Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial inv...Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI.Methods:A total of 53 patients with endometrial cancer,who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020,were evaluated in this study.Data were collected using a questionnaire on endometrial cancer.All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion.The involvement of myometrium thickness and histological findings were compared between two imaging modalities,and SPSS 23.0 was used to analyze the data.Results:Junctional irregularity was the most prevalent finding on transvaginal sonography.Based on transvaginal sonography,myometrial invasion of less than 50%was found in 73%of patients,while invasion of more than 50%was observed in 26.31%.In 57.44%of MRIs,there was less than 50%myometrial invasion,while in 42.55%of MRIs,there was more than 50%myometrial invasion.In both modalities,the most common finding was myometrial invasion of less than 50%.The accuracy,sensitivity,and specificity of transvaginal sonography were 0.47,0.27,and 0.75,respectively,whereas the accuracy,sensitivity,and specificity of MRI were 0.54,0.45,and 0.61,respectively.Conclusion:MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning,as well as reducing the complications of non-indicated lymphadenectomy.展开更多
Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa...Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.展开更多
AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic exami...AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades. and. hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen's kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a 'mosaic pattern'. In patients with grades III and IV hemorrhoids, the number of patients with 'mosaic pattern' as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a 'mosaic pattern' in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz's muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen's kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between 'mosaic pattern' in the TPUS and arteriovenous fistula in pathology was very good (K = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a 'mosaic pattern' in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. 'Mosaic pattern' may be a parameter for surgical indication of grades III and IV hemorrhoids.展开更多
Background Endometrial polyps （EPs） occur in approximately 34.9% of infertile women. Transvaginal sonography （TVS） is a routine, non-invasive component of fertility evaluation. Most ultrasonographic studies of EPs...Background Endometrial polyps （EPs） occur in approximately 34.9% of infertile women. Transvaginal sonography （TVS） is a routine, non-invasive component of fertility evaluation. Most ultrasonographic studies of EPs have focused on abnormal uterine bleeding; few have assessed EPs in infertile women. Furthermore, no studies have explored endometrial thickness and its correlation with EPs in infertile women. This study aimed to assess transvaginal sonographic assessment of endometrial thickness and its value in diagnosis and prediction of EPs in infertile women. Methods A retrospective study on 314 infertile women was conducted from June to December 2010. After TVS, endometrial biopsies were obtained by hysteroscopy. Pathologically confirmed EPs were taken as the gold standard. Results Based on recognized criteria, TVS had a sensitivity of 37.04%, specificity of 98.71%, positive predictive value of 90.91%, negative predictive value of 81.85%, and accuracy of 82.80% for diagnosing EPs. Mean endometrial thickness was significantly different in patients with and without EPs （P=0.0001）. In women in the mid and late-proliferative phase, the endometrial thickness was significantly greater in those with EPs than in those without them （P=0.0001 and 0.024）. Receiver operating characteristic analysis showed that endometrial thickness had a sensitivity of 85.2% and specificity of 38% in the diagnosis of EPs, the area under the curve being 0.64. In the mid-proliferative phase, sensitivity was up to 90.9%, the area under the curve being 0.70. Conclusions TVS is poor at detecting EPs in infertile women; however, transvaginal sonographic measurement of endometrial thickness is helpful. It is suggested that the diagnostic value of TVS for EPs in infertile women could be improved by adding the measurement of endometrial thickness to the variables that are routinely assessed.展开更多
文摘Background:The most prevalent type of gynecological cancer is endometrial cancer.Accurate surgical staging is the most important aspect in the management of endometrial cancer.Preoperative evaluation of myometrial invasion and appropriate management could be achieved by transvaginal sonography and pelvic MRI.Methods:A total of 53 patients with endometrial cancer,who were referred to a gynecology oncology department of an academic hospital in Mashhad University of Medical Sciences from 2018 to 2020,were evaluated in this study.Data were collected using a questionnaire on endometrial cancer.All the patients underwent preoperative transvaginal sonography and pelvic MRI to evaluate myometrial invasion.The involvement of myometrium thickness and histological findings were compared between two imaging modalities,and SPSS 23.0 was used to analyze the data.Results:Junctional irregularity was the most prevalent finding on transvaginal sonography.Based on transvaginal sonography,myometrial invasion of less than 50%was found in 73%of patients,while invasion of more than 50%was observed in 26.31%.In 57.44%of MRIs,there was less than 50%myometrial invasion,while in 42.55%of MRIs,there was more than 50%myometrial invasion.In both modalities,the most common finding was myometrial invasion of less than 50%.The accuracy,sensitivity,and specificity of transvaginal sonography were 0.47,0.27,and 0.75,respectively,whereas the accuracy,sensitivity,and specificity of MRI were 0.54,0.45,and 0.61,respectively.Conclusion:MRI can be the modality of choice for evaluating myometrial invasion and optimizing endometrial cancer treatment planning,as well as reducing the complications of non-indicated lymphadenectomy.
