Rodrigo Menezes Jales

Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of a magnetic resonance scoring (ADNEX MR scoring system)

To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses. 171 women with adnexal masses were included from February 2014 to February 2016. 120 women had histopathological diagnosis obtained from surgery or percutaneous biopsy. The other 51 women were submitted to surveillance with ultrasound (US) for at least 1 year. Patients were examined with US and MR. US reports were rendered using IOTA systems. We compared five diagnostic approaches, aimed at diagnosing women with malignant tumors among those with adnexal masses: We calculated the performance and net benefits (decision curve analysis) for five distinct diagnostic approaches: (1) US simple rules (SR), (2) simple rules risk score (SRRisk), (3) US SR followed by subjective assessment (SA) of indeterminate cases, (4) SR followed by MR score for the indeterminate cases, and (5) MR score for all women. The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit. Although this study leaves no doubt about the superiority of MR score over US-based methods for the discrimination of malignant tumors in women with adnexal masses, restricting the use of MR score only to women with indeterminate masses on US SR is a safe, appropriate way to triage women with adnexal masses.

Open- source computed tomography (CT)-based sarcopenia assessment in women with suspicious adnexal masses: a feasibility and reproducibility study

Ovarian cancer is the most lethal gynecologic malignancy, with prognosis linked to stage at diagnosis. Ultrasonography is the first-line tool for adnexal mass evaluation, while computed tomography (CT) supports staging and surgical planning. Sarcopenia-low skeletal muscle mass-is a prognostic factor in oncology and measurable on routine CT. Its role in women with indeterminate or malignant adnexal masses remains unclear. This study aimed to assess the feasibility, reproducibility, and clinical utility of CT-based sarcopenia analysis using open-source software in this population. In this prospective pilot study, 38 women with suspicious adnexal masses (classified as indeterminate or malignant by International Ovarian Tumor Analysis Simple Rules, Ovarian-Adnexal Reporting and Data System, or subjective assessment) underwent CT-based sarcopenia analysis. Axial CT images at the L3 level were segmented using 3D Slicer. Skeletal muscle index (SMI, cm²/m²) was calculated, with sarcopenia defined as SMI <38.5 cm Sarcopenia analysis was feasible and reproducible (κ = 0.839). Significant associations were observed with advanced tumor stage (P = .028) and peritoneal carcinomatosis (P = .033), but not with histopathological malignancy, lymphadenopathy, adjacent invasion, or suspicion of alternative primary tumor. Diagnostic performance for malignancy prediction was limited. CT-based sarcopenia analysis using open-source software is feasible and reproducible. Although associated with advanced disease, sarcopenia did not enhance malignancy prediction and should not guide preoperative risk stratification. Its potential value may lie in identifying patients who could benefit from prehabilitation or targeted nutritional support before treatment.