A pure and bizarre ovarian malignancy - choriocarcinoma: case report

Germ cell malignancies represent 15% of ovarian cancers in Asians. Choriocarcinoma is a malignant tumor of the ovary with trophoblastic differentiation can be gestational or non-gestational in origin the study is aimed to increase awareness of rare malignant cancer in children that can present in uncommon symptoms and is diagnosed only if the doctor is vigilant. It is a prospective observational case report. Though uncommon a cancer, choriocarcinoma cases have been reported several times in the literature with no definitive treatment plan. The neoadjuvant chemotherapy followed by surgery has proven too successful in the above case. A multidisciplinary approach to juvenile cancer can have a fruitful outcome with high cure rates. The rarity of this cancer makes it difficult to have clear cut diagnosis fixed treatment plan. A good history taking and easy availability of ultrasound with fast-track referral can save many lives from the deadly disease like cancer. Due to paucity of data in regard to pure choriocarcinoma this case report may help in gathering more attention to the research towards this cancer

Factors influencing pregnancy outcome in women with vaginal bleeding before midpregnancy: a prospective case control study

Background: Pregnancy complications are observed to be higher among women with first trimester bleeding compared to those without bleeding. We intended to compare the obstetric outcome based on details of bleeding episodes, i) in groups with spotting, bleeding and brown discharge; ii) in those with or without subchorionic haemorrhage; and iii) between single versus recurrent episodes of bleeding.Methods: We conducted a prospective case control study involving the women enrolled for antenatal care before 20 weeks of gestation. Information was collected regarding the details of bleeding, the pregnancy complications and the perinatal outcome. The outcome variables were analysed as per the study objectives using SPSS version 16.0.Results: Pregnancies complicated by bleeding before 20 weeks of gestation were associated with the significant increase in preterm premature rupture of the membranes [P 0.045; RR 4.8 (95% CI 1.5-15)], intrauterine growth restriction [P 0.039; RR 2.5(95% CI 1.1-6.3)], oligohydramnios [RR  4.3 (95% CI 2-9)], hypertension [RR 1.8 (95% CI 1.07-3.09)], small for gestational age babies [P 0.047; RR 2.7 (95% CI 1.2-6.1)] and NICU admissions [P 0.016; RR 2.7 (95% CI 1.1-6.5)]. Fresh bleeding/ spotting were associated with increased pregnancy complications (P 0.048) compared to brownish discharge. Presence of subchorionic hemorrhage on ultrasound in women with vaginal bleeding was associated with increased pregnancy complications (P 0.044). No difference in terms of complications, mean gestational age and mean birth weight was noted depending on the number of episodes of bleeding.Conclusions: Fresh bleeding and presence of subchorionic hemorrhage predict a poor pregnancy outcome in women with bleeding before 20 weeks of pregnancy

Comparison of CA-125, conventional ultrasound and CT imaging in diagnosis and staging of ovarian cancer correlated with surgico-pathological findings

Background: Preoperative evaluation of suspected ovarian malignancy is of paramount importance and a diagnostic tool with high degree of precision helps treating physician in planning appropriate surgery and also neoadjuvant chemo therapy in candidates who are not currently fit for extensive surgical procedure. Though the ultrasound examination of abdomen and pelvis helps one in detection and characterization of adnexal lesion to some extent, its diagnostic ability is further improved by addition of advanced imaging techniques such as computed tomography, magnetic resonance imaging and thus can prove beneficial in choosing patient for right surgery, there by optimising the treatment outcome. Objective of current study was to compare ultrasonography imaging, CT imaging, CA-125 values, RMI 3 score, surgical staging and histopathological findings in carcinoma ovary.Methods: The study is a prospective observational study, carried out between September 2011 and July 2013, in the department of obstetrics and gynaecology, Kasturba hospital, Manipal. All cases of carcinoma ovary who underwent imaging (USG, CT/ MRI) were followed by staging laparotomy during the course of study. All cases of carcinoma ovary who has undergone neoadjuvant chemotherapy were excluded. All patients included in the study underwent CA-125 estimation, conventional ultrasound, CT scan (Sixty four slice with contrast) followed by staging laparotomy and histopathological examination of the specimen. RMI-3 (Risk Malignancy Index Score-3) was calculated in all cases.Results: 54 patients were included in the evaluation. The efficacy of CT (Sensitivity 95.1%, specificity 46.2%) and Ultrasound (Sensitivity 90.2%, specificity 53.8%) were comparable in detection of ovarian malignancy. Combination of CT and USG (Sensitivity 95%, specificity 78.6%) gave the best result in non-invasive investigations whereas combination of CT and surgical staging (Sensitivity 95.1%, specificity 84.6%) gave a better result when invasive modalities were considered. RMI-3 score had sensitivity of 82% and specificity of 64% and did not improve the accuracy.Conclusions: Optimal preoperative evaluation was achieved with combination of USG and CT. Additional of CA-125 further improved the precision. All the three modes had good diagnostic performances, and complimented each other in further refining the characterization of the mass, local spread and distant tumour dissemination

