Use Of Transvaginal Ultrasound Research Articles

The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis: A Systematic Review and Meta-Analysis.

The aim of this study is to determine the accuracy of transvaginal ultrasound (TVU) for the diagnosis of ureteral involvement in women with deep infiltrating endometriosis (DIE). The meta-analysis included primary studies comparing the use of TVU for diagnosing endometriotic involvement of the ureter, using laparoscopic surgery and histological diagnosis as the reference standard. Search was performed in several databases (Scopus, Web of Science, and PubMed/MEDLINE). The studies' quality and bias risk were assessed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2). Diagnostic performance was estimated by assessing pooled sensitivity and specificity. A total of 496 citations were found. Six articles were ultimately selected for this systematic review and meta-analysis after the inclusion and exclusion criteria were applied. Pooled sensitivity and specificity were 0.81 (95% CI: 0.42-0.96), 1.00 (95% CI: 0.93-1.00). The heterogeneity observed was high for both sensitivity and specificity. Overall risk of bias was low. TVU is a valuable tool for the pre-operative identification of ureteral involvement by DIE.

A Cross-Sectional Study Examined the use of Transvaginal Ultrasound in Assessing Endometrial Cancer in Postmenopausal Women

Aim: to determine how successfully transvaginal ultrasonography can be used to identify endometrial cancer in postmenopausal bleeding patients.. Methods: The Khyber Teaching Hospital Peshawar Radiology department performed this cross-sectional study from January 2015 to January 2016. TV-tested endometrial-thickness women were included. The endometrial cavity was examined colonially and sagittal from the internal Os to the fundus. D&C transmitted biopsy samples to the hospital pathology lab for histopathology and TVS comparison. A preform had all this info. Spss 26 analyzed data. Results: The patients' average age was 64.82 + 07.84 years. On average, menopause lasted 10.45 07.73 years. When endometrial thickness was assessed with tvs, the average thickness was 05.564.26 mm; 45 (32.8%) of the ladies did not have an endometrial thickness of 04 mm. Histopathological examination of endometrial cancer revealed ninety four (66.5%) females with the disease and forty six (32.8%) without. The sensitivity, specificity, npv, ppv, and diagnostic accuracy of tvs were determined to be [93.1%], [86.5%], [91.4%], [94.6%], and [93.6%], respectively. Conclusion: According to the study's results, tvs is an effective diagnostic tool for ruling out postmenopausal hemorrhage and sparing patients from intrusive treatments. Keywords: Transvaginal ultrasonography, endometrial carcinoma, diagnosis, accuracy, positive-predictive-value, negative predictive value

Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis.

Transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are used for the clinical diagnosis of adenomyosis. To compare the diagnostic accuracy of TVS and MRI for the diagnosis of adenomyosis. A search of studies was performed in five databases comparing TVS and MRI for the diagnosis of adenomyosis from January 1990 to May 2022. Studies were eligible if they reported on the use of TVS and MRI in the same set of patients. The reference standard must be pathology (hysterectomy). The quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity of both techniques were estimated and compared. Six studies comprising 595 women were included. The risk of bias of patient selection was high in three studies. The risk of bias for index tests and reference test was low. Pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for TVS were 75%, 81%, 3.9, and 0.31, respectively. These figures for MRI were 69%, 80%, 3.5, and 0.39, respectively. No statistically significant differences were found (p= 0.7509). Heterogeneity was high. MRI and TVS have similar performances for the diagnosis of adenomyosis.

