Browsing by Author "Likic Ladjevic, Ivana (12761162800)"

Objectives: The aim of this study was to evaluate the accuracy of IOTA Simple Rules (SR), IOTA ADNEX model, Risk of Malignancy Index (RMI), and subjective assessment (SA) which is used for adnexal mass assessment in our institution. Design: This is a prospective observational study. Participants/Materials, Setting, Methods: We included patients with at least one adnexal mass who needed elective surgical evaluation based on clinical and laboratory findings. Patients admitted to Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, were recruited for the study between January 2019 and June 2021. Level II ultrasonographers performed a gray scale and Doppler exam for each patient. Preoperative classification of adnexal masses (benign or malignant) was performed by SA, the International Ovarian Analysis Group (IOTA) SR, IOTA ADNEX model, and Risk of Malignancy Index (RMI). Postoperatively obtained histological findings were used as a reference. Results: During the study period, we enrolled 179 premenopausal and 217 postmenopausal patients, representing 396 patients in our sample. Prevalence of malignant disease in pre- and postmenopausal groups was 16.2% (29/179) and 41% (89/217), respectively. Malignant disease was diagnosed in 29.8% (118/396) of patients. SA achieved the highest discrimination accuracy between benign and malignant tumors (area under the curve [AUC] of 0.928, 95% CI [0.898-0.952]). For SA, the overall diagnostic accuracy, sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were 91.4%, 88.1%, 92.8%, 12.25, and 0.13. The AUC for Simple Rules with subjective assessment in inconclusive cases (SR + SA) was 0.912 (95% CI [0.880-0.938]). Regarding SR + SA, diagnostic accuracy, sensitivity, specificity, LR+, and LR- were 92.4%, 88.1%, 94.2%, 15.31, and 0.13. The ADNEX model had the AUC of 0.914 (95% CI [0.882-0.940]). Binary classification using the ADNEX model at a cut-off value of 10% for malignancy had the sensitivity, specificity, LR+ and LR- of 92.4%, 73.0%, 3.42, and 0.10. This resulted in the lowest overall accuracy of 78.8%. The AUC for RMI was 0.854 (95% CI [0.815-0.887]), with overall accuracy, sensitivity, specificity, LR+ and LR- of 82.3%, 73.7%, 86.0%, 5.26, and 0.31. There was no difference in the AUCs of the SA and IOTA models for the whole group, premenopausal, and postmenopausal groups. RMI performed worse compared to SA and the IOTA models. The ADNEX model achieved the highest accuracy at the cut-off value of 35%. Limitations: The data generalizability is limited by a single institution-dependent sampling. Conclusions: The IOTA SR and ADNEX model were reliable and comparable with the SA and performed better than the RMI. The IOTA SR model offers the potential for immediate and reliable diagnosis, even in the hands of less experienced ultrasonographers. Both IOTA models studied can be a valuable adjunct to a clinician's decision-making process. © 2023 S. Karger AG, Basel. All rights reserved.

Background/Objectives: Due to the rarity and histological heterogeneity of non-epithelial ovarian cancers (NEOCs), monitoring their reproductive and oncological outcomes is challenging. Therefore, this study aimed to investigate the oncological and reproductive outcomes of patients with NEOCs treated with fertility-sparing surgery over the past 10 years at our tertiary referral university clinic. Methods: This retrospective study included all the NEOC patients diagnosed and treated with fertility-sparing surgery from 2010 to 2019. The patient demographic and clinical characteristics; data regarding the treatment andthe clinical, laboratory, and imaging findings during follow-up; and disease recurrences were recorded. In this study, the recurrence-free survival and the overall survival were the oncological outcomes. The reproductive outcomes were assessed as attempting and achieving pregnancy. Results: This study included 39 patients. The most frequent NEOCs were granulosa cell tumors (53.8%). The majority of the tumors were in the IA or IC1 stage. The initial therapy was generally a unilateral salpingo-oophorectomy (30.8%). Adjuvant chemotherapy was received by 48.7% of the patients. An NEOC recurrence was registered in 25.6% of the patients, mostly during the first two postoperative years. The recurrence-free survival was 76.92%. A regression analysis showed that amore advanced stage of NEOC was the most important predictor of disease recurrence. The overall survival rate was 87.2%, with a mean time to an adverse outcome of 23.01 +/−10.68 months. The regression analysis showed that better survival depended mostly on not having disease recurrence. After treatment, ten patients tried to conceive and seven succeeded. All the children were in good condition upon birth. Conclusions: Fertility-sparing treatment for NEOCs was proven as a safe and successful option in terms of both oncological and reproductive outcomes. © 2025 by the authors.

