smoking status, and age. Similarly, endometrial thickness and mean serum progesterone levels the day before FET as well as the number of embryos transferred were comparable between groups. Adenomyosis patients were more likely to proceed with a deferred FET (freeze-all protocol) as compared with no-adenomyosis women (p = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 injections) (P &amp;lt; 0.001). Multivariable logistic regression, adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis, demonstrated that the use of GnRH agonist protocol did not affect miscarriage, clinical pregnancy rate or live birth rate. However, the presence of adenomyosis significantly decreased clinical pregnancy rates (OR 0.62, 95% CI: 0.39-0.98, P = 0.040) and live birth rates (OR 0.46, 95% CI: 0.27-0.75, P = 0.003) and significantly increased miscarriage rates (OR 2.13, 95% CI 0.98-4.37, p = 0.045). PGT-A was the only factor associated with a significative reduction in miscarriage rate. Limitations, reasons for caution The main limitation of this study is the single-center retrospective approach. Furthermore, due to the limited number of cases with adenomyosis focal and diffuse adenomyosis were analyzed together although this may be clinically distinct entities. Wider implications of the findings The results of this study demonstrate that presence of adenomyosis has significant negative impact on the clinical outcomes of patients undergoing FET. Future prospective studies are needed to create a consensus on the optimal ET technique for these patients. Trial registration number Not Applicable