Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome

Christ, Jacob; Willis, Amy; Brooks, Eric D.; Brink, Heidi Vanden; Jarrett, Brittany Y; Pierson, R.A.; Chizen, Donna R.; Lujan, Marla E.

doi:10.1016/j.fertnstert.2013.10.001

Cited by 40 publications

(50 citation statements)

References 45 publications

(57 reference statements)

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“…Some studies do not find a greater discrimination using follicle number per ovary compared to follicle number in a single plane (20). Others demonstrate a similar AUC when comparing follicle number per ovary to a combination of follicle number in a single plane and the universally measured ovarian volume (19). In the context of our very large study, which started when follicle number in a single plane was the recommended measure to document polycystic ovary morphology, the simplicity and discriminatory power are sufficient to recommend the current measurements to define polycystic ovary morphology.…”

Section: Discussionmentioning

confidence: 89%

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Polycystic ovary morphology: age-based ultrasound criteria

Kim

Adams

Gudmundsson

et al. 2017

Fertility and Sterility

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Objective To determine age-based criteria for polycystic ovary morphology. Design The study was a cross sectional, case-control design. Setting The study took place in an outpatient setting. Subjects Women with PCOS defined by hyperandrogenism and irregular menses (n=544) and controls with regular menses and no evidence of hyperandrogenism (n=666) participated. Parameters were tested in a second cohort of women with PCOS (n=105) and controls (n=32) meeting the same criteria. Interventions Subjects underwent a pelvic ultrasound documenting ovarian volume and maximum follicle number in a single plane. Main Outcome Measures A receiver operating characteristic curve was constructed to determine the ovarian volume and follicle number with the best sensitivity and specificity to define PCOS for age groups at approximately 5 year intervals from age 18 to >44 years. Results The best sensitivity and specificity were obtained using a threshold volume of 12 mL and 13 follicles age ≤24 yrs, 10 mL and 14 follicles age 25–29 yrs, 9 mL and 10 follicles age 30–34 yrs, 8 mL and 10 follicles age 35–39 yrs, 10 mL and 9 follicles for age 40–44 yrs and 6 mL and 7 follicles for age >44 years. Data from a second cohort confirmed the need to decrease volume and follicle number with increasing age to diagnose PCOS. Polycystic ovary morphology was most accurate at predicting the PCOS diagnosis for women aged 30 to 39 years. Conclusion The ovarian volume and follicle number threshold to define polycystic ovary morphology should be lowered starting at age 30 years.

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Section: Discussionmentioning

confidence: 89%

“…While it has been suggested that follicle number per ovary provides a more accurate assessment of polycystic ovary morphology (17, 19), the data are not as simple to obtain in large studies. Some studies do not find a greater discrimination using follicle number per ovary compared to follicle number in a single plane (20).…”

Section: Discussionmentioning

confidence: 99%

Polycystic ovary morphology: age-based ultrasound criteria

Kim

Adams

Gudmundsson

et al. 2017

Fertility and Sterility

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“…Our finding that total mFG scores were neither predictive of, or related to, total testosterone levels is supported by some (24, 29, 44, 46) but not all studies (9, 47, 48). Differences in findings might relate to the inclusion of more severe manifestations of hirsutism in women with overt androgen excess disorders by some studies (12, 13, 45) as well as differences in the racial and ethnic groups investigated (12–15).…”

Section: Discussionmentioning

confidence: 40%

“…The largest single cross-sectional view of each ovary was evaluated by a single investigator for ovarian volume (OV), ovarian area (OA), stroma-to-total area ratio (S/A), and stromal index (SI) as previously described (29). In short, OA was calculated using the equation π/4 (transverse diameter) × (longitudinal diameter) and OV calculated based on the equation π/6 (transverse diameter) × (anteroposterior diameter) × (longitudinal diameter).…”

Section: Methodsmentioning

confidence: 99%

“…We (29), using mass spectrometry, and others (8, 30–32), using commercially available assays, have shown that ovarian markers, such as antral follicle count, ovarian size and stromal characteristics are significantly associated with total testosterone concentrations. In the case of antral follicle count, this is consistent with the concept that small antral follicles are a significant source of androgen production by the ovaries (33).…”