Accuracy of transvaginal ultrasound versus MRI in the PreOperative Diagnostics of low-grade Endometrial Cancer (PODEC) study: a prospective multicentre study

To investigate if the diagnostic accuracy of transvaginal ultrasound (TVUS) performed by gynaecologists is sufficient for preoperative assessment of low-grade endometrial cancer (EC) compared to magnetic resonance imaging (MRI). MRI and TVUS performed by gynaecologists were assessed at the participating centres. The MRI examinations were interpreted by two radiologists at the tertiary centre. Deep myometrial and cervical stroma invasion were visually assessed and compared to postoperative histopathology. Two hundred and fifty-nine patients were included. There was a statistically significant difference in specificity assessing deep myometrial invasion between MRI and TVUS (MRI 0.88, TVUS 0.68). There was no difference in sensitivity (MRI 0.73, TVUS 0.68). When assessing cervical stroma infiltration, MRI had a higher specificity (MRI 0.96, TVUS 0.90), but there was no difference in sensitivity (MRI 0.41, TVUS 0.32). MRI has higher specificity than TVUS performed by gynaecologists for assessing deep MI and CSI in low-grade EC, but similar sensitivities. The use of TVUS as a first-line test, rather than MRI, may be supported by this study in centres where access to MRI may be limited.

Literature Review of the Use of Transvaginal Ultrasound for Rectovaginal Endometriosis

<h3>Study Objective</h3> To review recent literature in the Journal of Minimally Invasive Gynecology (JMIG), the only peer-reviewed journal dedicated to minimally invasive gynecologic surgery, on the use of transvaginal ultrasound (TVU) in patients with rectovaginal endometriosis (RVE). <h3>Design</h3> An all-content search of "rectovaginal endometriosis transvaginal ultrasound" on JMIG.org. <h3>Setting</h3> JMIG.org. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The search retrieved 135 results of which 56 were from the last five years. Of these, 22 addressed TVU for RVE patients: 16 research articles, 3 abstracts, 2 editorials, and 1 case report. The research articles were assigned Canadian Task Force classifications to evaluate quality. Only 3 reached level II-1 and none reached level I. There was an even mix of prospective, retrospective studies and case reports. <h3>Conclusion</h3> The majority of articles currently cite TVU as first-line imaging in RVE, but more work is needed to harness sonography's potential. The three studies that met the II-1 classification reviewed conditions that improved TVU's accuracy for RVE, e.g., when used with bowel prep. Presently, use of TVU for RVE is wide-ranging and unstructured. The most common uses include preoperative diagnosis, comparison with different imaging and comparison to histopathology, long-term maintenance and fertility assessment. Clinician experience and limited collaboration can create variability in ultrasound data. As TVU is more globally accessible than other imaging modalities, training gynecologists in endometriosis ultrasound can improve diagnosis and preoperative planning for RVE patients. Given its lower cost, accessibility, and high sensitivity and specificity for endometriosis, TVU is poised to improve patient outcomes for RVE patients. This review of recent literature in <i>JMIG</i> on TVU for RVE indicates a need for standardized structured imaging reports, guidelines, and support. In keeping with <i>JMIG'</i>s mission to improve the quality and safety of healthcare for women through access to minimally invasive surgical options, we must work towards the full potential of ultrasound imaging.

Value of Strain-Ratio Elastography in the Diagnosis and Differentiation of Uterine Fibroids and Adenomyosis.

Benign uterine disorders, including uterine fibroids (UF) and adenomyosis (AM), can impact the life quality and fertility of women of reproductive age. Transvaginal ultrasound (TVUS) has long been used for their early identification, but its combined use with elastography seems to improve diagnostic accuracy of UF and AM. Thus, a prospective pilot study was conducted on 79 patients who underwent hysterectomy (25 microscopically diagnosed with AM and 53 with UF), with the aim of assessing the ability of TVUS combined with strain ratio elastography (SE) to accurately diagnose and distinguish UF and AM. Significantly higher mean and maximal strain ratio (SR) values were identified for patients with histologically confirmed AM as opposed to those with UF (p < 0.001). Diagnostic sensitivity and specificity, calculated in comparison with histology results, were higher for UF than AM. Receiver operating characteristic (ROC) analysis was applied between the two study groups, revealing cutoff values of 7.71 for mean SR and 8.91 for maximal SR, respectively, with good sensitivity and specificity parameters (100% and 96.23%; 96% and 96.23%). Our results support the use of TVUS in combination with SE for the positive and differential diagnosis of UF and AM, through identification of their particular tissue stiffness features.

