IntroductionDiagnostic accuracy of first-line sonographic evaluation by obstetrics/gynecology residents in determining the need for emergency surgery in women with acute pelvic pain is unknown. Aim of this study was to evaluate the diagnostic accuracy of routine ultrasound evaluation by obstetrics/gynecology residents, available 24 hours a day, in patients with acute pelvic pain.MethodsA cross-sectional retrospective study included consecutive patients who underwent emergency laparoscopy for acute pelvic pain at a teaching hospital gynecologic emergency unit, between January 1, 2004, and December 31, 2006. The laparoscopic diagnosis was the reference standard. Gynecologic and nongynecologic conditions requiring immediate surgery to avoid severe morbidity or death were defined as surgical emergencies. In all patients, obstetrics/gynecology residents routinely performed clinical examination and standardized ultrasonography was routinely recorded. Sonograms were re-interpreted for the study, blinded to physical examination and laparoscopic findings, according to evidence-based predetermined criteria. Sensitivity, specificity, and likelihood ratios were computed for clinical data alone, sonographic data alone, and the combination of both.ResultsEmergency laparoscopy was performed in 234 patients, diagnosing 139 (59%) surgical emergencies. Clinical and sonographic examinations performed by the residents each independently predicted a need for emergency surgery. Combining both examinations was superior over each examination alone and had an acceptable false-negative rate of 1%.ConclusionsFirst-line combined clinical and sonographic examination by obstetrics/gynecology residents is effective in ruling out surgical emergencies in patients with acute pelvic pain.
Objectives: To prospectively assess the accuracy of transvaginal ultrasound (US) and magnetic resonance (MR), using histology as gold standard, in the evaluation of early cervical cancer (ECC) and of locally advanced cervical cancer (LACC) after neoadjuvant treatment. Methods: Patients with ECC or with LACC, triaged to surgery after neoadjuvant treatment, who underwent transvaginal US and MR examination within one week before surgery, were included in the study. Results: An invasive cervical cancer tumor was confirmed in the 33 patients triaged for exclusive surgery, and residual tumor mass was documented in 27 out of 35 patients after neoadjuvant treatment, with complete pathological response in 8 (23%) cases. Considering the tumor preoperative detection, US and MR examinations were able to recognize the presence of the tumor mass in 56/60 and in 53/60 cases, respectively. Both US and MR provided similar rates (Positive predictive value (PPV) = 52% and 62%, respectively; negative predictive value (NPV) = 100% and 98%, respectively) in recognizing whole thickness stromal infiltration cases. Both US and MR provided very low PPVs (30% and 22% respectively) and high NPVs (97% and 95%, respectively) for the parametrial infiltration. At histopathological examination, metastatic pelvic lymph nodes were diagnosed in 11 cases. No case of metastatic lymph nodes, except one, was detected at US examination, while MR was able to correctly identify 3 positive cases with 8 false negative cases. Conclusions: Both US and MR provided similar figures for almost all the investigated preoperative cervical cancer parameters. Considering the advances of ultrasound technology, its relative low cost, its widespread availability and the rapidity of the procedure, the performance of US examination is likely to be reconsidered in the preoperative work-up of cervical cancer. Objectives: To evaluate the role of transvaginal ultrasonography in the detection of pelvic adhesions in women suspected to have endometriomas. Materials and Methods: Ninety-seven women who underwent surgery for cystic ovarian endometriosis were prospectively recruited. All patients underwent transvaginal ultrasonography before surgery and the presence of fixation of the ovary to the uterus was considered characteristic of presence of pelvic adhesions. Patients were classified as having tuboperitoneal abnormalities if evidence of fimbrial, peritubal and/or peri-ovarian adhesions was encountered during surgery. Results: Seventy-two women had pelvic adhesions. The likelihood ratio for fixation of the ovary to the uterus was 7.12 (95% CI 1.86-27) and for a 'normal' ultrasound 0.47 (0.35-0.63). The pre-test probability of pelvic adhesions in our population of women with an endometrioma was 74%, and this probability raised to 95% (95% CI 84%-99%) when fixation of the ovary to the uterus was present. On the contrary, the probability of presence of pelvic adhesions fell to 57% (95% CI 50%-64%) when this ultrasonographic finding was absent. Conclusions: This approach improves ...
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