文摘Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.
基金the National Natural Science Foundation of China,No.81460133Innovation Program of regional Cooperation of Xinjiang Uygur Autonomous region,No.2016E02063
文摘AIM to evaluate the diagnostic value of different sonographic methods in hemorrhoids. METHODS Forty-two healthy volunteers and sixty-two patients with grades I -IV. hemorrhoids received two different sonographic examinations from January 2013 to January 2016 at the First and Second Hospitals of Xinjiang Medical University in a prospective way. We analyzed the ultrasonographic findings of these participants and evaluated the outcomes. Resected grades. and. hemorrhoid tissues were pathologically examined. The concordance of ultrasonographic results with pathology results was assessed with the Cohen's kappa coefficient. RESULTS All healthy volunteers and all patients had no particular complications related to sonography. There were no statistically significant differences between the participants regarding age (P = 0.5919), gender (P = 0.4183), and persistent symptoms (P > 0.8692). All healthy control participants had no special findings. However, 30 patients with hemorrhoids showed blood signals around the dentate line on ultrasonography. When grades I and II hemorrhoids were analyzed, there were no significant differences between transrectal ultrasound (TRUS), transperianal ultrasound (TPUS), and transvaginal ultrasound (TVUS) (P > 0.05). Grades III and IV hemorrhoids revealed blood flow with different directions which could be observed as a 'mosaic pattern'. In patients with grades III and IV hemorrhoids, the number of patients with 'mosaic pattern' as revealed by TRUS, TPUS and TVUS was 22, 12, and 4, respectively. Patients with grades III and IV disease presented with a pathologically abnormal cushion which usually appeared as a 'mosaic pattern' in TPUS and an arteriovenous fistula in pathology. Subepithelial vessels of resected grades III and IV hemorrhoid tissues were manifested by obvious structural impairment and retrograde and ruptured changes of internal elastic lamina. Some parts of the Trietz's muscle showed hypertrophy and distortion. Arteriovenous fistulas and venous dilatation were obvious in the anal cushion of hemorhoidal tissues. After pathological results with arteriovenous fistulas were taken as the standard reference, we evaluated the compatibility between the two methods according to the Cohen's kappa co-efficiency calculation. The compatibility (Cohein kappa co-efficiency value) between 'mosaic pattern' in the TPUS and arteriovenous fistula in pathology was very good (K = 0.8939). When compared between different groups, TRUS presented the advantage that the mosaic pattern could be confirmed in more patients, especially for group A. There was a statistical difference when comparing group A with group B or C (P < 0.05 for both). There were obvious statistical differences between group A and group B with regard to the vessel diameter and blood flow velocity measured by TRUS (P < 0.05). CONCLUSION Patients with grades III and IV hemorrhoids present with a pathologically abnormal cushion which usually appears as a 'mosaic pattern' in sonography, which is in accord with an arteriovenous fistula in pathology. There are clearly different hemorrhoid structures shown by sonography. 'Mosaic pattern' may be a parameter for surgical indication of grades III and IV hemorrhoids.
文摘Background Endometrial polyps （EPs） occur in approximately 34.9% of infertile women. Transvaginal sonography （TVS） is a routine, non-invasive component of fertility evaluation. Most ultrasonographic studies of EPs have focused on abnormal uterine bleeding; few have assessed EPs in infertile women. Furthermore, no studies have explored endometrial thickness and its correlation with EPs in infertile women. This study aimed to assess transvaginal sonographic assessment of endometrial thickness and its value in diagnosis and prediction of EPs in infertile women. Methods A retrospective study on 314 infertile women was conducted from June to December 2010. After TVS, endometrial biopsies were obtained by hysteroscopy. Pathologically confirmed EPs were taken as the gold standard. Results Based on recognized criteria, TVS had a sensitivity of 37.04%, specificity of 98.71%, positive predictive value of 90.91%, negative predictive value of 81.85%, and accuracy of 82.80% for diagnosing EPs. Mean endometrial thickness was significantly different in patients with and without EPs （P=0.0001）. In women in the mid and late-proliferative phase, the endometrial thickness was significantly greater in those with EPs than in those without them （P=0.0001 and 0.024）. Receiver operating characteristic analysis showed that endometrial thickness had a sensitivity of 85.2% and specificity of 38% in the diagnosis of EPs, the area under the curve being 0.64. In the mid-proliferative phase, sensitivity was up to 90.9%, the area under the curve being 0.70. Conclusions TVS is poor at detecting EPs in infertile women; however, transvaginal sonographic measurement of endometrial thickness is helpful. It is suggested that the diagnostic value of TVS for EPs in infertile women could be improved by adding the measurement of endometrial thickness to the variables that are routinely assessed.