Use of Transvaginal Ultrasound in the Evaluation of Endometrial Pathology in Women with a History of Tamoxifen Use and Postmenopausal Bleeding

Use of Transvaginal Ultrasound in the Evaluation of Endometrial Pathology in Women with a History of Tamoxifen Use and Postmenopausal Bleeding

Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis.

To perform a systematic review of studies comparing the accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in diagnosing deep infiltrating endometriosis (DIE) including only studies in which patients underwent both techniques. An extensive search was carried out in PubMed/MEDLINE and Web of Science for papers from January 1989 to October 2016 comparing TVS and MRI in DIE. Studies were considered eligible for inclusion if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE and using surgical data as a reference standard. Quality was assessed using the QUADAS-2 tool. A random-effects model was used to determine pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR). Of 375 citations identified, six studies (n = 424) were considered eligible. For MRI in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.78-0.90), specificity was 0.95 (95% CI, 0.83-0.99), LR+ was 18.4 (95% CI, 4.7-72.4), LR- was 0.16 (95% CI, 0.11-0.24) and DOR was 116 (95% CI, 23-585). For TVS in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.68-0.94), specificity was 0.96 (95% CI, 0.85-0.99), LR+ was 20.4 (95% CI, 4.7-88.5), LR- was 0.16 (95% CI, 0.07-0.38) and DOR was 127 (95% CI, 14-1126). For MRI in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.66 (95% CI, 0.51-0.79), specificity was 0.97 (95% CI, 0.89-0.99), LR+ was 22.5 (95% CI, 6.7-76.2), LR- was 0.38 (95% CI, 0.23-0.52) and DOR was 65 (95% CI, 21-204). For TVS in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.59 (95% CI, 0.26-0.86), specificity was 0.97 (95% CI, 0.94-0.99), LR+ was 23.5 (95% CI, 9.1-60.5), LR- was 0.42 (95% CI, 0.18-0.97) and DOR was 56 (95% CI, 11-275). For MRI in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.70 (95% CI, 0.55-0.82), specificity was 0.93 (95% CI, 0.87-0.97), LR+ was 10.4 (95% CI, 5.1-21.2), LR- was 0.32 (95% CI, 0.20-0.51) and DOR was 32 (95% CI, 12-85). For TVS in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.67 (95% CI, 0.55-0.77), specificity was 0.86 (95% CI, 0.73-0.93), LR+ was 4.8 (95% CI, 2.6-9.0), LR- was 0.38 (95% CI, 0.29-0.50) and DOR was 12 (95% CI, 7-24). Confidence intervals of pooled sensitivities, specificities and DOR were wide for both techniques in all the locations considered. Heterogeneity was moderate or high for sensitivity and specificity for both TVS and MRI in most locations assessed. According to QUADAS-2, the quality of the included studies was considered good for most domains. The diagnostic performance of TVS and MRI is similar for detecting DIE involving rectosigmoid, uterosacral ligaments and rectovaginal septum. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Universal cervical length screening for preterm birth prevention in the United States

Objective: To evaluate the incidence of implementation of universal cervical length (CL) screening for preterm birth (PTB) prevention among institutions with Maternal–Fetal Medicine (MFM) fellowship training in the United states.Methods: In January 2015, we conducted a national survey of institutions with MFM Fellowship Programs regarding implementation of universal CL screening, defined as CL screening of women with singleton gestations without a prior spontaneous PTB. We identified whether a transabdominal ultrasound (TAU) or transvaginal ultrasound (TVU) was used for screening. Results were compared by geographical regions.Results: We identified 78 MFM fellowship programs nationwide, of which 100% responded to the survey, provided by MFM fellows (86%) and MFM division directors (14%). In January 2015, 53 programs (68%) had implemented a CL screening program, with 25 programs (32%) using TVU while the rest (36%) used TAU for CL screening. The 16 programs in the Midwest had the highest percent of CL screening (15 programs, 94%), with the highest use of TVU (8 programs 50%). The 24 programs in the South had the lowest percent of CL screening (14 programs, 58%) (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.19–1.46) and the lowest use of TVU (3 programs,12.5%) (OR: 0.22, 95% CI: 0.05–0.78) compared to rest of US).Conclusion: Universal CL screening has been implemented by over two-thirds of institutions with MFM Fellowship Programs, as of January 2015. Of these programs, about half screen by TAU and half by TVU.

