Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review

Anthoulakis, Christos; Nikoloudis, N.

doi:10.1016/j.ygyno.2013.10.022

Cited by 96 publications

(65 citation statements)

References 48 publications

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“…Several attempts to address failures in imaging methods are currently underway; they range from the modelling of US evaluation and reporting, such as the simple rules of the International Ovarian Tumor Analysis group (6, 7), to the proposition ADNEX MR scoring system based on a simplified MRI protocol • 67 Uterine cancer 1 (13) Other (lymphoma) 1 (1.3)…”

Section: Discussionmentioning

confidence: 99%

“…MRI has the best potential for preoperative evaluation of adnexal masses. It has shown greater accuracy (88.9%) than transvaginal US (63.9%) in the characterization of adnexal masses as malignant, and better specificity (83.7% vs. 39.5%) (13). Systematic reviews showed that MRI has improved the preoperative evaluation of suspicious adnexal lesions.…”

mentioning

confidence: 99%

“…Systematic reviews showed that MRI has improved the preoperative evaluation of suspicious adnexal lesions. In the evaluation of ultrasound-indeterminate adnexal lesions, MRI could be considered as the gold standard, highlighting the high specificity of this imaging method in the characterization of benign lesions (13,14).…”

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confidence: 99%

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Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses

Pereira

Sarian

Yoshida

et al. 2018

Diagn Interv Radiol

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PURPOSEWe aimed to evaluate the ADNEX MR scoring system for the prediction of adnexal mass malignancy, using a simplified magnetic resonance imaging (MRI) protocol. METHODSIn this prospective study, 200 patients with 237 adnexal masses underwent MRI between February 2014 and February 2016 and were followed until February 2017. Two radiologists calculated ADNEX MR scores using an MRI protocol with a simplified dynamic study, not a high temporal resolution study, as originally proposed. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the area under the receiver operating characteristic curve were calculated (cutoff for malignancy, score ≥ 4). The reference standard was histopathologic diagnosis or imaging findings during >12 months of follow-up. RESULTSOf 237 lesions, 79 (33.3%) were malignant. The ADNEX MR scoring system, using a simplified MRI protocol, showed 94.9% (95% confidence interval [CI], 87.5%-98.6%) sensitivity and 97.5% (95% CI, 93.6%-99.3%) specificity in malignancy prediction; it was thus highly accurate, like the original system. The level of interobserver agreement on simplified scoring was high (κ = 0.91). CONCLUSIONIn a tertiary cancer center, the ADNEX MR scoring system, even based on a simplified MRI protocol, performed well in the prediction of malignant adnexal masses. This scoring system may enable the standardization of MRI reporting on adnexal masses, thereby improving communication between radiologists and gynecologists.You may cite this article as: Pereira PN, Sarian LO, Yoshida A, et al. Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses. Diagn Interv Radiol 2018; 24:63-71. A dnexal masses are frequent findings in pelvic and abdominal imaging studies, such as those conducted with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) (1). Preoperative evaluation of these lesions and determination of the risk of malignancy are critical to define treatment. A lesion with a low risk of malignancy can be followed or treated with minimally invasive surgery performed by a general gynecologist. When the risk of malignancy is significant, the patient should be referred to a tertiary center for treatment by a multidisciplinary team that includes an oncologic gynecologist (2, 3).Every year, about 240 000 women worldwide are diagnosed with ovarian cancer. The 5-year survival rate is less than 45%, and ovarian cancer is responsible for about 150 000 deaths annually. Thus, it is the seventh most common cancer and the eighth most common cause of cancer death among women (4).US is the first-line modality for the assessment of suspected adnexal masses, with very accurate results (5). However, US examination yields indeterminate findings in approximately 20% of adnexal masses (6-8). Exophytic and large tumors, fatty components, clots that mimic vegetation, and fibrous tumors have morphologic characteristics that are difficult to interpret with US. Other imaging methods (e...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses

Pereira

Sarian

Yoshida

et al. 2018

Diagn Interv Radiol

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“…Regarding conventional CT imaging, BML lung lesions appear as well-circumscribed, multiple bilateral nodules ranging from several millimiters to any centimeters, generally not calcified. Whole-body PET/CT using F-18 FDG [7] is largely used with the aim to differentiate malignant from benign uterine tumors; in general myomatous lesions have a low uptake of 18-FDG [8] while uterine sarcomas show a significantly higher uptake.…”

Section: [3]mentioning

confidence: 99%

Benign leiomyoma metastasizing to the lung: a case report and a brief review of the literature

Lazzari¹,

Perri²,

Scarpati³

et al. 2017

JUMD

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The authors have investigated a rare clinical condition consisting of a benign metastatic leiomyoma (BML) spreading in the lung, in a young woman. A 42-year-old woman affected by multiple pulmonary nodules histologically diagnosed as metastases from uterine sarcoma (one of them has been resected in the past and a pathologic diagnosis of uterine leyomiosarcoma was done) in concomitance with uterine bleeding, was referred to the Radiation Oncology Department of Taranto (Italy) Hospital, with the aim to perform an hemostatic radiotherapy after 4 cycles of induction chemotherapy. The patients underwent a myomectomy 9 years before. An accurate tissue samples review was performed both on myomectomy sample and on lung specimens, and as result, a diagnosis of BML was done, mainly on the basis of the mitotic activity. The patient was successfully treated with hysterectomy and oophorectomy followed by megestrol therapy, and a partial remission of the lung disease was obtained. Pulmonary metastatic leiomyomatosis should be considered in a premenopausal woman bearing a uterine myoma. The evaluation of the mitotic activity should be considered as the most reliable feature available to distinguish BML from uterine sarcoma. Key words:Leiomyoma, mitotic activity, uterine myoma, lung metastases, megestrol ABSTRACTArticle history:

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“…Studies have shown that MRI demonstrates sensitivity of 67 to 100% and specificity of 77 to 100% in the diagnosis of cancer. 14,15 These analysis also imply that MRI in some circumstance is recommended as second-line investigation for the characterization of complex adnexal masses that are indeterminate on US, although it is a more inexpensive investigation and is less readily available than US. …”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Role of Imaging in Dilemma of Adnexal Masses in Postmenopausal Women

Agarwal¹,

Gupta²,

Yadav³

et al. 2017

Journal of SAFOMS

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Adnexal masses in postmenopausal women represent a spectrum of conditions from gynaecologic and non gynaecologic sources. Post-menopausal women are especially at high risk of gynaecologic malignancy however even in this population majority of adnexal masses are benign. Tumor markers and high frequency transvaginal ultrasonography with doppler studies project high quality images allowing for detailed macroscopic appearances of masses and remain the least expensive modalities available. Adnexal masses that are suspicious for cancer, women should be referred to gynaecologic oncologist for optimal care.

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Pelvic MRI as the “gold standard” in the subsequent evaluation of ultrasound-indeterminate adnexal lesions: A systematic review

Cited by 96 publications

References 48 publications

Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses

Accuracy of the ADNEX MR scoring system based on a simplified MRI protocol for the assessment of adnexal masses

Benign leiomyoma metastasizing to the lung: a case report and a brief review of the literature

Role of Imaging in Dilemma of Adnexal Masses in Postmenopausal Women

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