Evaluating use of two-step International Ovarian Tumor Analysis strategy to classify adnexal masses identified in pregnancy: pilot study.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2024-12-01 DOI:10.1002/uog.27707

J Barcroft, M Pandrich, S Del Forno, N Cooper, K Linton-Reid, C Landolfo, D Timmerman, S Saso, T Bourne

{"title":"Evaluating use of two-step International Ovarian Tumor Analysis strategy to classify adnexal masses identified in pregnancy: pilot study.","authors":"J Barcroft, M Pandrich, S Del Forno, N Cooper, K Linton-Reid, C Landolfo, D Timmerman, S Saso, T Bourne","doi":"10.1002/uog.27707","DOIUrl":null,"url":null,"abstract":"Objectives: The primary aim was to validate the International Ovarian Tumor Analysis (IOTA) benign simple descriptors (BDs) followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model, if BDs cannot be applied, in a two-step strategy to classify adnexal masses identified during pregnancy. The secondary aim was to describe the natural history of adnexal masses during pregnancy.Methods: This was a retrospective analysis of prospectively collected data from women with an adnexal mass identified on ultrasonography during pregnancy between 2017 and 2022 at Queen Charlotte's and Chelsea Hospital, London, UK. Clinical and ultrasound data were extracted from medical records and ultrasound software. Adnexal masses were classified and managed according to expert subjective assessment (SA). Borderline ovarian tumors (BOTs) were classified as malignant. BDs were applied retrospectively to classify adnexal masses, and if BDs were not applicable, the ADNEX model (using a risk- of-malignancy threshold ≥ 10%) was used, in a two-step strategy. The reference standard was histology (where available) or expert SA at the postnatal ultrasound scan.Results: A total of 291 women with a median age of 33 (interquartile range (IQR), 29-36) years presented with an adnexal mass during pregnancy, at a median gestational age of 12 (IQR, 8-17) weeks. Of those, 267 (91.8%) were followed up to the postnatal period. Based on the reference standard, 4.1% (11/267) of adnexal masses were classified as malignant (all BOTs) and 95.9% (256/267) as benign. BDs were applicable in 68.9% (184/267) of adnexal masses; of these, only one (0.5%) BOT was misclassified as benign. The ADNEX model was used to classify the 83 residual masses and misclassified 3/10 (30.0%) BOTs as benign and 25/73 (34.2%) benign masses as malignant, of which 13/25 (52.0%) were classified as decidualized endometrioma on expert SA. The two-step strategy had a specificity of 90.2%, sensitivity of 63.6%, negative predictive value of 98.3% and positive predictive value of 21.9%. A total of 56 (21.0%) women underwent surgical intervention: four (1.5%) as an emergency during pregnancy, four (1.5%) electively during Cesarean section and 48 (18.0%) postnatally. During follow-up, 64 (24.0%) adnexal masses resolved spontaneously. Cyst-related complications occurred in four (1.5%) women during pregnancy (ovarian torsion, n = 2; cyst rupture, n = 2) and six (2.2%) women in the postnatal period (all ovarian torsion). Overall, 196/267 (73.4%) women had a persistent adnexal mass at postnatal ultrasound. Presumed decidualization occurred in 31.1% (19/61) of endometriomas and had resolved in 89.5% (17/19) by the first postnatal ultrasound scan.Conclusions: BDs apply to most adnexal masses during pregnancy. However, the small number of malignant tumors in this cohort (4.1%) restricted the evaluation of the ADNEX model, so expert SA should be used to classify adnexal masses during pregnancy when BDs do not apply. A larger multicenter prospective study is required to evaluate the use of the ADNEX model to classify adnexal masses during pregnancy. Our data suggest that most adnexal masses can be managed expectantly during pregnancy, given the high rate of spontaneous resolution and low risk of complications. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"808-817"},"PeriodicalIF":6.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11609963/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ultrasound in Obstetrics & Gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/uog.27707","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ACOUSTICS","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: The primary aim was to validate the International Ovarian Tumor Analysis (IOTA) benign simple descriptors (BDs) followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model, if BDs cannot be applied, in a two-step strategy to classify adnexal masses identified during pregnancy. The secondary aim was to describe the natural history of adnexal masses during pregnancy.

Methods: This was a retrospective analysis of prospectively collected data from women with an adnexal mass identified on ultrasonography during pregnancy between 2017 and 2022 at Queen Charlotte's and Chelsea Hospital, London, UK. Clinical and ultrasound data were extracted from medical records and ultrasound software. Adnexal masses were classified and managed according to expert subjective assessment (SA). Borderline ovarian tumors (BOTs) were classified as malignant. BDs were applied retrospectively to classify adnexal masses, and if BDs were not applicable, the ADNEX model (using a risk- of-malignancy threshold ≥ 10%) was used, in a two-step strategy. The reference standard was histology (where available) or expert SA at the postnatal ultrasound scan.