Current Implementation of Universal Cervical Length Screening for Preterm Birth Prevention in the United States [19

INTRODUCTION: To evaluate the incidence of implementation of universal cervical length (CL) screening for preterm birth (PTB) prevention among institutions with Maternal-Fetal Medicine (MFM) fellowship training in the United States. METHODS: In January 2015, we conducted a national survey of institutions with MFM Fellowship Programs regarding implementation of universal CL screening, defined as CL screening of women with singleton gestations without a prior spontaneous PTB. We also identified whether a transabdominal ultrasound (TAU) or transvaginal ultrasound (TVU) was used for screening. Results were compared by geographical regions. We also assessed if a low obstetrical volume (annual deliveries<3000) affected implementation of TVU CL screening program. RESULTS: We identified 78 MFM fellowship programs, of which 100% responded to the survey. Fifty-three programs (68%) had implemented a CL screening program, with 25 programs (32%) using TVU while the rest (36%) used TAU for CL screening. The Midwest had the highest percent of CL screening (94%), with the highest use of TVU (50%). The South had the lowest percent of CL screening (58%) (OR 0.52 [0.19–1.46]) and the lowest use of TVU (12.5%) (OR 0.22 [0.05–0.78]) compared to rest of the United States. Lower annual obstetrical volume did not affect the likelihood of implementing a program using TVU (7.6%) compared to programs having higher obstetrical volume (24.3%) (OR 0.73 [0.24–2.17]). CONCLUSION/IMPLICATIONS: Universal CL screening has been implemented by over two thirds of institutions with MFM Fellowship Programs. Of these programs, approximately half screen by TAU and half by TVU.

Update on the ultrasound diagnosis of deep pelvic endometriosis

Transvaginal ultrasound (TVU) is evolving as an essential tool in the work up for women with pelvic pain and suspected endometriosis. Several studies have demonstrated the accuracy and reliability of TVU for the diagnosis of pelvic deep infiltrating endometriosis and pouch of Douglas obliteration. Assessment of the anterior pelvic compartment for urinary DIE and utero-vesical adhesions should also be considered in the TVU examination for women with pelvic/pain suspected endometriosis. In addition, the use of ultrasound markers such as ovarian endometriomas and ovarian immobility may also aid in the assessment for disease severity. The ability to map disease location and extent pre-operatively allows for appropriate triaging, surgical planning and patient counselling, and in turn, improved care for women with severe endometriosis. This update focuses on the most recent advances surrounding the use of TVU for the prediction of endometriosis location and severity.

Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis.