Influence of placental position on obstetric morbidity in placenta previa

Background: In placenta previa, the placenta occupies lower uterine segment and is likely to separate during pregnancy, resulting in significant maternal and perinatal morbidity and mortality. It has been well studied as the degree of placenta previa increases, the risk of bleeding also increases. However, there are few studies regarding configuration of placenta in relation to uterine wall (anterior, posterior or lateral) and associated complications. The primary purpose of this retrospective cohort study is to examine the whether the location of placenta in relation to lower uterine segment during caesarean delivery influences development of bleeding complications necessitating various surgical interventions. The secondary objective was to study various factors such as preterm delivery, fetal growth restriction, perinatal deaths and postpartum haemorrhage in relation to location of placenta.Methods: We conducted a retrospective study of 89 patients with placenta previa with ultrasonographically mapped placenta over a period of 5 years. The subjects were further categorized into anterior, posterior and lateral group depending upon location of placenta in relation to uterine wall. Differences between age, parity, history of previous caesarean delivery, antepartum haemorrhage, preterm deliveries, foetal growth restriction, perinatal deaths, operative complications and surgical interventions, placenta accreta and postpartum haemorrhage were studied and also were compared to traditional classification of placenta previa in relation to internal cervical ostium. The statistical analysis of the data was performed according to Pearson Chi-square test, one way ANOVA test using SPSS Software.Results: The overall incidence of placenta previa was 1.01%. Placental location was anterior in 23 women (25.8%), posterior in 49 women ((55%) and lateral in 17 (19.1%). No significant differences were found in these groups regarding age, gestational age at delivery, parity, previous history of caesarean delivery, incidence of antepartum and postpartum haemorrhage. Need for surgical interventions such as uterine artery ligation, internal iliac artery plication, caesarean hysterectomy was not specific any type of placenta previa. 39.1% of anterior, 40% of posterior and 35.2% of lateral placenta previa received blood component therapy and this variation was not statistically significant. The overall perinatal mortality was 45/1000 live births and mortality rate did not vary significantly in any of the groups.Conclusions: It is difficult to assign a maternal or perinatal morbidity risk to a particular type of placental location. The need for specialized surgical intervention such as uterine / internal iliac artery ligation, peripartum hysterectomy can arise irrespective of placental location, whether underneath the surgical incision (anterior), proximity to main uterine trunks (lateral) or encountered after the delivery of the baby (posterior). Pregnancies complicated by placenta previa must be delivered in the hospitals having expertise of senior and skilled surgeons and well equipped blood bank and good neonatal intensive care unit

Artificial intelligence and visual inspection in cervical cancer screening

INTRODUCTION: Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm.METHODS: A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values.RESULTS: Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively.CONCLUSION: This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.</p

Artificial intelligence and visual inspection in cervical cancer screening

INTRODUCTION: Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm.METHODS: A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values.RESULTS: Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively.CONCLUSION: This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.</p

Artificial intelligence and visual inspection in cervical cancer screening

INTRODUCTION: Visual inspection with acetic acid is limited by subjectivity and a lack of skilled human resource. A decision support system based on artificial intelligence could address these limitations. We conducted a diagnostic study to assess the diagnostic performance using visual inspection with acetic acid under magnification of healthcare workers, experts, and an artificial intelligence algorithm.METHODS: A total of 22 healthcare workers, 9 gynecologists/experts in visual inspection with acetic acid, and the algorithm assessed a set of 83 images from existing datasets with expert consensus as the reference. Their diagnostic performance was determined by analyzing sensitivity, specificity, and area under the curve, and intra- and inter-observer agreement was measured using Fleiss kappa values.RESULTS: Sensitivity, specificity, and area under the curve were, respectively, 80.4%, 80.5%, and 0.80 (95% CI 0.70 to 0.90) for the healthcare workers, 81.6%, 93.5%, and 0.93 (95% CI 0.87 to 1.00) for the experts, and 80.0%, 83.3%, and 0.84 (95% CI 0.75 to 0.93) for the algorithm. Kappa values for the healthcare workers, experts, and algorithm were 0.45, 0.68, and 0.63, respectively.CONCLUSION: This study enabled simultaneous assessment and demonstrated that expert consensus can be an alternative to histopathology to establish a reference standard for further training of healthcare workers and the artificial intelligence algorithm to improve diagnostic accuracy.</p

Investigating feasibility of 2021 WHO protocol for cervical cancer screening in underscreened populations:PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC)

Abstract Background High-risk human papillomavirus (hrHPV) testing has been recommended by the World Health Organization as the primary screening test in cervical screening programs. The option of self-sampling for this screening method can potentially increase women’s participation. Designing screening programs to implement this method among underscreened populations will require contextualized evidence. Methods PREvention and SCReening Innovation Project Toward Elimination of Cervical Cancer (PRESCRIP-TEC) will use a multi-method approach to investigate the feasibility of implementing a cervical cancer screening strategy with hrHPV self-testing as the primary screening test in Bangladesh, India, Slovak Republic and Uganda. The primary outcomes of study include uptake and coverage of the screening program and adherence to follow-up. These outcomes will be evaluated through a pre-post quasi-experimental study design. Secondary objectives of the study include the analysis of client-related factors and health system factors related to cervical cancer screening, a validation study of an artificial intelligence decision support system and an economic evaluation of the screening strategy. Discussion PRESCRIP-TEC aims to provide evidence regarding hrHPV self-testing and the World Health Organization’s recommendations for cervical cancer screening in a variety of settings, targeting vulnerable groups. The main quantitative findings of the project related to the impact on uptake and coverage of screening will be complemented by qualitative analyses of various determinants of successful implementation of screening. The study will also provide decision-makers with insights into economic aspects of implementing hrHPV self-testing, as well as evaluate the feasibility of using artificial intelligence for task-shifting in visual inspection with acetic acid. Trial registration ClinicalTrials.gov, NCT05234112 . Registered 10 February 202