Diagnosis of ovarian tumors by transvaginal Doppler ultrasound with color flow imaging]

Ovarian carcinoma is a silent disease with few symptoms. Early detection of ovarian cancer is difficult. Transvaginal Doppler ultrasound with color flow imaging is a new technique in the evaluation of gynecological diseases. This method was used in the diagnosis of ovarian tumors in 39 women who were treated in the Department of Obstetrics and Gynecology, Nagoya University Hospital. Wave forms of the parenchymal tumor arteries or tumor surface arteries were compared by according to the pulsatility index (PI). 1/PI was 0.69 +/- 0.04 in benign tumor and 2.33 +/- 1.36 in malignant tumors (p less than 0.01). When the cutoff value of 1/PI was set at 0.8 (cutoff value of PI: 1.25), the accuracy of diagnosis was 84.6% (33/39). The accuracy of ultrasonographic pattern classification and CA125 were 74.4% (29/39) and 53.8% (21/39), respectively. In 18 tumors with low CA125 (less than 35 U/ml), 5 of 7 malignant tumors (71.4%) had high 1/PI (greater than 0.8), and benign tumor, low 1/PI (less than 0.8) or non-detectable wave forms. This procedure should prove to be useful in the diagnosis of ovarian cancer.     

Conventional B-mode and transvaginal color Doppler in ultrasound assessment of ectopic pregnancy

The study was arranged in two parts. In the first part, 43 of the clinically suspected ectopic pregnancies were sent for a transvaginal color Doppler examination. Both cystic and complex adnexal masses were carefully scanned for their Doppler flow characteristics. The Pourcelot index (RI) was calculated and the RI 0.40 was used as a cut-off point to differentiate the trophoblastic (RI less than 0.40) and the normal blood flow (RI greater than 0.40). The diagnosis was confirmed by the beta hCG serum test. Three false-negative and one false-positive findings were obtained. The transvaginal color and pulsed Doppler study of the flow within ectopic pregnancy has a high degree of sensitivity (87.5%), specificity (94.7%) and accuracy (90.7%). Pelvic sonograms of another 110 patients with proven ectopic pregnancy were reviewed retrospectively. The ectopic gestational sac with the alive embryo was documented in 11.8% cases and without the embryo in 30.4% cases. A mixed, solid or cystic adnexal mass was detected in 57.8% patients. Intrauterine findings showed a pseudogestational sac in 13.6% cases, a cluster configuration in 18.6% cases and a linear configuration in 67.8% cases. Criteria for the ultrasound diagnosis of ectopic pregnancy influencing its specificity, sensitivity and accuracy are discussed.     

Transvaginal color Doppler and CA125 as tools in the differential diagnosis of postmenopausal ovarian masses

Objective: To evaluate whether transvaginal color Doppler and CA125 are valid in differentiating malignant from benign postmenopausal ovarian masses. Methods: Sixty-two women with ovarian masses were studied with transvaginal color Doppler ultrasound before surgery. Serum CA125 levels were also measured. Resistance index (RI) and pulsatility index (PI) were calculated from the waveforms generated from blood flow within the ovary. Results: Benign tumors had a significantly higher pulsatility index (mean 1.23 ± 1.02; range 0.65–2.99) and resistive index (mean 0.78 ± 0.22; range 0.5–1.1) than did malignant tumors. However some overlap in individual values for benign and malignant lesions was found. RI and PI sensitivity were significantly higher than those with CA125 (P < 0.05). Blood flow was detectable by color Doppler imaging in 95% of cases with malignant masses. Conclusion: Doppler sonographic evaluation of resistance and pulsatility indexes in the vessels of ovarian masses together with CA125 increased the sensitivity of prediction of malignancy for pelvic masses, but further work is needed before the validity of these factors is proved.     