To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of endometriosis in the uterosacral ligaments (USL), rectovaginal septum (RVS), vagina and bladder in patients with clinical suspicion of deep infiltrating endometriosis (DIE). An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. Studies were considered eligible if they reported on the use of TVS for the preoperative detection of endometriosis in the USL, RVS, vagina and bladder in women with clinical suspicion of DIE using the surgical data as a reference standard. Study quality was assessed using the PRISMA guidelines and QUADAS-2 tool. Of the 801 citations identified, 11 studies (n = 1583) were considered eligible and were included in the meta-analysis. For detection of endometriosis in the USL, the overall pooled sensitivity and specificity of TVS were 53% (95%CI, 35-70%) and 93% (95%CI, 83-97%), respectively. The pretest probability of USL endometriosis was 54%, which increased to 90% when suspicion of endometriosis was present after TVS examination. For detection of endometriosis in the RVS, the overall pooled sensitivity and specificity were 49% (95%CI, 36-62%) and 98% (95%CI, 95-99%), respectively. The pretest probability of RVS endometriosis was 24%, which increased to 89% when suspicion of endometriosis was present after TVS examination. For detection of vaginal endometriosis, the overall pooled sensitivity and specificity were 58% (95%CI, 40-74%) and 96% (95%CI, 87-99%), respectively. The pretest probability of vaginal endometriosis was 17%, which increased to 76% when suspicion of endometriosis was present after TVS assessment. Substantial heterogeneity was found for sensitivity and specificity for all these locations. For detection of bladder endometriosis, the overall pooled sensitivity and specificity were 62% (95%CI, 40-80%) and 100% (95%CI, 97-100%), respectively. Moderate heterogeneity was found for sensitivity and specificity for bladder endometriosis. The pretest probability of bladder endometriosis was 5%, which increased to 92% when suspicion of endometriosis was present after TVS assessment. Overall diagnostic performance of TVS for detecting DIE in uterosacral ligaments, rectovaginal septum, vagina and bladder is fair with high specificity.

Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis.

To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of deep myometrial infiltration in patients with endometrial cancer, comparing subjective and objective methods. An extensive search was performed in MEDLINE (PubMed) and EMBASE for studies published between January 1989 and December 2014. The eligibility criterion was use of TVS for preoperative assessment of myometrial infiltration by subjective evaluation and/or objective measurements. Objective measurements included, specifically, the approaches of Gordon (ratio of the distance between endometrium-myometrium interface and maximum tumor depth to the total myometrial thickness) and Karlsson (endometrial tumor thickness/anteroposterior uterine diameter ratio), in women with endometrial cancer, using the surgical pathological data as a reference standard. Study quality was assessed using the QUADAS-2 tool. Our extended search identified a total of 184 citations, among which we examined the full text of 24 articles. Overall pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of TVS for detecting deep myometrial infiltration were 82% (95% CI, 76-87%), 81% (95% CI, 76-85%), 4.3 (95% CI, 3.6-5.3) and 0.22 (95% CI, 0.16-0.30), respectively. We did not observe differences among the three methods in terms of diagnostic performance. Significant heterogeneity was found for sensitivity and specificity of all three methods (I(2) range, 60.6-95.0). The main limitation was that very few studies compared different approaches in the same set of patients. Diagnostic performance of TVS for detecting deep myometrial infiltration in women with endometrial cancer is moderate.

Methods for assessing pre-induction cervical ripening.

