Pagliuca, M. (Mariachiara)
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- Superficial endometriosis at ultrasound examination - a diagnostic criteria proposal(2023) Vieira-de-Oliveira, Y. (Ygor); Alcazar, J.L. (Juan Luis); Guerriero, S. (Stefano); Graupera, B. (Betlem); Podgaec, S. (Sergio); Pagliuca, M. (Mariachiara); Chesa-Pascual, M.A. (María Ángeles); Camargos, E. (Esdras); Pedrassani, M. (Marcelo); Ajossa, S. (Silvia)The actual prevalence of superficial endometriosis is not known. However, it is considered the most common subtype of endometriosis. The diagnosis of superficial endometriosis remains difficult. In fact, little is known about the ultrasound features of superficial endometriotic lesions. In this study, we aimed to describe the appearance of superficial endometriosis lesions at ultrasound examination, with laparoscopic and/or histologic correlation. This is a prospective study on a series of 52 women with clinical suspicion of pelvic endometriosis who underwent preoperative transvaginal ultrasound and received a confirmed diagnosis of superficial endometriosis via laparoscopy. Women with ultrasound or laparoscopic findings of deep endometriosis were not included. We observed that superficial endometriotic lesions may appear as a solitary lesions, multiple separate lesions, and cluster lesions. The lesions may exhibit the presence of hypoechogenic associated tissue, hyperechoic foci, and/or velamentous (filmy) adhesions. The lesion may be convex, protruding from the peritoneal surface, or it may appear as a concave defect in the peritoneum. Most lesions exhibited several features. We conclude that transvaginal ultrasound may be useful for diagnosing superficial endometriosis, as these lesions may exhibit different ultrasound features.
- O-RADS classification for ultrasound assessment of adnexal masses: agreement between IOTA lexicon and ADNEX model for assigning risk group(2023) Yakcich, J. (Javiera); Alcazar, J.L. (Juan Luis); Guerriero, S. (Stefano); Springer, S. (Serena); González de Canales-Díaz, J. (Juan); Brotóns-Almandoz, I. (Isabel); Pagliuca, M. (Mariachiara); Vara-García, J. (Julio); Pascual, M.A. (Maria Angela); Ajossa, S. (Silvia)Background: The O-RADS system is a new proposal for establishing the risk of malignancy of adnexal masses using ultrasound. The objective of this study is to assess the agreement and diagnostic performance of O-RADS when using the IOTA lexicon or ADNEX model for assigning the O-RADS risk group. Methods: Retrospective analysis of prospectively collected data. All women diagnosed as having an adnexal mass underwent transvaginal/transabdominal ultrasound. Adnexal masses were classified according to the O-RADS classification, using the criterion of the IOTA lexicon and according to the risk of malignancy determined by the ADNEX model. The agreement between both methods for assigning the O-RADS group was estimated using weighted Kappa and the percentage of agreement. The sensitivity and specificity of both approaches were calculated. Results: 454 adnexal masses in 412 women were evaluated during the study period. There were 64 malignant masses. The agreement between the two approaches was moderate (Kappa: 0.47), and the percentage of agreement was 46%. Most disagreements occurred for the groups O-RADS 2 and 3 and for groups O-RADS 3 and 4. The sensitivity and specificity for O-RADS using the IOTA lexicon and O-RADS using the ADNEX model were 92.2% and 86.1%, and 85.9% and 87.4%, respectively. Conclusion: The diagnostic performance of O-RADS classification using the IOTA lexicon as opposed to the IOTA ADNEX model is similar. However, O-RADS group assignment varies significantly, depending on the use of the IOTA lexicon or the risk estimation using the ADNEX model. This fact might be clinically relevant and deserves further research.
- Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis(Wiley, 2021) Martínez, L. (L.); Alcazar, J.L. (Juan Luis); Guerriero, S. (Stefano); Pagliuca, M. (Mariachiara); Pascual, M.A. (Maria Angela); Gómez, I. (I.); Ajossa, S. (Silvia)Objective To evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard. Methods A search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. 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 for TVS in the detection of parametrial deep endometriosis were calculated, and the post-test probability of parametrial deep endometriosis following a positive or negative test was determined. Results The search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10–64%), 98% (95% CI, 95–99%), 18.5 (95% CI, 8.8–38.9) and 0.70 (95% CI, 0.46–1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10–68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post-test probability of parametrial deep endometriosis. Conclusion TVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis.
- Advances in imaging for assessing pelvic endometriosis(2022) Deiala, F. (Fabio); Saba, L. (Luca); Alcazar, J.L. (Juan Luis); Guerriero, S. (Stefano); Graupera, B. (Betlem); Springer, S. (Serena); Taccori, V. (Valeria); Pilloni, M. (Monica); Pagliuca, M. (Mariachiara); Pascual, M.A. (Maria Angela); Ajossa, S. (Silvia); Borzacchelli, A. (Antonietta)In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16 alpha-[18F]fluoro-17 beta-estradiol.