Preoperative CA125 as a prognostic factor in stage I epithelial ovarian cancer

The purpose of the present study was to evaluate preoperative CA125 as a prognostic factor in stage I epithelial ovarian cancer (EOC). Preoperative serum CA125 levels from 118 women with FIGO (International Federation of Gynaecology and Obstetrics) stage I EOC were analysed and the prognostic value was evaluated and compared with other prognostic factors (age, grade, substages, histologic type). By the Kaplan-Meier estimate we demonstrated that patients with stage I EOC and preoperative serum CA125 levels <65 U/mL had a significantly longer survival compared to stage I EOC patients with preoperative serum CA125 > or = 65 U/mL (p=0.01). The results from the present study may be useful for decision making respecting postoperative chemotherapy in stage I EOC patients. Serum CA125 levels might therefore be included as a prognostic factor in future clinical trials of stage I EOC.     

阴道彩色多普勒探测不孕症妇女卵巢动脉血流变化与卵泡成熟度的关系

目的　探测卵巢因素引起的不孕症妇女的卵巢动脉血流变化与卵泡成熟度的关系。方法　经阴道探头探测卵巢动脉血流指标和卵泡生长情况。结果　正常健康组随着卵泡的生长 ,卵巢动脉的搏动指数 (PI)、阻力指数 (RI)值逐渐减低 ;不孕症未经治疗组 ,卵泡无明显增大 ,卵巢动脉的PI、RI值未见逐渐降低 ;两者相比 (P <0 .0 1)。不孕症经治疗组随着卵泡的生长 ,卵巢动脉的PI、RI值出逐渐降低 ,与正常健康组相比 (P >0 .0 5 )。结论　不孕症患者卵巢动脉血流变化与卵泡成熟度密切相关 ,二者呈负相关。测量卵巢动脉的PI、RI值可作为不孕症监测的重要指标之一。     

经阴道彩色多普勒对宫角妊娠诊断的临床价值

目的 探讨经阴道彩色多普勒血流显像对宫角妊娠诊断与鉴别诊断的临床价值。方法 对经手术和病理已证实的64例宫角妊娠二维图像、血流分布及频谱特征进行回顾性分析。结果 根据64例经阴道二维超声与彩色多普勒检查结果，将宫角妊娠分为三种类型，①典型孕囊型13例，超声诊断正确率100％(13／13)；②不典型孕囊型16例，诊断正确率93％(15／16)；③包块型35例，诊断正确率69％(24／35)，内含4例残角妊娠破裂误诊为官外孕。结论 经阴道彩色多普勒对宫角妊娠的早期诊断与鉴别诊断具有重要价值。     

阴道彩超介入治疗宫颈妊娠的临床研究

目的评价阴道彩超局部介入治疗对宫颈妊娠的疗效,探索简便、安全、疗效可靠的治疗方法。方法通过阴道彩超（TV-CDU）进行术前诊断及在TV-CDU的引导下行局部甲氨喋呤注药,对13例宫颈妊娠的术前后变化进行分析。结果TV-CDU对宫颈妊娠的术前诊断准确率高,介入治疗有效率为93.3%,随访均无明显并发症发生。结论TV-CDU为临床及时处理和早期保守治疗提供可靠的诊断依据,TV-CDU介导宫颈妊娠的局部保守治疗具有较好的治愈率、较低的并发症,值得进一步推广。     

彩色多普勒检测子宫动脉预测妊高征的价值研究

目的探讨彩色多普勒检测子宫动脉预测妊娠高血压综合征（妊高征）的价值及临床意义。方法应用彩色多普勒超声对587例20～24周妊娠妇女的子宫动脉进行检测,通过观察追踪随访孕妇至分娩,根据是否出现高血压,把检测20～24周妊娠妇女的子宫动脉参数分为两组：正常组（560例）和高危组（27例）,进行对照研究,对比分析两组受检者子宫动脉血流动力学变化及声像图表现。结果①高危组子宫动脉收缩期峰值血流速度（Vd）较正常组快,舒张期最小血流速度（Vs）和平均血流速度（Vm）减慢（P〈0.01）,高危组子宫动脉阻力指数（RI）、搏动指数（PI）和收缩期峰值血流速度/舒张期最小血流速度（S/D）比正常组高（P〈0.01）,②高危组子宫动脉多普勒频谱表现典型者出现舒张早期＂V＂切迹。结论高危组患者子宫动脉血流动力学和多普勒频谱形态与正常组妊娠妇女有明显的不同,常规定期监测20～24周妊娠妇女子宫动脉血流动力学变化及多普勒频谱形态,对早期发现和治疗妊高征,保障母婴健康具有极其重要的意义。     