BackgroundInduction of labour is the artificial initiation of labour in a pregnant woman after the age of fetal viability but without any objective evidence of active phase labour and with intact fetal membranes. The need for induction of labour may arise due to a problem in the mother, her fetus or both, and the procedure may be carried out at or before term. Obstetricians have long known that for this to be successful, it is important that the uterine cervix (the neck of the womb) has favourable characteristics in terms of readiness to go into the labour state.ObjectivesTo compare Bishop score with any other method for assessing pre‐induction cervical ripening in women admitted for induction of labour.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies to identify randomised controlled trials (RCTs).Selection criteriaAll RCTs comparing Bishop score with any other methods of pre‐induction cervical assessment in women admitted for induction of labour. Cluster‐RCTs were eligible for inclusion but none were identified. Quasi‐RCTs and studies using a cross‐over design were not eligible for inclusion. Studies published in abstract form were eligible for inclusion if they provided sufficient information.Comparisons could include the following. 1. Bishop score versus transvaginal ultrasound (TVUS). 2. Bishop score versus Insulin‐like growth factor binding protein‐1 (IGFBP‐1). 3. Bishop score versus vaginal fetal fibronectin (fFN). However, we only identified data for a comparison of Bishop score versus TVUS.Data collection and analysisTwo review authors independently assessed the trials for inclusion, extracted the data and assessed trial quality. Data were checked for accuracy.Main resultsWe included two trials that recruited a total of 234 women. The overall risk of bias was low for the two studies. Both studies compared Bishop score withTVUS.The two included studies did not show any clear difference between the Bishop score and TVUS groups for the following main outcomes: vaginal birth (RR 1.07, 95% CI 0.92 to 1.25, moderate quality evidence), caesarean delivery (RR 0.81, 95% CI 0.49 to 1.34, moderate quality evidence), neonatal admission into neonatal intensive care unit (RR 1.67, 95% CI 0.41 to 6.71, moderate quality evidence). Both studies only provided median data in relation to induction‐delivery interval and reported no clear difference between the Bishop and TVUS groups. Perinatal mortality was not reported in the included studies.For the review's secondary outcomes, the need for misoprostol for cervical ripening was more frequent in the TVUS group compared to the Bishop score group (RR 0.52, 95% CI 0.41 to 0.66, two studies, 234 women, moderate quality evidence). In contrast, there were no clear differences between the Bishop scope and TVUS groups in terms of meconium staining of the amniotic fluid, fetal heart rate abnormality in labour, and Apgar score less than seven. Only one trial reported median data on the induction‐delivery interval and induction to active phase interval, the trialist reported no difference between the Bishop group and the TVUS group for this outcome. Neither of the included studies reported on uterine rupture.Authors' conclusionsModerate quality evidence from two small RCTs involving 234 women that compared two different methods for assessing pre‐induction cervical ripening (Bishop score and TVUS) did not demonstrate superiority of one method over the other in terms of the main outcomes assessed in this review. We did not identify any data relating to perinatal mortality. Whilst use of TVUS was associated with an increased need for misoprostol for cervical ripening, both methods could be complementary.The choice of a particular method of assessing pre‐induction cervical ripening may differ depending on the environment and need where one is practicing since some methods (i.e. TVUS) may not be readily available and affordable in resource‐poor settings where the sequelae of labour and its management is prevalent.The evidence in this review is based on two studies that enrolled a small number of women and there is insufficient evidence to support the use of TVUS over the standard digital vaginal assessment in pre‐induction cervical ripening. Further adequately powered RCTs involving TVUS and the Bishop score and including other methods of pre‐induction cervical ripening assessment are warranted. Such studies need to address uterine rupture, perinatal mortality, optimal cut‐off value of the cervical length and Bishop score to classify women as having favourable or unfavourable cervices and cost should be included as an outcome.

The Use of Transvaginal Ultrasound in Type II Endometrial Cancer.

To determine the use of the transvaginal ultrasound (TVUS) in postmenopausal women with type II endometrial cancer. A retrospective review was conducted for 173 women with pathology proven type II endometrial cancer at a single institution. Those who underwent preoperative TVUS were included, and the following data were obtained: endometrial stripe (EMS) measurement, uterine and/or adnexal findings, and uterine size/volume. Clinicopathologic factors were abstracted. Descriptive and regression analyses were performed. Fifty-eight women comprised the cohort, and the median age was 66.5 years (50-85 years). The most commonly reported symptom was postmenopausal bleeding in 53 patients (91.4%). The EMS was reported as thin (≤ 5 mm) or indistinct in 16 patients (27.5%). Approximately 60% of patients had 1 or more ultrasound abnormalities: intracavitary mass (31%), intracavitary fluid (12.1%), myometrial lesion (31.03%), and adnexal mass (12.1%). Poorly differentiated endometrioid cancer (53.45%) represented the predominant histology. Of the 16 (27.5%) women with a thin/indistinct EMS, 5 women (8.6%) did not have any abnormal ultrasound findings whatsoever. Women with type II endometrial cancer had a thin/indistinct EMS on TVUS in approximately 25% of cases. Lack of any ultrasound abnormality, including a thickened EMS, was noted in approximately 10% of patients. The use of TVUS, which has been of value in type I cancer, is limited in type II endometrial cancer. Therefore, endometrial sampling should be included in the evaluation of all women with postmenopausal bleeding, regardless of EMS thickness.

Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy

Abstract number 1: The futility of transvaginal ultrasound in type II endometrial cancer

number 1: The futility of transvaginal ultrasound in type II endometrial cancer C. Billingsley, K. Kenne, C. Cansino, D. O'Malley, D. Cohn, J. Fowler, E. Eisenhauer, L. Copeland, F. Backes, R. Salani, The Ohio State University, Columbus, OH, USA, University of California Davis, Sacramento, CA, USA, University of Cincinnati, UC Health Medical Arts Building, Cincinnati, OH, USA Objectives: To determine the utility of transvaginal ultrasound (TVUS) in women with type II endometrial cancer, including serous, clear cell, and high-grade carcinomas. Methods: A retrospective review was conducted in women with pathology proven type II endometrial cancer that underwent preoperative TVUS. The following data were obtained: endometrial stripe (EMS) measurement, presence of intracavitary fluid or lesion, myometrial and/or adnexal masses, uterine size and volume. Pathology reports were reviewed and clinicopathologic factors were abstracted. Descriptive analyses were performed to assess demographic and comparative data. Results: Sixty-three women comprised the study cohort and the median age was 65 years. The most commonly reported symptom was postmenopausal bleeding in 51 patients (80.9%). The EMS was reported as thin (b5 mm) or indistinct in 18 patients (28.6%). Approximately 60% of patients were noted to have one or more ultrasound abnormalities: intracavitary lesion (18, 28.6%), intracavitary fluid (8, 12.7%), myometrial lesion (19, 30.2%), and adnexal mass (8, 12.7%). Poorly differentiated endometrioid cancer (33; 52.4%) represented the predominant histology. Of the 28% of women with a thin/indistinct EMS, seven women did not have an ultrasound abnormality, representing 11% of women with type II endometrial cancer who had no abnormal ultrasound findings whatsoever. Conclusions: Women with type II endometrial cancer were found to have a thin/indistinct EMS on TVUS in approximately 25% of cases. Furthermore, lack of any ultrasound abnormality, including a thickened EMS, were noted in 11% of patients. The use of TVUS, which has been of diagnostic and triaging value for women with type I cancer, is of limited utility in type II endometrial cancer. Therefore, endometrial sampling should be included in the evaluation of all women with postmenopausal bleeding, regardless of EMS thickness. doi:10.1016/j.ygyno.2014.04.019 Abstract number 2: Durationof intra-chemotherapy anemia is associatedwith prognosis and survival in epithelial ovarian cancer R. Brightwell, K. Eng, S. Lele, K. Odunsi, Roswell Park Cancer Institute,number 2: Durationof intra-chemotherapy anemia is associatedwith prognosis and survival in epithelial ovarian cancer R. Brightwell, K. Eng, S. Lele, K. Odunsi, Roswell Park Cancer Institute,

The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound 'sliding sign' technique: inter- and intra-observer reproducibility

