Morphological ultrasound types known as ‘blob’ and ‘bagel’ signs should be reclassified from suggesting probable to indicating definite tubal ectopic pregnancy

Nadim, B.; Infante, F.; Lü, Chuan; Sathasivam, N.; Condous, G.

doi:10.1002/uog.17435

Cited by 24 publications

(19 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some researchers believe that, in many cases, ultrasound findings are non‐specific and they propose that a conclusive diagnosis of tubal EP can be made only in cases in which a gestational sac containing an embryo or a yolk sac is visible, whilst the other morphological types should be classified as probable EP. This approach has been questioned by others, who showed that conclusive ultrasound diagnosis of tubal EP could be made in most cases regardless of the morphological type.…”

Section: Introductionmentioning

confidence: 99%

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Dooley

Chaggar

Braud

et al. 2019

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objectives To assess the overall accuracy of transvaginal ultrasound (TVS) for diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also aimed to assess the positive predictive value (PPV) of TVS for each of the different ultrasound morphological types of EUEP. Methods This was a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP at a single early pregnancy unit between January 2009 and December 2017. The preoperative TVS findings were recorded, including the exact location and morphological type (Type I–V; defined using ultrasound criteria) of EUEP. TVS findings were compared with operative and histological findings. The performance of ultrasound in diagnosing EUEP overall and according to morphological type was assessed, using visual confirmation of ectopic pregnancy at surgery as the reference standard. Results A total of 26 401 women presented with early‐pregnancy complications during the study period, including 1241 (4.7%; 95% CI, 4.5–5.0%) women with a conclusive diagnosis of EUEP on TVS or a presumed diagnosis based on severe pain and significant hemoperitoneum. Surgery was performed in 721/1241 (58.1%; 95% CI, 55.3–60.8%) cases, of which 710 (98.5%; 95% CI, 97.6–99.4%) had a conclusive diagnosis of EUEP on preoperative TVS. The remaining 11 women had severe pain and significant hemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound examination. At laparoscopy, the diagnosis of EUEP was confirmed in 706/710 (99.4%; 95% CI, 98.6–99.8%) women with a positive ultrasound diagnosis and in all 11 women with a presumed ultrasound diagnosis of EUEP. The PPV of preoperative ultrasound for the diagnosis of EUEP was 99.4% (95% CI, 98.6–99.8%) with sensitivity of 98.5% (95% CI, 97.3–99.1%). There was no statistically significant difference in the accuracy of preoperative ultrasound diagnosis between the five morphological types (P = 0.76). Conclusions The accuracy of preoperative ultrasound for diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of preoperative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Dooley

Chaggar

Braud

et al. 2019

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…The retrospective and single‐centre nature limit our ability to suggest that M4 be introduced throughout Australia. A prospective multicentre interventional study could be undertaken, but it would require clear definitions of a PUL1, with clarity around what constitutes a definitive EP on TVS 16 . Considering that many early pregnancy units are staffed by registrars/residents and clinical fellows, proficiency in sonographic EP diagnosis must also be ensured in study design.…”

Section: Discussionmentioning

confidence: 99%

“…This is a retrospective observational diagnostic accuracy study, Women diagnosed with PUL were managed according to EPASspecific protocol that relies on an hCG ratio (48-h hCG/0-h) 16 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

External validation of risk prediction model M4 in an Australian population: Rationalising the management of pregnancies of unknown location

Nadim

Leonardi

Stamatopoulos

et al. 2020

Aust NZ J Obst Gynaeco

Self Cite

View full text Add to dashboard Cite

Background: The prediction model M4 can successfully classify pregnancy of unknown location (PUL) into a low-or high-risk group in developing ectopic pregnancy. M4 was validated in UK centres but in very few other countries outside UK. Aim: To validate the M4 model's ability to correctly classify PULs in a cohort of Australian women. Materials and Methods: A retrospective analysis of women classified with PUL, attending a Sydney-based teaching hospital between 2006 and 2018. The reference standard was the final characterisation of PUL: failed PUL (FPUL) or intrauterine pregnancy (IUP; low risk) vs ectopic pregnancy (EP) or persistent PUL (PPUL; high risk). Each patient was entered into the M4 model calculator and an estimated risk of FPUL/ IUP or EP/PPUL was recorded. Diagnostic accuracy of the M4 model was evaluated. Results: Of 9077 consecutive women who underwent transvaginal sonography, 713 (7.9%) classified with a PUL. Six hundred and seventy-seven (95.0%) had complete study data and were included. Final outcomes were: 422 (62.3%) FPULs, 150 (22.2%) IUPs, 105 (15.5%) EPs and PPULs. The M4 model classified 455 (67.2%) as low-risk PULs of which 434 (95.4%) were FPULs/IUPs and 21 (4.6%) were EPs or PPULs. EPs/PPULs were correctly classified with sensitivity of 80.0% (95% CI 71.1-86.5%), specificity of 75.9% (95% CI 72.2-79.3%), positive predictive value of 37.8% (95% CI 33.8-42.1%) and negative predictive value of 95.3% (95% CI 93.1-96.9%). Conclusions: We have externally validated the prediction model M4. It classified 67.2% of PULs as low risk, of which 95.4% were later characterised as FPULs or IUPs while still classifying 80.0% of EPs as high risk.

show abstract

“…Definitive diagnosis of ectopic pregnancy can be achieved by TVS, but it relies on a precise analysis of ultrasound findings [1,15-19]. However, in most emergency units, the initial TVS is usually performed by trainees or sonographers with basic expertise in OB/GYN scanning.…”

Section: Discussionmentioning

confidence: 99%

A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study

Dhombres¹,

Maurice²,

Guilbaud³

et al. 2019

J Med Internet Res

View full text Add to dashboard Cite

Background Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound. Objective This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality. Methods Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system. Results Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P <.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P <.001), and higher confidence in reporting conclusions (trust score: +20%; P <.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant ( P =.002 and P <.001, respectively). Conclusions The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).

show abstract

Morphological ultrasound types known as ‘blob’ and ‘bagel’ signs should be reclassified from suggesting probable to indicating definite tubal ectopic pregnancy

Cited by 24 publications

References 27 publications

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

External validation of risk prediction model M4 in an Australian population: Rationalising the management of pregnancies of unknown location

A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study

Contact Info

Product

Resources

About