Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis

Objective: To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. Methods: This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. Results: The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. Conclusions: The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Objetivo.Evaluar la precision diagnostica de diferentes indicios ecograficos para el diagnostico de la torsion anexial,utilizando la cirugia como patron de referencia. Metodos. Se trata de una revision sistematica y un metaanalisis de los estudios publicados entre enero de 1990 y noviembre de 2021 que evaluaron el edema ovarico, la masa anexial, los resultados del flujo Doppler ovarico, el ‘‘signo del remolino’’ (torsion ovarica) y el liquido pelvico como indicios ecograficos (pruebas de referencia) para detectar la torsion anexial, utilizando los resultados quirurgicos como patron de referencia. La busqueda de estudios se realizo en las bases de datos PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov y Web of Science.Para evaluar la calidad de los estudios se utilizo la herramienta de Evaluacion de Calidad de los Estudios de Precision Diagnostica-2 (QUADAS-2, por sus siglas en ingles). Se calcularon por separado los valores combinados de sensibilidad,especificidad y cocientes de verosimilitud positivos y negativos, y se determino tambien la probabilidad posterior a la prueba de la torsion anexial tras una prueba positiva o negativa. Resultados. La busqueda identifico 1267 citas, una vez excluidas las duplicadas. Se incluyeron dieciocho estudios en las sıntesis cualitativa y cuantitativa. Ocho estudios (809 pacientes) analizaron la presencia de edema ovarico, ocho estudios(1044 pacientes) analizaron la presencia de una masa anexial, 14 estudios (1742 pacientes) analizaron el flujo Doppler ovarico, seis estudios (545 pacientes) analizaron el ‘‘signo del remolino’’ y siete estudios (981 pacientes) analizaron la presencia de lıquido pelvico como indicios ecograficos de torsion anexial. En general, la calidad de la mayorıa de los estudios se considero moderada o buena. Sin embargo, hubo un alto riesgo de sesgo en una proporcion significativa de estudios en las areas de seleccion de pacientes y texto de referencia (con la excepcion del ‘‘signo del remolino’’). Los valores combinados de la sensibilidad, la especificidad y los cocientes de probabilidad positivos y negativos de cada indicio ecografico fueron del 58%, 86%, 4,0 y 0,49 para el edema ovarico, del 69%, 46%, 1,3 y 0,67 para la masa anexial, del 65%, 91%, 7,6 y 0,38 para el ‘‘signo del remolino’’, del 53%, 95%, 11,0 y 0,49 para los resultados del Doppler ovarico y del 55%, 69%, 1,7 y 0,66 para el liquido pelvico. La heterogeneidad fue elevada en todos los analisis. Conclusion. La presencia de una masa anexial o de liquido pelvico apenas tienen precision diagnostica como indicios ecograficos de torsion anexial, mientras que la presencia de edema ovarico, el ‘‘signo del remolino’’ y la disminucion o ausencia de flujo Doppler ovarico tienen una buena especificidad, pero una sensibilidad moderada para detectar la torsion anexial

Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis

Objective: To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. Methods: This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. Results: The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. Conclusions: The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Objetivo.Evaluar la precision diagnostica de diferentes indicios ecograficos para el diagnostico de la torsion anexial,utilizando la cirugia como patron de referencia. Metodos. Se trata de una revision sistematica y un metaanalisis de los estudios publicados entre enero de 1990 y noviembre de 2021 que evaluaron el edema ovarico, la masa anexial, los resultados del flujo Doppler ovarico, el ‘‘signo del remolino’’ (torsion ovarica) y el liquido pelvico como indicios ecograficos (pruebas de referencia) para detectar la torsion anexial, utilizando los resultados quirurgicos como patron de referencia. La busqueda de estudios se realizo en las bases de datos PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov y Web of Science.Para evaluar la calidad de los estudios se utilizo la herramienta de Evaluacion de Calidad de los Estudios de Precision Diagnostica-2 (QUADAS-2, por sus siglas en ingles). Se calcularon por separado los valores combinados de sensibilidad,especificidad y cocientes de verosimilitud positivos y negativos, y se determino tambien la probabilidad posterior a la prueba de la torsion anexial tras una prueba positiva o negativa. Resultados. La busqueda identifico 1267 citas, una vez excluidas las duplicadas. Se incluyeron dieciocho estudios en las sıntesis cualitativa y cuantitativa. Ocho estudios (809 pacientes) analizaron la presencia de edema ovarico, ocho estudios(1044 pacientes) analizaron la presencia de una masa anexial, 14 estudios (1742 pacientes) analizaron el flujo Doppler ovarico, seis estudios (545 pacientes) analizaron el ‘‘signo del remolino’’ y siete estudios (981 pacientes) analizaron la presencia de lıquido pelvico como indicios ecograficos de torsion anexial. En general, la calidad de la mayorıa de los estudios se considero moderada o buena. Sin embargo, hubo un alto riesgo de sesgo en una proporcion significativa de estudios en las areas de seleccion de pacientes y texto de referencia (con la excepcion del ‘‘signo del remolino’’). Los valores combinados de la sensibilidad, la especificidad y los cocientes de probabilidad positivos y negativos de cada indicio ecografico fueron del 58%, 86%, 4,0 y 0,49 para el edema ovarico, del 69%, 46%, 1,3 y 0,67 para la masa anexial, del 65%, 91%, 7,6 y 0,38 para el ‘‘signo del remolino’’, del 53%, 95%, 11,0 y 0,49 para los resultados del Doppler ovarico y del 55%, 69%, 1,7 y 0,66 para el liquido pelvico. La heterogeneidad fue elevada en todos los analisis. Conclusion. La presencia de una masa anexial o de liquido pelvico apenas tienen precision diagnostica como indicios ecograficos de torsion anexial, mientras que la presencia de edema ovarico, el ‘‘signo del remolino’’ y la disminucion o ausencia de flujo Doppler ovarico tienen una buena especificidad, pero una sensibilidad moderada para detectar la torsion anexial

Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis.

Background. After the LACC trial, the SUCCOR study, and other studies, we know that patients who have un- dergone minimally invasive surgery for cervical cancer have worse outcomes, but today, we do not know if the surgical approach can be a reason to change the pattern of relapses on these patients. We evaluated the relapse pattern in patients with stage IB1 cervical cancer (FIGO, 2009) who underwent radical hysterectomy with differ- ent surgical approaches. Methods. A systematic review of literature was performed in PubMed, Cochrane Library, Clinicaltrials.gov, and Web of science. Inclusion criteria were prospective or retrospective comparative studies of different surgical approaches that described patterns or locations of relapse in patients with stage IB1 cervical cancer. Heterogeneity was assessed by calculating I2. Results. The research resulted in 782 eligible citations from January 2010 to October 2020. After filtering, nine articles that met all inclusion criteria were analyzed, comprising data from 1663 patients who underwent radical hysterectomy for IB1 cervical cancer, and the incidence of relapse was 10.6%. When we compared the pattern of relapse (local, distant, and both) of each group (open surgery and minimally invasive surgery), we did not see statistically significant differences, (OR 0.963; 95% CI, 0.602–1.541; p = 0.898), (OR 0.788; 95% CI, 0.467–1.330; p = 0.542), and (OR 0.683; 95% CI, 0.331–1.407; p = 0.630), respectively. Conclusion. There are no differences in patterns of relapse across surgical approaches in patients with stage IB1 cervical cancer undergoing radical hysterectomy as primary treatment

Pattern of relapse in patients with stage IB1 cervical cancer after radical hysterectomy as primary treatment. Minimally invasive surgery vs. open approach. Systematic review and meta-analysis.

Background. After the LACC trial, the SUCCOR study, and other studies, we know that patients who have un- dergone minimally invasive surgery for cervical cancer have worse outcomes, but today, we do not know if the surgical approach can be a reason to change the pattern of relapses on these patients. We evaluated the relapse pattern in patients with stage IB1 cervical cancer (FIGO, 2009) who underwent radical hysterectomy with differ- ent surgical approaches. Methods. A systematic review of literature was performed in PubMed, Cochrane Library, Clinicaltrials.gov, and Web of science. Inclusion criteria were prospective or retrospective comparative studies of different surgical approaches that described patterns or locations of relapse in patients with stage IB1 cervical cancer. Heterogeneity was assessed by calculating I2. Results. The research resulted in 782 eligible citations from January 2010 to October 2020. After filtering, nine articles that met all inclusion criteria were analyzed, comprising data from 1663 patients who underwent radical hysterectomy for IB1 cervical cancer, and the incidence of relapse was 10.6%. When we compared the pattern of relapse (local, distant, and both) of each group (open surgery and minimally invasive surgery), we did not see statistically significant differences, (OR 0.963; 95% CI, 0.602–1.541; p = 0.898), (OR 0.788; 95% CI, 0.467–1.330; p = 0.542), and (OR 0.683; 95% CI, 0.331–1.407; p = 0.630), respectively. Conclusion. There are no differences in patterns of relapse across surgical approaches in patients with stage IB1 cervical cancer undergoing radical hysterectomy as primary treatment

Endometrial Cancer Individualized Scoring System (ECISS): A machine learning-based prediction model of endometrial cancer prognosis

Objective: To establish a prognostic model for endometrial cancer (EC) that individualizes a risk and management plan per patient and disease characteristics. Methods: A multicenter retrospective study conducted in nine European gynecologic cancer centers. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pretreatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). Results: Of 1150 women, 1144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88%, and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracies of models I, II, and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. Conclusion: The Endometrial Cancer Individualized Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy