The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery
Identifieur interne : 001130 ( Istex/Corpus ); précédent : 001129; suivant : 001131The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery
Auteurs : George Condous ; Emeka Okaro ; Asma Khalid ; Chuan Lu ; Sabine Van Huffel ; D. Timmerman ; Tom BourneSource :
- Human Reproduction [ 0268-1161 ] ; 2005-05.
English descriptors
- KwdEn :
Abstract
BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.
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DOI: 10.1093/humrep/deh770
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Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Bourne, Tom" sort="Bourne, Tom" uniqKey="Bourne T" first="Tom" last="Bourne">Tom Bourne</name><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:57B1AC84D43463B085A9F6F1C81136347EA3FC87</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1093/humrep/deh770</idno><idno type="url">https://api.istex.fr/document/57B1AC84D43463B085A9F6F1C81136347EA3FC87/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001130</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title><author><name sortKey="Condous, George" sort="Condous, George" uniqKey="Condous G" first="George" last="Condous">George Condous</name><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Okaro, Emeka" sort="Okaro, Emeka" uniqKey="Okaro E" first="Emeka" last="Okaro">Emeka Okaro</name><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Khalid, Asma" sort="Khalid, Asma" uniqKey="Khalid A" first="Asma" last="Khalid">Asma Khalid</name><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Lu, Chuan" sort="Lu, Chuan" uniqKey="Lu C" first="Chuan" last="Lu">Chuan Lu</name><affiliation><mods:affiliation>Department of Electrical Engineering (ESAT), and</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Van Huffel, Sabine" sort="Van Huffel, Sabine" uniqKey="Van Huffel S" first="Sabine" last="Van Huffel">Sabine Van Huffel</name><affiliation><mods:affiliation>Department of Electrical Engineering (ESAT), and</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Timmerman, D" sort="Timmerman, D" uniqKey="Timmerman D" first="D" last="Timmerman">D. Timmerman</name><affiliation><mods:affiliation>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Bourne, Tom" sort="Bourne, Tom" uniqKey="Bourne T" first="Tom" last="Bourne">Tom Bourne</name><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Human Reproduction</title><title level="j" type="abbrev">Hum. Reprod.</title><idno type="ISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-05">2005-05</date><biblScope unit="volume">20</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="1404">1404</biblScope><biblScope unit="page" to="1409">1409</biblScope></imprint><idno type="ISSN">0268-1161</idno></series><idno type="istex">57B1AC84D43463B085A9F6F1C81136347EA3FC87</idno><idno type="DOI">10.1093/humrep/deh770</idno><idno type="href">deh770.pdf</idno><idno type="local">deh770</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0268-1161</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>adnexal mass</term><term>ectopic pregnancy</term><term>hyper-echoic ring</term><term>inhomogeneous mass (blob sign)</term><term>transvaginal ultrasonography</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>George Condous</name><affiliations><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string><json:string>E-mail: gcondous@hotmail.com</json:string></affiliations></json:item><json:item><name>Emeka Okaro</name><affiliations><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Asma Khalid</name><affiliations><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Chuan Lu</name><affiliations><json:string>Department of Electrical Engineering (ESAT), and</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Sabine Van Huffel</name><affiliations><json:string>Department of Electrical Engineering (ESAT), and</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item><json:item><name>D Timmerman</name><affiliations><json:string>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item><json:item><name>Tom Bourne</name><affiliations><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string><json:string>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>ectopic pregnancy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>adnexal mass</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>inhomogeneous mass (blob sign)</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>hyper-echoic ring</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>transvaginal ultrasonography</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.</abstract><qualityIndicators><score>6.925</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>2113</abstractCharCount><pdfWordCount>3925</pdfWordCount><pdfCharCount>25105</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>333</abstractWordCount></qualityIndicators><title>The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title><genre><json:string>research-article</json:string></genre><host><volume>20</volume><publisherId><json:string>humrep</json:string></publisherId><pages><last>1409</last><first>1404</first></pages><issn><json:string>0268-1161</json:string></issn><issue>5</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1460-2350</json:string></eissn><title>Human Reproduction</title></host><categories><wos><json:string>OBSTETRICS & GYNECOLOGY</json:string><json:string>REPRODUCTIVE BIOLOGY</json:string></wos></categories><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1093/humrep/deh770</json:string></doi><id>57B1AC84D43463B085A9F6F1C81136347EA3FC87</id><score>0.23722789</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/57B1AC84D43463B085A9F6F1C81136347EA3FC87/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/57B1AC84D43463B085A9F6F1C81136347EA3FC87/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/57B1AC84D43463B085A9F6F1C81136347EA3FC87/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org</p></availability><date>2005</date></publicationStmt><notesStmt><note>4To whom correspondence should be addressed at: Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. Email: gcondous@hotmail.com</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title><author xml:id="author-1"><persName><forename type="first">George</forename><surname>Condous</surname></persName><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-2"><persName><forename type="first">Emeka</forename><surname>Okaro</surname></persName><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-3"><persName><forename type="first">Asma</forename><surname>Khalid</surname></persName><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-4"><persName><forename type="first">Chuan</forename><surname>Lu</surname></persName><affiliation>Department of Electrical Engineering (ESAT), and</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-5"><persName><forename type="first">Sabine</forename><surname>Van Huffel</surname></persName><affiliation>Department of Electrical Engineering (ESAT), and</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-6"><persName><forename type="first">D</forename><surname>Timmerman</surname></persName><affiliation>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author><author xml:id="author-7"><persName><forename type="first">Tom</forename><surname>Bourne</surname></persName><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation></author></analytic><monogr><title level="j">Human Reproduction</title><title level="j" type="abbrev">Hum. Reprod.