Juvenile granulosa cell tumour in the third trimester of pregnancy

This case report describes the rare finding of a granulosa cell tumour in the third trimester of pregnancy. The presentation, investigation, management, histopathological findings and subsequent follow up are detailed. The difficulties associated with such diagnoses in pregnancy are explored

Automated characterisation of ultrasound images of ovarian tumours: the diagnostic accuracy of a support vector machine and image processing with a local binary pattern operator

Introduction: Preoperative characterisation of ovarian masses into benign or malignant is of paramount importance to optimise patient management. Objectives: In this study, we developed and validated a computerised model to characterise ovarian masses as benign or malignant. Materials and methods: Transvaginal 2D B mode static ultrasound images of 187 ovarian masses with known histological diagnosis were included. Images were first pre-processed and enhanced, and Local Binary Pattern Histograms were then extracted from 2 × 2 blocks of each image. A Support Vector Machine (SVM) was trained using stratified cross validation with randomised sampling. The process was repeated 15 times and in each round 100 images were randomly selected. Results: The SVM classified the original non-treated static images as benign or malignant masses with an average accuracy of 0.62 (95% CI: 0.59-0.65). This performance significantly improved to an average accuracy of 0.77 (95% CI: 0.75-0.79) when images were pre-processed, enhanced and treated with a Local Binary Pattern operator (mean difference 0.15: 95% 0.11-0.19, p < 0.0001, two-tailed t test). Conclusion: We have shown that an SVM can classify static 2D B mode ultrasound images of ovarian masses into benign and malignant categories. The accuracy improves if texture related LBP features extracted from the images are considered

OC04.04 : A machine-learning algorithm to distinguish benign and malignant adnexal tumours from ultrasound images

The accurate preoperative diagnosis of adnexal tumours as benign or malignant is pivotal to optimise patient management. We developed a Machine Learning (ML) Algorithm to characterise adnexal tumours as benign or malignant from ultrasound images

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Ultrasound scan characterisation of ovarian masses

Background: Different ultrasound based models, rules and descriptors are used to characterise ovarian masses. LR2 is a logistic regression model with six variables to assess the preoperative risk of ovarian malignancy. Simple rules (SR) are ten features of an adnexal mass that may be identified using ultrasonography. Simple descriptors (SD) are five ultrasound characteristics and one based on age and serum CA 125 that enable an intuitive classification of adnexal masses. Objectives: The main aim was to assess the performance of the conventional (Risk of Malignancy Index RMI) and the IOTA (International Ovarian Tumour Analysis Group) models (LR2, SR and SD) and subjective assessment (SA) by examiners of varied ultrasound training and experience (level II). Methods: We carried out a prospective single-blinded randomised controlled trial (IOTA 4a) to investigate the referral pattern following the use of RMI and LR2. In IOTA 4b, diagnostic performance measures for LR2, RMI, SR, SD and SA were compared in a three-year multicentre prospective observational study. A prospective comparison was also carried out between LR2 and ROMA (Risk of Ovarian Malignancy Algorithm). Results: In the IOTA 4a RCT, LR2 correctly classified 100% of benign masses as low risk compared to 70% for RMI (difference of 30%. p<0.0001). In IOTA 4b study, a higher AUC for LR2 compared to RMI was observed in premenopausal women (0.93 and 0.83 respectively. p=0.05). Overall the combination of SD and SR were able to characterise 89% of masses (DOR of 348). Subjective assessment by level II ultrasound examiners had a DOR of 85.56. In relation to ROMA, the AUC of LR2 for discriminating between benign and malignant adnexal masses (0.952) was higher than that of ROMA (0.893) (p=0.0004). Conclusion: The overall test performance of IOTA LR2, SR and SD was maintained in the hands of examiners with varying levels of training and experience. This performance was generally better than the RMI. LR2 showed a better diagnostic performance than ROMA.Open Acces

Spontaneous Heterotopic Pregnancy Associated with Massive Intraperitoneal Haemorrhage and a Normal Heart Rate, Illustrating the Concept of Relative Bradycardia

A 28-year-old, 9 and a half weeks pregnant (spontaneous conception) multigravida presented with abdominal pain and vaginal bleeding. On examination, her abdomen was diffusely tender, particularly in the right iliac fossa, though guarding was absent. Transabdominal and transvaginal ultrasonography demonstrated a viable intrauterine pregnancy and large-volume intraperitoneal haemoperitoneum; the right ovary could not be identified. The patient became hypotensive with decreased responsiveness, yet her heart rate remained normal. She proceeded to surgery where a ruptured right tubal ectopic pregnancy was identified and right salpingectomy was performed. Estimated blood loss was 3900ml. Postoperative recovery was uneventful. Ultrasound 3 days after surgery demonstrated a viable intrauterine pregnancy of gestational age 9 weeks + 1 day. The patient remains well. Her anomaly scan at 20 weeks and 6 days showed normal growth, amniotic fluid, and Dopplers with no obvious structural defects. She is currently 27 weeks pregnant and will be rescanned at 36 weeks