Background/Objectives: Due to the rarity and histological heterogeneity of non-epithelial ovarian cancers (NEOCs), monitoring their reproductive and oncological outcomes is challenging. Therefore, this study aimed to investigate the oncological and reproductive outcomes of patients with NEOCs treated with fertility-sparing surgery over the past 10 years at our tertiary referral university clinic. Methods: This retrospective study included all the NEOC patients diagnosed and treated with fertility-sparing surgery from 2010 to 2019. The patient demographic and clinical characteristics; data regarding the treatment andthe clinical, laboratory, and imaging findings during follow-up; and disease recurrences were recorded. In this study, the recurrence-free survival and the overall survival were the oncological outcomes. The reproductive outcomes were assessed as attempting and achieving pregnancy. Results: This study included 39 patients. The most frequent NEOCs were granulosa cell tumors (53.8%). The majority of the tumors were in the IA or IC1 stage. The initial therapy was generally a unilateral salpingo-oophorectomy (30.8%). Adjuvant chemotherapy was received by 48.7% of the patients. An NEOC recurrence was registered in 25.6% of the patients, mostly during the first two postoperative years. The recurrence-free survival was 76.92%. A regression analysis showed that amore advanced stage of NEOC was the most important predictor of disease recurrence. The overall survival rate was 87.2%, with a mean time to an adverse outcome of 23.01 +/−10.68 months. The regression analysis showed that better survival depended mostly on not having disease recurrence. After treatment, ten patients tried to conceive and seven succeeded. All the children were in good condition upon birth. Conclusions: Fertility-sparing treatment for NEOCs was proven as a safe and successful option in terms of both oncological and reproductive outcomes. © 2025 by the authors.

Background and Objectives: Severe hemoperitoneum of ovarian bleeding origin is a rare but potentially life-threatening complication of transvaginal oocyte retrieval (TVOR) procedure. The study aimed to present a case series of surgically managed patients from our clinic with hemoperitoneum caused by ovarian bleeding after TVOR, as well as to perform a comprehensive literature review in order to summarize and analyze all published cases with this condition and their management. Materials and Methods: The data of 2939 patients, who underwent TVOR procedures for IVF/ICSI (in vitro fertilization, intracytoplasmic sperm injection) in our clinic between 2010 and 2021 were reviewed. Moreover, a systemic literature search was performed. Main outcome measures from the pooled analysis were incidence and risk factors, type of surgery, intraoperative finding and intervention leading to hemostasis. Results: In our Clinic 4 (0.136%), cases of hemoperitoneum due to ovarian bleeding were surgically managed. Moreover, 39 cases from 18 studies reported in the literature were identified. No risk factors besides lean women with PCOS were identified. In the pooled analysis, the bleeding symptoms appeared in 58.1% of patients within eight hours after TVOR and cumulatively in 81.4% cases during the 24 h after TVOR. The average time from TVOR to surgery was 27.19 ± 53.25 h. Hemostasis was mostly established using electrocoagulation, although few cases of ovariectomy were also reported. Embryo transfer at 60% of cases was postponed and embryos cryopreserved. Conclusions: Severe hemoperitoneum due to ovarian bleeding after TVOR is a rare event that should be treated by techniques of minimally invasive surgery whenever possible. Protocols should be developed to enable optimal management strategies for infertility patients. Embryos obtained should be cryopreserved. © 2023 by the authors.