Results: A total of 291 women with a median age of 33 (interquartile range (IQR), 29-36) years presented with an adnexal mass during pregnancy, at a median gestational age of 12 (IQR, 8-17) weeks. Of those, 267 (91.8%) were followed up to the postnatal period. Based on the reference standard, 4.1% (11/267) of adnexal masses were classified as malignant (all BOTs) and 95.9% (256/267) as benign. BDs were applicable in 68.9% (184/267) of adnexal masses; of these, only one (0.5%) BOT was misclassified as benign. The ADNEX model was used to classify the 83 residual masses and misclassified 3/10 (30.0%) BOTs as benign and 25/73 (34.2%) benign masses as malignant, of which 13/25 (52.0%) were classified as decidualized endometrioma on expert SA. The two-step strategy had a specificity of 90.2%, sensitivity of 63.6%, negative predictive value of 98.3% and positive predictive value of 21.9%. A total of 56 (21.0%) women underwent surgical intervention: four (1.5%) as an emergency during pregnancy, four (1.5%) electively during Cesarean section and 48 (18.0%) postnatally. During follow-up, 64 (24.0%) adnexal masses resolved spontaneously. Cyst-related complications occurred in four (1.5%) women during pregnancy (ovarian torsion, n = 2; cyst rupture, n = 2) and six (2.2%) women in the postnatal period (all ovarian torsion). Overall, 196/267 (73.4%) women had a persistent adnexal mass at postnatal ultrasound. Presumed decidualization occurred in 31.1% (19/61) of endometriomas and had resolved in 89.5% (17/19) by the first postnatal ultrasound scan.

Conclusions: BDs apply to most adnexal masses during pregnancy. However, the small number of malignant tumors in this cohort (4.1%) restricted the evaluation of the ADNEX model, so expert SA should be used to classify adnexal masses during pregnancy when BDs do not apply. A larger multicenter prospective study is required to evaluate the use of the ADNEX model to classify adnexal masses during pregnancy. Our data suggest that most adnexal masses can be managed expectantly during pregnancy, given the high rate of spontaneous resolution and low risk of complications. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

查看原文本刊更多论文

评估使用 IOTA 两步策略对妊娠期发现的附件肿块进行分类：试点研究。

目标：主要目的是验证良性描述指标（BDs），然后评估不同的附件炎（ADNEX）（当无法应用良性描述指标时），采用两步策略对妊娠期附件肿块进行分类。次要目的是描述妊娠期附件肿块的自然病史：回顾性分析前瞻性收集的 2017 年至 2022 年期间妊娠期超声检查发现附件包块的妇女数据。研究在英国夏洛特女王和切尔西医院进行。相关临床和超声数据均从病历和超声软件 astraia 中提取。附件肿块根据专家主观评估（SA）进行分类和管理。超声检查时对超声特征进行前瞻性记录。边界卵巢肿瘤（BOT）被归类为恶性。附件肿块的分类采用良性描述符（BDs），如果BDs不适用，则采用ADNEX模型（恶性风险>10%），分两步走。该两步策略采用回顾性方法。结果：291 名中位数年龄为 33（IQR 29-36）岁的妇女在妊娠 12（IQR 8-17）周时出现附件包块。267名（267/291，91.8%）妇女接受了产后随访，24名（24/291，8.2%）妇女失去了随访机会。根据参考标准，4.1%的附件肿块（11/267）被归类为恶性（全部为 BOTs），95.9%（256/267）被归类为良性（41 例以组织学为依据，215 例以产后超声检查的专家诊断为依据）。68.9%的附件肿块（184/267）可应用BDs；其中只有一个肿块（BOT）被误诊为良性（1/184，0.5%）。ADNEX被用于对残留肿块（83/267）进行分类，结果有3个BOT被误诊为良性（3/10，30.0%），25个良性肿块（基于参考标准）被误诊为恶性（25/73，34.2%），其中13个（13/25，52.0%）被专家SA分类为蜕膜化子宫内膜瘤，并在产后证实蜕膜化已经消退。两步法的特异性为 90.2%，敏感性为 63.6%，阴性预测值为 98.3%，阳性预测值为 21.9%。56（56/267，21.0%）名妇女接受了手术治疗，其中 4 人是在孕期急诊（4/267，1.5%），4 人（4/267，1.5%）是在剖腹产时选择手术治疗。48（48/267，18.0%）名妇女在产后接受了手术干预，其中 11（11/267，4.1%）名妇女在产后 12 周内接受了手术干预，37（37/267，13.9%）名妇女在产后 12 周以上接受了手术干预。64例（64/267，24.0%）附件肿块在随访期间自行消退。有 4 名妇女（4/267，1.5%）在孕期出现了囊肿相关并发症（卵巢扭转 n=2，囊肿破裂 n=2），有 6 名妇女（6/267，2.2%）在产后出现了囊肿相关并发症（均为卵巢扭转）。196人（196/267，73.4%）有持续性附件包块，其中一名妇女卵巢扭转后接受了去扭转术，产后超声检查时发现有持续性附件包块。31.1%（19/61）的子宫内膜异位症发生蜕膜化，89.5%（17/19）的子宫内膜异位症在产后第一次超声扫描时已经消退：我们发现良性描述符适用于大多数妊娠期肿块，但由于队列中恶性肿瘤的数量较少（4.1%），限制了对ADNEX模型的评估，因此在良性描述符不适用的情况下，应使用专家的主观评估对妊娠期附件肿块进行分类。需要进行更大规模的多中心前瞻性研究，以评估使用ADNEX模型对妊娠期附件肿块进行分类的效果。我们的数据表明，鉴于大部分附件肿块可自行消退，且并发症风险较低，因此大多数附件肿块可在孕期得到预期管理。本文受版权保护。保留所有权利。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.