Diagnostyka ultrasonograficzna guzów przydatków – praktyczna przydatność różnych schematów prognostycznych oceny ryzyka onkologicznego

• Authors: Krzysztof Nowosielski , Andrzej Witek , Ewa Kapuśniak , Ewelina Stawicka-Ociepka

Title variants

EN

Ultrasound diagnosis of adnexal masses: the practical usefulness of various malignancy risk prediction models

• Languages of publication: PL EN

Abstracts

PL

Guzy przydatków występują u kobiet w różnym wieku, zarówno przed menopauzą, jak i po niej. Zdecydowana większość z nich ma charakter łagodny i jest rozpoznawana przypadkowo. Część zmian przydatków budzi jednak wątpliwości diagnostyczno-kliniczne co do charakteru zmiany (łagodna czy złośliwa). Właściwe rozpoznanie przedoperacyjne warunkuje odpowiednie postępowanie w odniesieniu zarówno do zakresu i techniki operacji, jak i ośrodka wykonującego daną procedurę medyczną (ośrodek ginekologii onkologicznej/oddział ginekologiczny). W wielośrodkowych badaniach dotyczących diagnostyki guzów przydatków analizowane są różne metody obrazowania, z których każda cechuje się odpowiednim poziomem czułości i specyficzności. Prace międzynarodowych grup, w tym grupy IOTA, wskazują na możliwość zastosowania różnych schematów diagnostycznych, opartych na ocenie obrazów ultrasonograficznych (model prostych reguł), złożonych modelach matematycznych (LR1, LR2), markerach biochemicznych (ROMA, ROCA, OVERA) czy wreszcie skojarzeniu danych klinicznych, markerów biochemicznych i cech ultrasonograficznych (ADNEX, RMI). Wszystkie te schematy mają na celu diagnostykę różnicową guzów i ustalenie przynależności do grup niskiego, pośredniego i wysokiego ryzyka. Dzięki takiemu postępowaniu nawet przy braku możliwości oceny dokonanej przez eksperta możliwa staje się właściwa kwalifikacja pacjentek, co z kolei optymalizuje jakość zapewnianej im opieki medycznej. Niniejsza praca ma charakter poglądowy i prezentuje dostępne metody diagnostyki obrazowej guzów przydatków, oparte na ultrasonografii, markerach biochemicznych oraz złożonych modelach matematycznych. Przedstawia również nowe propozycje schematów diagnostycznych guzów przydatków, oparte na wynikach najnowszych opracowań naukowych i wytycznych towarzystw ginekologów i położników. Mogą one być pomocne w codziennej praktyce lekarzy ginekologów w przedoperacyjnej klasyfikacji guzów jako prawdopodobnie łagodnych lub wysokiego ryzyka onkologicznego.

EN

Adnexal masses are found in women of all ages, both pre- and postmenopausal. A large majority of them are benign and are diagnosed incidentally. Some cases, nonetheless, pose diagnostic and clinical challenges regarding the character of the lesion (whether benign or malignant). Correct preoperative classification is crucial for proper management both in terms of the scope and technique of surgery as well as the choice of the medical center where a given medical procedure is to be held (an gynecologic oncology center/a gynecologic ward). The usefulness of various imaging modalities (each characterized by a given level of sensitivity and specificity) for the diagnosis of ovarian cancer has been analyzed in multicenter studies. Studies by international groups, such as the IOTA, indicate the possibility of applying various diagnostic algorithms, relying on ultrasound assessment (Simple Rules model), complex mathematical models (LR1, LR2), biomarker measurements (ROMA, ROCA, OVERA), or a conjunction of clinical data, serum marker levels and ultrasound findings (ADNEX, RMI). All these models facilitate a differential diagnosis of ovarian tumors and help to triage patients into low-, moderate- or highrisk groups, thus warranting correct classification of patients for further management even when expert diagnosis is not feasible, and optimizing the quality of care provided. This study is a review of the available predictive formulas utilizing ultrasound findings, serum biomarker measurements and complex mathematical models as well as newly proposed diagnostic algorithms, based on the results of the most recent studies and guidelines of various gynecologic and obstetric societies. They may be helpful in day-to-day practice of gynecologists, aiding preoperative classification of adnexal masses as likely benign or malignant.

Keywords

EN

diagnostyka; guzy przydatków; ocena ryzyka onkologicznego

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Current Gynecologic Oncology
• Year: 2017
• Volume: 15
• Issue: 3
• Pages: 194–217

Contributors

author

Krzysztof Nowosielski

• Oddział Ginekologii iPołożnictwa, Śląski Instytut Matki i Noworodka, Chorzów, Polska

author

Andrzej Witek

• Oddział Ginekologii iPołożnictwa, Uniwersyteckie Centrum Kliniczne Śląskiego Uniwersytetu Medycznego w Katowicach, Szpital Ligota – CSK, Katowice, Polska

author

Ewa Kapuśniak

• Oddział Ginekologii iPołożnictwa, Śląski Instytut Matki i Noworodka, Chorzów, Polska

author

Ewelina Stawicka-Ociepka

• Oddział Ginekologiczno-Położniczy zPododdziałem Ginekologii Onkologicznej, Wojewódzki Szpital Specjalistyczny wTychach, Tychy, Polska

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• Document Type: article