</title><idno type="pISSN">0268-1161</idno><idno type="eISSN">1460-2350</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-05"></date><biblScope unit="volume">20</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="1404">1404</biblScope><biblScope unit="page" to="1409">1409</biblScope></imprint></monogr><idno type="istex">57B1AC84D43463B085A9F6F1C81136347EA3FC87</idno><idno type="DOI">10.1093/humrep/deh770</idno><idno type="href">deh770.pdf</idno><idno type="local">deh770</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2005</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>ectopic pregnancy</term></item><item><term>adnexal mass</term></item><item><term>inhomogeneous mass (blob sign)</term></item><item><term>hyper-echoic ring</term></item><item><term>transvaginal ultrasonography</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2005-05">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/57B1AC84D43463B085A9F6F1C81136347EA3FC87/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">humrep</journal-id><journal-id journal-id-type="nlm-ta">Hum Reprod</journal-id><journal-id journal-id-type="publisher-id">humrep</journal-id><journal-title>Human Reproduction</journal-title><abbrev-journal-title abbrev-type="publisher">Hum. Reprod.</abbrev-journal-title><issn pub-type="ppub">0268-1161</issn><issn pub-type="epub">1460-2350</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">deh770</article-id><article-id pub-id-type="doi">10.1093/humrep/deh770</article-id><article-categories><subj-group subj-group-type="heading"><subject>Early Pregnancy</subject></subj-group></article-categories><title-group><article-title>The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Condous</surname><given-names>George</given-names></name><xref rid="AFF1">1</xref><xref rid="COR1">4</xref></contrib><contrib contrib-type="author"><name><surname>Okaro</surname><given-names>Emeka</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Khalid</surname><given-names>Asma</given-names></name><xref rid="AFF1">1</xref></contrib><contrib contrib-type="author"><name><surname>Lu</surname><given-names>Chuan</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Van Huffel</surname><given-names>Sabine</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Timmerman</surname><given-names>D</given-names></name><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Bourne</surname><given-names>Tom</given-names></name><xref rid="AFF1">1</xref></contrib><aff><target target-type="aff" id="AFF1"></target><label>1</label>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK <target target-type="aff" id="AFF2"></target><label>2</label>Department of Electrical Engineering (ESAT), and <target target-type="aff" id="AFF3"></target><label>3</label>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</aff></contrib-group><author-notes><corresp id="COR1"><label>4</label>To whom correspondence should be addressed at: Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. Email: <ext-link xlink:href="gcondous@hotmail.com" ext-link-type="email">gcondous@hotmail.com</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>5</month><year>2005</year></pub-date><volume>20</volume><issue>5</issue><fpage>1404</fpage><lpage>1409</lpage><history><date date-type="accepted"><day>10</day><month>01</month><year>2005</year></date><date date-type="received"><day>16</day><month>09</month><year>2004</year></date><date date-type="rev-recd"><day>21</day><month>12</month><year>2004</year></date></history><permissions><copyright-statement><italic>© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: <ext-link xlink:href="journals.permissions@oupjournals.org" ext-link-type="email">journals.permissions@oupjournals.org</ext-link></italic></copyright-statement><copyright-year>2005</copyright-year></permissions><self-uri content-type="arthw-pdf" xlink:href="deh770.pdf"></self-uri><abstract xml:lang="en"><p>BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>ectopic pregnancy</kwd><kwd>adnexal mass</kwd><kwd>inhomogeneous mass (blob sign)</kwd><kwd>hyper-echoic ring</kwd><kwd>transvaginal ultrasonography</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>1404</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>May 2005</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Articles</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery</title></titleInfo><name type="personal"><namePart type="given">George</namePart><namePart type="family">Condous</namePart><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Emeka</namePart><namePart type="family">Okaro</namePart><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Asma</namePart><namePart type="family">Khalid</namePart><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chuan</namePart><namePart type="family">Lu</namePart><affiliation>Department of Electrical Engineering (ESAT), and</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Sabine</namePart><namePart type="family">Van Huffel</namePart><affiliation>Department of Electrical Engineering (ESAT), and</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Timmerman</namePart><affiliation>Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Tom</namePart><namePart type="family">Bourne</namePart><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><affiliation>Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2005-05</dateIssued><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.</abstract><note type="author-notes">4To whom correspondence should be addressed at: Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. Email: gcondous@hotmail.com</note><subject lang="en"><genre>KWD</genre><topic>ectopic pregnancy</topic><topic>adnexal mass</topic><topic>inhomogeneous mass (blob sign)</topic><topic>hyper-echoic ring</topic><topic>transvaginal ultrasonography</topic></subject><relatedItem type="host"><titleInfo><title>Human Reproduction</title></titleInfo><titleInfo type="abbreviated"><title>Hum. Reprod.</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0268-1161</identifier><identifier type="eISSN">1460-2350</identifier><identifier type="PublisherID">humrep</identifier><identifier type="PublisherID-hwp">humrep</identifier><identifier type="PublisherID-nlm-ta">Hum Reprod</identifier><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>20</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>1404</start><end>1409</end></extent></part></relatedItem><identifier type="istex">57B1AC84D43463B085A9F6F1C81136347EA3FC87</identifier><identifier type="DOI">10.1093/humrep/deh770</identifier><identifier type="href">deh770.pdf</identifier><identifier type="local">deh770</identifier><accessCondition type="use and reproduction" contentType="copyright">© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. 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