OBJECTIVES: International Ovarian Tumor Analysis (IOTA) working group proposed a logistic regression (IOTA LR2) model. It is served as a risk prediction model for benign and malignant adnexal tumors. This study aims to compare the diagnostic efficiency between the IOTA LR2 model and doctors' subjective assessment on diagnosing benign and malignant adnexal mass. METHODS: The ultrasonographic images of 616 adnexal masses were retrospectively analyzed by the senior doctors' group and the junior doctors' group using the IOTA LR2 model and subjective assessment. The postoperative pathological diagnosis was used as the gold standard to compare the diagnostic efficiency of the 2 methods. RESULTS: The area under the curves of subjective assessment and IOTA LR2 model for diagnosing malignant adnexal masses were 0.86 and 0.90 for the senior doctors' group and 0.79 and 0.88 for the junior doctors' group, respectively. The sensitivity and specificity of subjective assessment for diagnosing the malignant adnexal masses were 81.0% and 91.3% for the senior doctors' group and 70.1% and 88.7% for the junior doctors' group, respectively. The sensitivity and specificity of the IOTA LR2 model for diagnosing the malignant adnexal masses were 79.6% and 88.1% for the senior doctors' group, and 79.6% and 81.7% for the junior doctors' group, respectively.There were no significant difference in the sensitivities between the senior doctors' group and junior doctors' group using the IOTA LR2 model and the senior doctors' group using subjective assessment (both P>0.05). CONCLUSIONS The diagnostic efficiency of the IOTA LR2 model is equal to the senior doctors' experiences. This model can help junior doctors to reduce the missed diagnosis of malignant adnexal masses.
Adnexal Diseases/pathology* ; Diagnosis, Differential ; Female ; Humans ; Ovarian Neoplasms/diagnostic imaging* ; Retrospective Studies

This article reports a patient who suffered from Wolffian adnexal tumor.We also briefly elucidate the pathogenesis,clinicopathological features,diagnosis,differentiation,and treatment of Wolffian adnexal tumor,with an attempt to increase the awareness of the disease and reduce misdiagnosis.
Adenoma ; Adnexal Diseases ; Female ; Humans ; Immunohistochemistry ; Wolffian Ducts

Isolated tubal torsion is an uncommon cause of acute abdomen in pregnancy. Tubal torsion may occur in the absence of adnexal disease. Diagnosing tubal torsion is especially difficult in pregnancy because no precise preoperative radiological and biochemical investigations have been conducted. Most patients are diagnosed during surgery. Here, I present a case of isolated tubal torsion in a pregnant woman at 35 weeks and 6 days of gestation that was managed with salpingectomy and cesarean section simultaneously.
Abdomen, Acute ; Abdominal Pain ; Adnexal Diseases ; Cesarean Section ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Third ; Pregnancy ; Pregnant Women ; Salpingectomy ; Torsion Abnormality

OBJECTIVE: To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain. METHODS: This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS). RESULTS: There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55–222] vs. 100 [50–185] minutes, P=0.137) and estimated blood loss (50 [30–1,500] vs. 125 [30–1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2–6] vs. 3.5 [2–5], P=0.478), 6 to 8 hours (3.5 [2–6] vs. 3 [1–8], P=0.478), and 16 to 24 hours (3 [2–4] vs. 3 [1–7], P=0.664) did not differ between groups. CONCLUSION: Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.
Adnexal Diseases* ; Anesthesia, Local ; Bupivacaine ; Cohort Studies ; Female ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Prospective Studies ; Surgical Instruments ; Visual Analog Scale

BACKGROUND: The IOTA Simple Rules provide a standardized ultrasound description in order to correctly classify ovarian tumors as benign or malignant even among non - expert readers. Its high accuracy rate was noted in foreign studies but was never validated in the local setting. The IOTA inconclusive tumors that were either assumed to be malignant or referred to experts in other studies were separately addressed in this research.

GENERAL OBJECTIVE: To determine the accuracy of the IOTA Simple Rules to predict malignant ovarian tumors

MATERIALS AND METHODS: Subjects: Patients with ovarian tumors admitted for surgery with complete ultrasound records done at Women's Health Unit and those with histopathologic report from the Department of Pathology. Setting: Department of Obstetrics and Gynecology in a tertiary hospital from August 2015 to February 2017. Design: Cross-sectional Diagnostic Accuracy Test. Data Collection: After obtaining approval from the IRB and Office of the Medical Director, the ovarian tumors were tallied and categorized according to their IOTA classification and final histopathologic diagnoses. The sensitivity, specificity, positive and negative predictive values, and accuracy were obtained using a 2x2 table. The biopsy reports of the inconclusive tumors were also reviewed and the sonographic characteristics of those which turned out to be malignant were noted.

RESULTS: A total of 110 adnexal masses were included, with the IOTA Simple Rules applicable in 84.55% of cases. It produced an accuracy rate of 100%. Among the 17 inconclusive tumors, two proved to be truly malignant with the presence of only one papillarity in a borderline tumor and the complex appearance of a germ cell tumor.

CONCLUSION: The IOTA Simple Rules is an accurate preoperative diagnostic tool in predicting ovarian malignancy. Two malignant tumors were classified as inconclusive and their sonographic characteristic of only one papillarity and the complex appearance of these tumors may warrant malignancy.