Reply: ovarian reserve and reproductive age may be determined from measurement of ovarian volume by transvaginal sonography

Sir, We welcome the opportunity to respond to the letter of Broekmansand colleagues. We agree that the assessment of reproductivepotential in women is complex and is likely to include a mathematicalsynthesis of a number of indicators,     

Immunohistochemical localization of CA 125 antigen in formalin-fixed paraffin sections of ovarian tumors with the use of Pronase

The OC 125 monoclonal antibody was used to localize CA 125 antigen in routine paraffin sections of ovarian tumors with the use of a modified avidin-biotin-peroxidase complex (ABC) technic. Pretreatment of the paraffin sections with Pronase allowed subsequent detection of CA 125 antigen. OC 125 stained 4 (80%) of 5 benign and borderline serous ovarian tumors, 12 (86%) of 14 serous adenocarcinomas, and 3 (23%) of 13 benign and malignant mucinous ovarian tumors. The pattern of distribution of CA 125 antigen was mostly at the intraluminal and peripheral cell surfaces, while intracytoplasmic staining also was seen. Overall, CA 125 antigen detectability rate in paraffin sections was found to be compatible with those reported in frozen sections. The method allows retrospective immunohistochemical examination of a large number of cases with ovarian tumors.     

Color Doppler imaging and angiogenesis in ovarian tumors

The detection and assessment of ovarian lesions are an important part of gynecological practice. Advance knowledge of whether an overt ovarian mass is malignant may be useful for improving the effectiveness of surgical treatment. Pelvic ultrasonography has been developed continuously, and (in conjunction with biochemical and genetic markers) is being used to achieve these objectives with increasing accuracy. At the same time, knowledge is being accrued about the relationship between ultrasound-derived indices of ovarian tumor vascularity and the molecular aspects of angiogenesis. There is now the exciting prospect that color Doppler imaging with pulsed Doppler spectral analysis could also be used to monitor the development and intermediate effectiveness of novel anticancer treatment.     

彩超引导胎儿心脏穿刺术取血用于产前诊断的意义评价

目的彩超引导下对脐静脉穿刺术困难经腹胎儿心脏穿刺术取胎血检测胎儿染色体核型等产前诊断。方法使用22G穿刺针对6例胎儿超声心动图检出心脏异常的胎儿脐血穿刺失败后在彩超引导下心脏穿刺术抽取胎血检测，平均孕周31．5w，孕妇平均年龄29．5岁，术前超声检查见心脏畸形或扩大外伴羊水过多或过少。结果6例均成功穿刺取血，术后1例出现心包积液，5例出现心动过缓，心率30—80／min，持续时间4—8min。胎血细胞培养成功5例，检出染色体异常核型13-三体1例。结论当脐静脉穿刺困难时可行胎儿心脏穿刺术，彩超引导可清晰显示胎儿心内血流变化并缩短穿刺时间。胎儿心脏穿刺术有一定的风险性应慎重选择病例。该技术可用于为未来的胎儿基因治疗。     

Ovarian reserve and reproductive age may be determined from measurement of ovarian volume by transvaginal sonography

BACKGROUND: The human ovary contains a fixed number of primordial follicles that decreases bi-exponentially with age, culminating in the menopause at an average age of 50-51 years. There currently is no reliable test of ovarian reserve for individual women that will accurately predict their remaining reproductive lifespan. METHODS AND RESULTS: We use the Faddy-Gosden model of human primordial follicle population decline to describe the natural decay of the ovarian follicle pool. Assuming that the wide distribution for age at menopause is due to the wide variation in number of primordial follicles at birth, we describe follicle population decline for early and late menopausal women. Using published data on age-related ovarian volume as measured by transvaginal sonography, we have obtained a highly significant correlation between primordial follicle population and ovarian volume. We show that ovarian volume in women aged 25-51 years accurately reflects the number of primordial follicles remaining, and describe how measurement of ovarian volume by transvaginal sonography may determine ovarian reserve and reproductive age. CONCLUSIONS: The accurate assessment of ovarian reserve will revolutionize the management of women requesting assisted conception, those who have had treatment for childhood cancer and those who are considering delaying a family for personal or professional reasons.     

