T. Van den Bosch

KU Leuven

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Hysteroscopic management of caesarean scar defects

Journal of Obstetrics and Gynaecology (2022)

V. Vrijdaghs K. Dewilde Wouter Froyman T. Van den Bosch

A caesarean section may lead to a defect of the myometrium at the site of the uterine scar. The association with abnormal uterine bleeding or impaired fertility has been demonstrated. Hysteroscopic remodelling reportedly reduces the symptoms. To review the available literature reporting on hysteroscopic treatment of these defects in symptomatic women with abnormal uterine bleeding or impaired fertility. A systematic search of PubMed and Cochrane databases has been performed until January 2021, including 27 articles. Hysteroscopic remodelling relieved symptoms of abnormal uterine bleeding in 60–100% and 25–100% of women with impaired fertility conceived within the follow up period. No major complications were reported. Hysteroscopic remodelling seems a treatment option in the management of symptomatic caesarean scar defects. Long-term follow-up and larger studies are needed to evaluate the effect on abnormal uterine bleeding as well as on reproductive outcomes.

10.1080/01443615.2021.2003310

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Citations (9)

Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women With Postmenopausal Bleeding

Obstetrics and Gynecology (2010)

Anne Timmermans Brent C. Opmeer Khalid S. Khan Lucas M. Bachmann E. Epstein

To estimate the accuracy of endometrial thickness measurement in the detection of endometrial cancer among women with postmenopausal bleeding with individual patient data using different meta-analytic strategies.Original data sets of studies detected after reviewing the included studies of three previous reviews on this subject. An additional literature search of published articles using MEDLINE databases was preformed from January 2000 to December 2006 to identify articles reporting on endometrial carcinoma and sonographic endometrial thickness measurement in women with postmenopausal bleeding.We identified 90 studies reporting on endometrial thickness measurements and endometrial carcinoma in women with postmenopausal bleeding.We contacted 79 primary investigators to obtain the individual patient data of their reported studies, of which 13 could provide data. Data on 2,896 patients, of which 259 had carcinoma, were included. Several approaches were used in the analyses of the acquired data. First, we performed receiver operator characteristics (ROC) analysis per study, resulting in a summary area under the ROC curve (AUC) calculated as a weighted mean of AUCs from original studies. Second, individual patient data were pooled and analyzed with ROC analyses irrespective of study with standardization of distributional differences across studies using multiples of the median and by random effects logistic regression. Finally, we also used a two-stage procedure, calculating sensitivities and specificities for each study and using the bivariate random effects model to estimate summary estimates for diagnostic accuracy. This resulted in rather comparable ROC curves with AUCs varying between 0.82 and 0.84 and summary estimates for sensitivity and specificity located along these curves. These curves indicated a lower AUC than previously reported meta-analyses using conventional techniques.Previous meta-analyses on endometrial thickness measurement probably have overestimated its diagnostic accuracy in the detection of endometrial carcinoma. We advise the use of cutoff level of 3 mm for exclusion of endometrial carcinoma in women with postmenopausal bleeding.

POSTMENOPAUSAL BLEEDING

10.1097/aog.0b013e3181e3e7e8

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Citations (285)

OC07.01: The International Endometrial Tumor Analysis (IETA) study: interim analysis of measurement differences between centres

Ultrasound in Obstetrics and Gynecology (2015)

