X. Zhang

Diagnostic accuracy of Ovarian‐Adnexal Reporting and Data System, IOTA Simple Rules and Pediatric Risk of Malignancy Index for pediatric adnexal lesions: comparative study

ABSTRACT Objective Many risk stratification models have been developed to improve the accuracy of sonographic evaluation of adnexal lesions. Although these models have been validated across various adult populations, their accuracy in the pediatric population remains underexplored. This study aimed to evaluate and compare the diagnostic accuracy of three sonography‐based risk models in assessing pediatric adnexal lesions. Methods This was a single‐center retrospective diagnostic accuracy study conducted at a tertiary hospital in China, which included consecutive patients aged 17 years or younger with adnexal lesions managed either surgically or conservatively between January 2015 and January 2024. Each adnexal lesion was assessed using the Ovarian‐Adnexal Reporting and Data System (O‐RADS) ultrasound risk stratification and management tool, the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) followed by expert assessment for inconclusive cases in a two‐step strategy and the Pediatric Risk of Malignancy Index (PRMI) model. The reference standard was either surgical intervention or conservative management with ultrasound surveillance. The accuracy of the different sonography‐based risk models was evaluated using the area under the receiver‐operating‐characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values. The clinical utility of each model was evaluated using decision‐curve analysis. Results This study included 364 patients with a total of 375 adnexal lesions. The median age of the patients was 15.0 (interquartile range, 14.0–17.0) years, with a malignancy rate of 2.1% (8/375). The AUC for the O‐RADS tool, IOTA two‐step strategy and the PRMI model were 0.989 (95% CI, 0.980–0.999), 0.992 (95% CI, 0.985–0.998) and 0.806 (95% CI, 0.626–0.985), respectively. The IOTA two‐step strategy demonstrated the highest accuracy and provided the greatest net benefits at malignancy risk thresholds between 1% and 30% compared with the other two models. Conclusions In this retrospective pediatric cohort, the O‐RADS ultrasound model and the IOTA‐SR followed by expert assessment for inconclusive cases in a two‐step strategy exhibited high diagnostic accuracy in characterizing adnexal lesions, comparable to that observed in adults. These results support the applicability of both of these risk‐stratification methods to the pediatric population. The PRMI scoring system showed lower discriminative capacity compared with the other models; therefore, it is not recommended to serve as a standalone diagnostic tool. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of contrast-enhanced ultrasonography and magnetic resonance imaging in the evaluation of tumor size and local invasion of surgically treated cervical cancer

This retrospective study aimed to compare the performance of contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) in staging surgically treated early-stage cervical cancer. Patients with surgically treated cervical carcinoma confirmed by post-operative pathological findings were included between December 2016 and December 2018. All included patients underwent both CEUS and MRI examinations before the surgery. Post-operative pathology was used as the gold standard. The κ values were calculated to assess the agreements of CEUS and MRI in staging cervical carcinoma in comparison with post-operative pathology. Complete data were available for 39 patients. CEUS showed great inter-observer reproducibility in tumor measurement [Intra-class Correlation Coefficient (ICC) 0.831] and moderate inter-observer reproducibility in the evaluation of vaginal infiltration and parametrial invasion (Cohen's κ 0.692 and 0.624). Tumor size was comparable as measured by CEUS and MRI (ICC 0.769). Both CEUS and MRI presented good concordance with post-operative pathology in staging cervical cancer (weighted κ 0.732 and 0.761). CEUS was comparable to MRI in staging surgically treated cervical cancer and might be considered in the pre-treatment work-up for cervical cancer.

Ultrasound Microvessel Visualization in Cervical Cancer: Association Between Novel Ultrasound Techniques and Histologic Microvessel Densities

The aim of the work described here was to evaluate the feasibility of superb microvascular imaging (SMI) and vascular endothelial growth factor receptor 2 (VEGFR2)-targeted microbubble (MB Hela cells were used to establish subcutaneous cervical cancer models. SMI and MB Tumors with diameters ranging from 3 to 5 mm had the highest VI (39.07 ± 1.58) in SMI, and VI significantly decreased with increasing tumor size (all p values <0.001). The strongest signal intensity was observed in very early tumors (d < 3 mm: 43.80 ± 3.58%) after MB These findings validate the superiority and accuracy of MB

Integrating Contrast-enhanced US to O-RADS US for Classification of Adnexal Lesions with Solid Components: Time-intensity Curve Analysis versus Visual Assessment.

Purpose To compare the diagnostic performance of time-intensity curve (TIC) analysis and subjective visual assessment of contrast-enhanced US (CEUS) when integrated with the Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification system for characterizing adnexal lesions with solid components. Materials and Methods In this prospective multicenter study conducted from September 2021 to December 2022, female individuals with suspected adnexal lesions containing solid components detected at routine US were enrolled. All participants underwent preoperative CEUS examinations. Histopathologic findings were used as the reference standard for diagnosis. Lesions were classified according to the O-RADS US system. Enhancement of solid tissue compared with the outer myometrium was evaluated using both TIC analysis and subjective visual assessment. The diagnostic performance of O-RADS alone and each CEUS assessment method when integrated with the O-RADS US system was assessed and compared using receiver operating characteristic curve analysis. Results A total of 180 lesions (80 malignant and 100 benign histopathologic outcomes) in 175 participants (median age, 47 years [IQR, 33-56]) were analyzed. Incorporating CEUS (assessed through both TIC analysis and subjective visual assessment) with O-RADS US showed significantly improved diagnostic performance over O-RADS US alone, with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI: 0.80, 0.91) compared with 0.78 (95% CI: 0.71, 0.84). No evidence of a difference was observed between the AUCs of TIC analysis and subjective visual assessment in the enhancement evaluation of solid tissue with CEUS for adnexal malignancy categorization (