study question: What is the inter-/intra-observer agreement and diagnostic accuracy among gynaecological and non-gynaecological ultrasound specialists in the prediction of pouch of Douglas (POD) obliteration (secondary to endometriosis) at offline analysis of two-dimensional videos using the dynamic real-time transvaginal ultrasound (TVS) ‘sliding sign’ technique? summary answer: The inter-/intra-observer agreement and diagnostic accuracy for the interpretation of the TVS ‘sliding sign’ in the prediction of POD obliteration was found to be very acceptable, ranging from substantial to almost perfect agreement for the observers who specialized in gynaecological ultrasound. what is known already: Women with POD obliteration at laparoscopy are at an increased risk of bowel endometriosis; therefore, the pre-operative diagnosis of POD obliteration is important in the surgical planning for these women. Previous studies have used TVS to predict POD obliteration prior to laparoscopy, with a sensitivity of 72 –83% and specificity of 97 –100%. However, there have not been any reproducibility studies performed to validate the use of TVS in the prediction of POD obliteration pre-operatively. study design, size, duration: This was a reproducibility study which involved the offline viewing of pre-recorded video sets of 30 women presenting with chronic pelvic pain, in order to determine POD obliteration using the TVS ‘sliding sign’ technique. The videos were selected on real-time representative quality/quantity; they were not obtained from sequential patients. There were a total of six observers, including four gynaecological ultrasound specialists and two fetal medicine specialists. The study was conducted over a period of 1 month (March 2012–April 2012). participants/materials, setting, methods: The four gynaecological ultrasound observers performed daily gynaecological scanning, while the other two observers were primarily fetal medicine sonologists. Each sonologist viewed the TVS ‘sliding sign’ video in two anatomical locations (retro-cervix and posterior uterine fundus), i.e. 60 videos in total. The POD was deemed not obliterated, if ‘sliding sign’ was positive in both anatomical locations (i.e. anterior rectum/rectosigmoid glided smoothly across the retro-cervix/posterior fundus, respectively). If the ‘sliding sign’ was negative (i.e. anterior rectum/rectosigmoid did not glide smoothly over retro-cervix/posterior fundal region, respectively), the POD was deemed obliterated. Diagnostic accuracy and inter-observer agreement among the six sonologists was evaluated. The same sonologist was also asked to reanalyse the same videos, albeit in a different order, at least 7 days later to assess for intra-observer agreement. A separate analysis of the inter- and intra-observer correlation was also performed to determine the agreement among the four observers who specialized in gynaecological ultrasound. Cohen’s k coefficient ,0 meant that there was poor agreement, 0.01 –0.20 slight agreement, 0.21– 0.40 fair agreement, 0.41 –0.60 moderate agreement, 0.61 –0.80 substantial agreement and 0.81 –0.99 almost perfect agreement.

The Use of Transvaginal Ultrasound by Emergency Physicians in Medical Student Education

Abstract Paul L Foster School of Medicine at Texas Tech University Health Sciences Center in El Paso offers the students a faculty (both clinician and basic scientists) guided clinical presentation based curriculum. Emergency physicians have been an integral part of this curriculum. Bedside transvaginal ultrasound has become an adjunct to the history and physical examination for the evaluation in a timely manner of acute pelvic and lower abdominal pain and vaginal bleeding in the female of reproductive years. Discussion of the approach to diagnosis is divided into two broad categories; evaluation when there's a positive pregnancy test (first trimester) and a negative pregnancy test. The discussion also illustrates how the emergency physician can, using ultrasound, introduce, integrate, and review, the pertinent basic sciences (anatomy, embryology, pathology, physiology, microbiology and biochemistry) with the medical student.

Ovarian status in healthy postmenopausal women

We have previously reported on the point prevalence of ovarian lesions detected by transvaginal ultrasound (TVU) in 515 asymptomatic women at least 5 years postmenopause. The aims of this study were to report, in the same women, on the repeatability of visualization of the ovaries (TVU) and the natural history of ovarian lesions seen at baseline but not treated surgically and to assess whether any women developed new ovarian abnormalities 12 months later. The study involved a cohort of 515 postmenopausal women recruited from the community, at least 5 years past their last period. They were assessed at baseline and again after 12 months with TVU and serum levels of inhibin and CA-125. The right and left ovaries were seen on both occasions in 80% and 68% of women, respectively. Of the 49 women who had an ovarian lesion at baseline, did not undergo surgery at that time, and had a follow-up TVU, the lesion was unchanged 12 months later in 30 women. Four women developed a new ovarian lesion within the 12 months. None of the 14 women who underwent surgery on the basis of the ovarian appearance at baseline, or the 2 who had surgery on the basis of the ovarian appearance at follow-up, had an ovarian malignancy. The use of TVU in women at least 5 years after menopause is problematic because the ovaries cannot be visualized in all women and because TVU has the potential to identify many benign lesions that would otherwise remain undetected. These are important considerations in weighing up the risks and benefits of using TVU as a screening tool.