Laure Wynants Arnaud Installé M. Pascual F. Leone P. Sladkevicius

In multicentre studies, measurements will vary between centres for various reasons (e.g. subjectivity of measurements, differences in equipment, deviations from the protocol and differences in patient populations). The aim of this interim analysis by the International Endometrial Tumor Analysis group is to identify the variables with the strongest intercentre differences. 1864 consecutive women presenting with abnormal uterine bleeding underwent ultrasound examination by one of 20 international investigators. Women with an available histological diagnosis (n = 1504) were included in the analysis. We studied the variability in measurements of the endometrial thickness (unenhanced ultrasound examination (UUE) and fluid instillation sonography (FIS)), endometrial junction (UUE), presence of fibroids, patient age, BMI, use of anticoagulant therapy and use of hormonal therapy. The statistic used was the residual intraclass correlation (RICC) after adjustment for the type of lesion. An RICC of 0% indicates that the variability in the measurements is not due to differences between investigators. Normal endometria (n = 593) were distinguished from endometria with malignant (n = 100), focal (n = 609), diffuse (n = 116) and other (n = 86) lesions. The strongest differences between investigators were observed for the assessment of the endomyometrial junction as irregular (RICC = 56.9%), undefined (48.4%), or interrupted (36.9%) vs. regular. The use of anticoagulant therapy also varied across investigators (RICC = 41.7%), with 11 of 20 investigators not reporting anticoagulant therapy for any patient. The reported presence of fibroids, BMI and thickness of the endometrium (UUE) exhibited the smallest differences between investigators (RICC < 6%). The results suggest that the assessment of the endomyometrial junction is difficult and subjective and that anticoagulant therapy use is underreported. This should be considered when analysing the data.

Interim analysis

Adenomyosis

10.1002/uog.14992

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Non-Invasive Imaging Techniques for Diagnosis of Pelvic Deep Endometriosis and Endometriosis Classification Systems: An International Consensus Statement

Journal of Minimally Invasive Gynecology (2024)

G. Condous B. Gerges Isabelle Thomassin‐Naggara Christian M. Becker Carla Tomassetti

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counseling and planning of surgical treatment strategies.

Statement (logic)

Consensus conference

Pelvic endometriosis

10.1016/j.jmig.2024.04.006

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Journal Editorial Board

Ultrasound in Obstetrics and Gynecology (2018)

B. Thilaganathan Kurt Hecher Sarah Hatcher Stuart Campbell Juan-Luis Alcazar

Editorial board

10.1002/uog.18862

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Showing pictograms in electronic data capture software improves interrater agreement

Arnaud Installé T. Van den Bosch Dominique Van Schoubroeck Julie Heymans Letizia Zannoni

Pictogram

Inter-Rater Reliability

Source

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OP16.08: Three‐dimensional (3D) in vitro ultrasound examination in adenomyosis

Ultrasound in Obstetrics and Gynecology (2014)

A. Votino T. Van den Bosch Ann Cornelis Dominique Van Schoubroeck C. Van Pachterbeke

Focal adenomyosis may be missed by the pathologist at examination of the hysterectomy specimen. In this report we suggest a new method allowing in vitro, ultrasound guided localization of adenomysosis lesions prior to anatomo-pathological examination. Using a Voluson S8 with transvaginal probe 4–9 MHz, we acquired a three-dimensional (3D) volume in a patient presenting persistent lower back pain, deep dyspareunia and abnormal uterine bleeding. Reconstructing the image in coronal plane with VCI 2 mm and tomographic ultrasound imaging (TUI) myometrial cysts, hyperechoic islands, parallel shadowing, linear striation and an irregular endometrial -myometrial junction, suggested the diagnosis of extensive adenomyosis. Immediately after hysterectomy, the specimen was examined in vitro by ultrasonography using a transabdominal 4-6 MHz probe. The uterus was fixed to a solid basis and immersed in a water box. 3D volumes were acquired. To allow a better orientation at the pathologic examination, a needle was inserted under ultrasound guidance at the level of the isthmus. The specimen was sent to the anatomo-pathological laboratory where the uterus was cut in 7 transversal pieces from the isthmus to the bottom of the uterine cavity in analogy to the slices of the TUI. In vitro ultrasound guided needle localization proved to be technically feasible. The in vitro ultrasound findings showed a good concordance with the preoperative ultrasound examination as well as with microscopy- and macroscopy findings at anatomo-pathology. We propose a new approach to localize adenomyosis lesions prior to anatomo-pathologic examination. We demonstrated the feasibility of in vitro under water 3D-ultrasound examination compared to preoperative in vivo ultrasound examination in the detection of adenomyosis lesions.