Human ; Female ; Gynecology ; Obstetrics ; Physician Executives ; Tertiary Care Centers ; Ethics Committees, Research ; Adnexal Diseases ; Ovarian Neoplasms ; Ultrasonography ; Sensitivity And Specificity ; Biopsy ; Neoplasms, Germ Cell And Embryonal

BACKGROUNDSingle port laparoscopic surgery (SPLS) is an innovative approach that is rapidly gaining recognition worldwide. The aim of this study was to determine the feasibility and safety of SPLS compared to conventional laparoscopic surgery for the treatment of benign adnexal masses.

METHODSIn total, 99 patients who underwent SPLS for benign adnexal masses between December 2013 and March 2015 were compared to a nonrandomized control group comprising 104 conventional laparoscopic adnexal surgeries that were performed during the same period. We retrospectively analyzed multiple clinical characteristics and operative outcomes of all the patients, including age, body mass index, size and pathological type of ovarian mass, operative time, estimated blood loss (EBL), duration of postoperative hospital stay, etc.

RESULTSNo significant difference was observed between the two groups regarding preoperative baseline characteristics. However, the pathological results between the two groups were found to be slightly different. The most common pathological type in the SPLS group was mature cystic teratoma, whereas endometrioma was more commonly seen in the control group. Otherwise, the two groups had comparable surgical outcomes, including the median operation time (51 min vs. 52 min, P = 0.909), the median decreased level of hemoglobin from preoperation to postoperation day 3 (10 g/L vs. 10 g/L, P = 0.795), and the median duration of postoperative hospital stay (3 days vs. 3 days, P = 0.168). In SPLS groups, the median EBL and the anal exsufflation time were significantly less than those of the conventional group (5 ml vs. 10 ml, P < 0.001; 10 h vs. 22 h, P < 0.001).

CONCLUSIONSSPLS is a feasible and safe approach for the treatment of benign adnexal masses. Further study is required to better determine whether SPLS has significant benefits compared to conventional techniques.

Adnexal Diseases ; surgery ; Adult ; Case-Control Studies ; Dermoid Cyst ; surgery ; Endometriosis ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Operative Time ; Ovarian Neoplasms ; surgery ; Retrospective Studies ; Young Adult

OBJECTIVE: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. MATERIALS AND METHODS: This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. RESULTS: Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). CONCLUSION: Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.
Acute Pain/diagnosis/radiography ; Adnexa Uteri/pathology/*radiography ; Adnexal Diseases/*radiography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Child ; Female ; Humans ; Middle Aged ; Pelvis/radiography ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed/*methods ; Torsion Abnormality/*diagnosis/*radiography ; Young Adult

OBJECTIVE: To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset. RESULTS: Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 +/- 2.2 mGy) and DLP (641.2 +/- 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 +/- 2.7 mGy) and DLP (923.6 +/- 158.8 mGy) of UE + ECT (p < 0.0001). CONCLUSION: The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.
Adnexal Diseases/*radiography/surgery ; Adolescent ; Adult ; Aged ; Child ; Cone-Beam Computed Tomography ; Contrast Media/*diagnostic use ; Female ; Humans ; Middle Aged ; Multidetector Computed Tomography/*methods ; ROC Curve ; Radiation Dosage ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Young Adult

Adenoma ; metabolism ; pathology ; surgery ; ultrastructure ; Adnexa Uteri ; pathology ; surgery ; Adnexal Diseases ; metabolism ; pathology ; surgery ; Carcinoma, Endometrioid ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Granulosa Cell Tumor ; metabolism ; pathology ; Humans ; Hysterectomy ; Keratins ; metabolism ; Leiomyomatosis ; pathology ; surgery ; Microscopy, Electron ; Middle Aged ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; ultrastructure ; Sertoli-Leydig Cell Tumor ; metabolism ; pathology ; Uterine Neoplasms ; pathology ; surgery ; Vimentin ; metabolism ; WT1 Proteins ; metabolism

BACKGROUNDWith the advent of color Doppler flow imaging (CDFI) and technological development of detection of serum tumor markers, new opportunities are presented to the improved risk of malignancy index (RMI) based on Jacobs' research for predicting ovarian malignancy in patients with adnexal masses.

METHODSOne hundred and eighty women with an adnexal mass admitted for primary laparotomy were studied. Tumor specific growth factor (TSGF) adjusted ultrasound scores and the results of Doppler blood flow analysis were obtained before the operation. Based on the parameters which had been studied in Jacobs' research, TSGF levels and the findings of color Doppler flow imaging, the risk of malignancy model was redesigned using a binary Logistic regression model. The diagnostic efficacy of the improved risk of malignancy index (improved RMI) was compared with the Jacobs' model RMI by receiver operator characteristic (ROC) curve.

RESULTSThe ROC curve showed a higher sensitivity (Mcnamer's test, P < 0.05) in the discrimination between benign and malignant adnexal masses for the improved RMI than the RMI. Compared with the RMI, the improved RMI had an advantage in prediction of ovarian germ cell tumors and granular cell tumor (28.57% vs.71.43%, P < 0.05) and the early stage tumors and borderline tumors (33.33% vs. 66.67%, P < 0.05).

CONCLUSIONThe predictability of the improved RMI is better than the classic Jacobs' model, especially in diagnosis of the ovarian germ cell tumors and granular cell tumor and other early stage adnexal tumors.

Adnexal Diseases ; blood ; diagnosis ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; CA-125 Antigen ; blood ; Child ; Female ; Humans ; Logistic Models ; Middle Aged ; Ovarian Neoplasms ; blood ; diagnosis ; Ultrasonography, Doppler, Color ; Young Adult