• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2020.tde-29012020-130545
Document
Author
Full name
Ana Luiza Santos Marques
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Abrão, Mauricio Simões (President)
Diniz, Angélica Lemos Debs
Pastore, Ayrton Roberto
Podgaec, Sérgio
Title in Portuguese
Avaliação da adenomiose pela ultrassonografia transvaginal em modos 2D e 3D
Keywords in Portuguese
Adenomiose/diagnóstico por imagem
Espectroscopia de ressonância magnética
Hemorragia uterina
Histopatologia
Mulheres
Ultrassonografia Doppler
Abstract in Portuguese
Introdução: A adenomiose é uma doença ginecológica comum. O cenário epidemiológico da adenomiose mudou de uma doença típica identificada em mulheres multíparas, com idade superior a 40 anos, submetidas à histerectomia, para uma doença multifacetada diagnosticada também em mulheres jovens com sangramento uterino anormal (SUA), infertilidade, dor pélvica ou mesmo assintomáticas. Há várias características ultrassonográficas e radiológicas típicas que permitem a realização de diagnóstico não invasivo. Comparando os dois métodos ultrassonografia transvaginal (USTV) e Ressonância Magnética de pelve (RM), a primeira é mais bem tolerada pelas pacientes, é amplamente disponível e de baixo custo. O diagnóstico definitivo é estabelecido pela histologia do espécime uterino; no entanto, não há critérios definidos sobre os tipos de lesões adenomióticas, seja pela histologia ou cirurgia. Objetivo: Avaliar a acurácia da ultrassonografia transvaginal, nos modos 2D e 3D para o diagnóstico da adenomiose, em mulheres entre 18 e 40 anos, em comparação com a ressonância magnética de pelve, considerado teste índice padrão não invasivo. Métodos: O presente estudo, transversal, observacional e prospectivo, efetuado em 88 pacientes, do sexo feminino, sintomáticas ou assintomáticas, foi realizado de janeiro de 2018 a dezembro de 2018. As pacientes foram procedentes do ambulatório de dor pélvica crônica, do Hospital Universitário Getúlio Vargas da UFAM e tinham idades entre 18 e 40 anos (média 31,6 a ± 5,8). As pacientes foram submetidas aos exames de imagem (USTV) e (RM), realizados por especialistas em diagnóstico por imagem experientes, ambos na fase lútea média do ciclo menstrual. Foram excluídas mulheres virgens, grávidas, com diagnóstico de câncer de colo uterino ou em tratamento e em uso de análogos do GnRH (Gonadrotopin Releasing agonist hormone) e outras terapêuticas hormonais, como contraceptivos hormonais. A adenomiose foi identificada pela USTV utilizando-se o consenso do grupo MUSA. As variáveis USTV-2D foram: útero globoso e heterogêneo, cistos miometriais, estrias lineares hipoecóicas, ilhas hiperecogênicas (buds), assimetria de paredes uterinas e zona juncional (ZJ) mal definida. O Power Doppler foi usado para diferenciar adenomiose e leiomiomas e entre quaisquer cistos miometriais ou lacunas e componentes vasculares. As variáveis USTV-3D foram: ZJ definida ou mal definida, irregular, interrompida, espessura da ZJ e sua diferença entre as paredes anterior e posterior (diferente de ZJ) foram registradas. Foi considerada sugestiva de adenomiose: ZJmax >=8mm e / ou diferente de ZJ >=4mm. A adenomiose foi identificada pela RM quando foram identificados cistos com sangue, cistos sem sangue, espessura da ZJ entre 8 mm e 12 mm. Foram avaliados os valores de sensibilidade, de especificidade e a acurácia da USTV 2D e 3D para o diagnóstico de adenomiose, comparada com a RM, avaliada pelo índice Kappa. Resultados: A concordância entre os métodos USTV-2D e USTV-3D comparada com a RM, apresentaram os seguintes resultados:1) USTV-2D e USTV-3D: forte concordância (Kappa 0,613 p 0,000), 2) USTV-2D e RNM: fraca concordância (Kappa 0,107 p 0,110), 3) UTRV-3D e RNM: razoável concordância (Kappa 0,244 p 0,002). A acurácia entre os métodos: 1) USTV-2D e RM: sensibilidade de 83%, especificidade de 41% e acurácia de 47%, 2) USTV-3D e RM: sensibilidade de 92%, especificidade de 57% e acurácia de 61% (IC95%: 49 - 72). O valor preditivo positivo foi de 20% e 27% e o valor preditivo negativo foi de 93% e 97% quando comparado à RM, respectivamente