Adenomyosis

Echogenicity

Endometrial Polyp

10.1002/uog.13794

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Citations (1)

How to perform standardized sonographic examination of Cesarean scar pregnancy in the first trimester

Ultrasound in Obstetrics and Gynecology (2024)

Carry Verberkt I. P. M. Jordans T. Van den Bosch D. Timmerman T. Bourne

Early diagnosis and appropriate management of Cesarean scar pregnancy (CSP) are crucial to prevent severe complications, such as uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. In this article, we provide a step-by-step tutorial for the standardized sonographic evaluation of CSP in the first trimester. Practical steps for performing a standardized transvaginal ultrasound examination to diagnose CSP are outlined, focusing on criteria and techniques essential for accurate identification and classification. Key sonographic markers, including gestational sac location, cardiac activity, placental implantation and myometrial thickness, are detailed. The evaluation process is presented according to assessment of the uterine scar, differential diagnosis, detailed CSP evaluation and CSP classification. This step-by-step tutorial emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies. The CSP classification is described in detail and is based on the location of the largest part of the gestational sac relative to the uterine cavity and serosal lines. This descriptive classification is recommended for clinical use to stimulate uniform description and evaluation. Such a standardized sonographic evaluation of CSP in the first trimester is essential for early diagnosis and management, helping to prevent life-threatening complications and to preserve fertility. Training sonographers in detailed evaluation techniques and promoting awareness of CSP are critical. The structured approach to CSP diagnosis presented herein is supported by a free e-learning course available online. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Cesarean delivery

10.1002/uog.27604

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Front & Back Matter

Gynecologic and Obstetric Investigation (2013)

Éva Csatlós A. Hartman Wendy Wolfman Dan Nayot Michael Hartman

10.1159/000351367

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Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus nomenclature: prospective multicenter study

Ultrasound in Obstetrics and Gynecology (2017)

E. Epstein D. Fischerová L. Valentin A. C. Testa D. Franchi

ABSTRACT Objective To describe the sonographic features of endometrial cancer in relation to tumor stage, grade and histological type, using the International Endometrial Tumor Analysis (IETA) terminology. Methods This was a prospective multicenter study of 1714 women with biopsy‐confirmed endometrial cancer undergoing standardized transvaginal grayscale and Doppler ultrasound examination according to the IETA study protocol, by experienced ultrasound examiners using high‐end ultrasound equipment. Clinical and sonographic data were entered into a web‐based database. We assessed how strongly sonographic characteristics, according to IETA, were associated with outcome at hysterectomy, i.e. tumor stage, grade and histological type, using univariable logistic regression and the c ‐statistic. Results In total, 1538 women were included in the final analysis. Median age was 65 (range, 27–98) years, median body mass index was 28.4 (range 16–67) kg/m 2 , 1377 (89.5%) women were postmenopausal and 1296 (84.3%) reported abnormal vaginal bleeding. Grayscale and color Doppler features varied according to grade and stage of tumor. High‐risk tumors, compared with low‐risk tumors, were less likely to have regular endometrial–myometrial junction (difference of −23%; 95% CI, −27 to −18%), were larger (mean endometrial thickness; difference of +9%; 95% CI, +8 to +11%), and were more likely to have non‐uniform echogenicity (difference of +7%; 95% CI, +1 to +13%), a multiple, multifocal vessel pattern (difference of +21%; 95% CI, +16 to +26%) and a moderate or high color score (difference of +22%; 95% CI, +18 to +27%). Conclusion Grayscale and color Doppler sonographic features are associated with grade and stage of tumor, and differ between high‐ and low‐risk endometrial cancer. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Echogenicity

10.1002/uog.18909

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Citations (81)