Section: Introductionmentioning

confidence: 96%

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Sonographic markers of ovarian morphology, but not hirsutism indices, predict serum total testosterone in women with regular menstrual cycles

Brink

Willis

Jarrett

et al. 2016

Fertility and Sterility

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Objective To determine whether sonographic markers of ovarian morphology or male pattern hair growth scores predict androgen levels in women with regular or irregular menstrual cycles. Design Cross-sectional observational study. Setting Clinical research unit. Patient(s) Seventy-six women of reproductive age (18–39 years) were evaluated for male-pattern hair growth (using modified Ferriman-Gallwey scoring system), ovarian morphology (transvaginal ultrasonography) and total serum testosterone (liquid chromatography tandem mass spectrometry). Interventions None Main Outcome Measures Regional and total modified Ferriman-Gallwey (mFG) scores, number of follicles per follicle size category, follicle number per ovary (FNPO), ovarian volume (OV), ovarian area (OA), stromal to ovarian area ratio (S/A), stromal echogenicity index (SI), total testosterone (TT) and menstrual cycle length. Results Neither regional nor total mFG scores correlated with TT concentrations in women with regular or irregular menstrual cycles as judged by the Least Absolute Shrinkage and Selection Operator (LASSO) technique. By contrast, a sonographic marker (FNPO 6–9mm) significantly predicted TT concentrations in women with regular menstrual cycles but not in women with irregular menstrual cycles. Conclusion Sonographic markers of ovarian morphology, but not hirsutism scores, predicted TT levels. However, the predictive value of ovarian morphology for TT differed by menstrual cycle status. That sonographic markers did not predict androgen levels in a diverse cohort of women with cycle irregularity, suggests the potential for distinct variations in ovarian morphology for androgenic and non-androgenic types of cycle irregularity. Overall, our findings support that an assessment of ovarian morphology may be helpful in reflecting TT levels.

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Reliability and Agreement of Ultrasonographic Measures of the Ovarian Stroma: Impact of Methodology

Brink

Nosrati

Ortiz-Flores

et al. 2021

J of Ultrasound Medicine

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Objectives Increased ovarian stromal area (SA), stromal‐to‐ovarian area ratio (S/A), and echogenicity (SEcho) on ultrasonography have been proposed as diagnostic markers for polycystic ovary syndrome. Although several methods to evaluate the stroma exist, their reproducibility has not been defined which limits clinical utility. This study aimed to determine the interrater reliability and agreement of methods to evaluate SA, S/A, and SEcho. Methods Five raters tested 3 methods to obtain SA and S/A, and one to obtain SEcho on 30 ovarian cineloops under two imaging conditions, simulating real‐time (free‐choice) or offline (fixed‐frame) imaging. For SA, Method 1 subtracted follicular area from the ovarian area, Method 2 involved outlining the periphery of the stroma, and Method 3 represented a hybrid approach in which central follicles were subtracted from the outlined stroma. SEcho was scored on a subjective 3‐tiered scale. Intraclass correlation coefficients (ICCs) and the coefficient of variation were determined for SA and S/A, and Fleiss' kappa agreement statistics (κ) were determined for SEcho. Results Interrater reliability of SA was superior using Method 1 (ICC = 0.558 and ICC = 0.705) versus Method 2 (ICC = 0.522 and ICC = 0.230) or Method 3 (ICC = 0.429 and ICC = 0.305) under free‐choice and fixed‐frame imaging conditions, respectively. Interrater reliability of S/A was also moderate to poor across methods. SEcho was also not reliably assessed across raters (κ = <0.500). Conclusions Ultrasonographic assessments of the ovarian stroma were associated with moderate to poor reproducibility. Indirect estimates of the ovarian stroma (Method 1) could be optimized to yield a reproducible approach, clarifying the clinical relevance of the stroma.

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Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome

Cited by 40 publications

References 45 publications

Polycystic ovary morphology: age-based ultrasound criteria

Polycystic ovary morphology: age-based ultrasound criteria

Sonographic markers of ovarian morphology, but not hirsutism indices, predict serum total testosterone in women with regular menstrual cycles

Reliability and Agreement of Ultrasonographic Measures of the Ovarian Stroma: Impact of Methodology

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