Title in English
Evaluation of adenomyosis by transvaginal ultrasonography in 2D and 3D modes
Keywords in English
Adenomyosis/diagnostic imaging
Histopathology
Magnetic resonance spectroscopy
Ultrasonography Doppler
Uterine hemorrhage
Women
Abstract in English
Introduction: Adenomyosis is a common gynecological disease. The epidemiological scenario of adenomyosis has changed from a typical disease identified in multiparous women over 40 years undergoing hysterectomy to a multifaceted disease also diagnosed in young women with abnormal uterine bleeding (AUB), infertility, pelvic pain or even asymptomatic. There are several typical ultrasound and radiological features that allow for noninvasive diagnosis. Comparing the two methods: transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI), the first is better tolerated by patients, is widely available and inexpensive. The definitive diagnosis is established by the histology of the uterine specimen; however, there are no definite criteria for the types of adenomyotic lesions, either by histology or surgery. Objectives: To evaluate the accuracy of transvaginal ultrasonography in 2D and 3D models for the diagnosis of adenomyosis women between 18 and 40 years of age, compared to magnetic resonance imaging of the pelvis, considered a noninvasive standard index test. Patients and Methods: This cross-sectional observational and prospective study, conducted in 88 female patients, symptomatic, was conducted from January 2018 to December 2018. The patients came from the chronic pelvic pain ambulatory of the Getúlio Vargas University Hospital-UFAM and were aged between 18 and 40 years (mean age 31,6 y ± 5,8). The patients underwent imaging exams (USTV) and (MRI) performed by experienced imaging diagnostic specialists, both in the mid luteal phase of the menstrual cycle. Virgin, pregnant women diagnosed with cervical cancer or undergoing treatment and using GnRH (Gonadrotopin Releasing Agonist Hormone) analogues and other hormonal therapies such as hormonal contraceptives were excluded. Adenomyosis was identified by USTV using the consensus of the MUSA group. The USTV-2D variables were globous and heterogeneous uterus, myometrial cysts, hypoechoic linear striae, buds, uterine wall asymmetry, and poorly defined junctional zone (ZJ). Power Doppler was used to differentiate adenomyosis and leiomyomas and between any myometrial cysts or gaps and vascular components. The 3D-TVS variables were: JZ defined or ill-defined, irregular, interrupted and the thickness of the JZ and its difference (not equal JZ) were recorded. It was considered suggestive of adenomyosis: max JZ >=8mm and / or not equal JZ >=4mm. Adenomyosis was identified by MRI when blood cysts, bloodless cysts, JZ thickness between 8 mm and 12 mm were identified. The sensitivity, specificity and accuracy values of 2D and 3D TVS for the diagnosis of adenomyosis were compared with MRI, as assessed by the Kappa index. Results: A total of 78 patients, aged 18 to 40 years, underwent 2D-TVS and 3D-TVS. The prevalence of adenomyosis was 55.12% (43/78 patients). The agreement between 2D-TVS and 3D-TVS compared to MRI was: 1) 2D-TVS and 3D-TVS: strong agreement (Kappa 0.613 p 0.000), 2) 2D-TVS and MRI: poor agreement (Kappa 0.107 p 0.110), 3) 3D-TVS and MRI: reasonable agreement (Kappa 0.244 p 0.002). For 2D-TVS and 3D-TVS, respectively, the overall accuracy of adenomyosis diagnosis was 47% and 61%, sensitivity was 83% and 92%, specificity was 41% and 57% and the positive predictive value was 20% and 27% and the negative predictive value was 93% and 97% when compared to MRI
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2020-01-29
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2021. All rights reserved.