血清CA125、CA153、CA199的联合检测

目的：用蛋白芯片检测肿瘤标志物糖链抗原125（CA125）、糖链抗原153（CA153）、糖链抗原199（CA199），评价其敏感度与特异性及其临床应用价值。方法：通过探针蛋白特异性地捕获样品中的靶蛋白，经蛋白芯片检测系统进行定量分析，并与化学发光免疫分析法作比较。结果：蛋白芯片法的检测敏感度CA125为80.9%、CA153为71%、CA199为80.6%，与化学发光免疫分析法比较，三者均无显著差异（P>0.05）；特异性分别为62.5%、66.7%、56.7%，与化学发光免疫分析法比较，除CA199有显著差异（P<0.01），其他无显著差异（P>0.05）。两种方法的CA125受试者操作特征曲线（ROC）非常接近，CA153的ROC曲线也非常接近，CA199的ROC曲线分离。结论：PRCH适合于肿瘤标志物CA125、CA153、CA199的定量分析及临床应用，但CA199的特异性尚需提高。     

Explosive rise of serum CA 125 following the rupture of ovarian endometrioma

Serum CA 125 concentration is seldom >100 IU/ml in endometriosis. We report a patient with ruptured endometrioma presenting with a very high CA 125 concentration, 9300 IU/ml. Elimination of endometriosis was followed by a sharp decrease in serum CA 125. We conclude that some of the CA 125 molecules from the ruptured endometriotic cyst may be transferred through the peritoneum, thereby increasing serum CA 125 concentration. The associated inflammatory reaction of the mesothelial cells of the peritoneum was probably the most important contributor to this phenomenon, as mesothelial cells are an important source of CA 125.      

Spontaneous interstitial pregnancy on a tubal stump after unilateral adenectomy followed by transvaginal colour Doppler ultrasound

Transvaginal colour and angio Doppler blood flow analysis combined with serial measurement of human chorionic gonadotrophin (HCG) concentration is reported here for the first time to study the local vascularity of a cornual pregnancy and to monitor the effectiveness of medical therapy. Interestingly, a strong relationship between morphological changes of trophoblastic tissue and the intensity of neovascularization was noted. Systemic single-dose methotrexate (MTX) therapy allowed successful treatment of an interstitial ectopic pregnancy involving part of the proximal portion of a tubal stump. We suggest that, by adding colour Doppler to conventional transvaginal ultrasonography, the outpatient surveillance of ectopic pregnancy evolution following MTX therapy is greatly enhanced. This is of particular value in cornual pregnancies which are highly likely to develop harmful complications during surgical intervention or even during puncture for local MTX injection.      

应用组织芯片技术研究CA125和EPCAM联合检测卵巢癌的价值

目的：构建高通量的组织芯片，评价CA125、EPCAM联合和单一检测对卵巢癌诊断的价值，探讨免疫荧光染色及激光非共聚焦方法扫描组织芯片的可行性。方法：制备卵巢组织芯片，含82例样本，其中卵巢上皮性癌52例，正常卵巢组织30例。用免疫组织化学法检测CA125和EPCAM的表达，四格表法统计出四项诊断指标值。结果：联合CA125和EP-CAM，诊断卵巢癌的特异性由86．67％上升到93．33％，阳性预测值则升至96．97％。结论：免疫荧光技术具有特异性强、敏感性高、速度快等特点，用于组织芯片染色是可行的。CA125和EPCAM的联合检测可提高特异性和阳性预测值，对卵巢癌的诊断有较高价值。