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Objective The management of pregnant women with an adnexal tumor is still challenging and in the literature few data are available. The aim of this study was to describe the management and outcome of patients with ovarian masses detected during pregnancy. As secondary aims, we evaluated the prevalence of malignancy in the International Ovarian Tumor Analysis (IOTA) morphological classes of ovarian masses diagnosed during pregnancy, and created an algorithm for the management of patients with adnexal masses during pregnancy. Methods This was a retrospective single centered study including patients with adnexal masses detected at any trimester during pregnancy between January 2000 and December 2019. Clinical, ultrasound, surgical, and histological data were retrieved from medical records as well as information on management (ultrasound follow-up vs surgery). Indications for surgery were recorded in terms of suspicion of malignancy based on pattern recognition of the ultrasound examiner or on symptoms or prevention of complications, such as torsion, rupture, or obstacle to normal full-term pregnancy. All masses were described using IOTA terminology. Results A total of 113 patients were selected for the analysis. Of these, 48 (42%) patients had surveillance and 65 (58%) patients underwent surgery (11 primary ovarian tumors, one recurrence of ovarian cancer, four metastases to the ovary, 20 borderline tumors, and 29 benign lesions). Indications for surgery were suspicious malignancy in 41/65 (63.1%) cases and symptoms or prevention of complications in 24/65 (36.9%) cases. All patients in the surveillance group showed no morphological changes of the ovarian lesions at 6 months after delivery. According to the IOTA ultrasound morphological category, the prevalence of malignancy was 0% (0/37) in the unilocular cyst group, 27% (4/15) in the multilocular group, 35% (11/31) in the unilocular solid group, 70% (14/20) in the multilocular solid group, and 70% (7/10) in the solid group. Neither obstetric nor neonatal complications were reported for patients in the surveillance group or in those with benign, borderline, or primary epithelial invasive histology. In contrast, two neonatal deaths were observed in patients with ovarian choriocarcinoma and ovarian metastases. Three of the four patients with ovarian metastases died after pregnancy. Conclusions IOTA ultrasound morphological classification seems useful in the characterization of ovarian masses during pregnancy. A clinical and morphological based algorithm for counseling patients has been designed. [ABSTRACT FROM AUTHOR]

Fertility preservation is an integral component of clinical decision-making and treatment design. However, the selection criteria on imaging for patients eligible for fertility preservation is still unclear. The present review aimed to summarize the main findings reported in both the literature and international guidelines on the role of imaging in the selection of patients for fertility preservation. A search strategy was developed and applied to PubMed, Scopus, Web of Science, and EMBASE to identify previous citations reporting imaging and fertility preservation in patients with gynecological cancer. We also retrieved the published guidelines on the eligibility criteria for fertility-sparing treatment of gynecological neoplasms. A description of the internal multidisciplinary guidelines, clinically in use in our institution, is provided with representative clinical cases. The literature review revealed 1291 articles and 18 of these were selected for the analysis. Both ultrasound and MRI represented the primary imaging methods for selecting patients for fertility preservation in cervical and endometrial cancers. Eligibility criteria of fertility-sparing management in patients with cervical cancer were: tumor size <2 cm, tumor distance from the internal os >1 cm, and no parametrium invasion. For patients with endometrial cancer, these included no myometrial and cervical stroma invasion. Both ultrasound and MRI play a key role in characterizing adnexal masses. These modalities provide a useful tool in identifying small ovarian lesions, thus key in the surveillance of patients after fertility sparing surgery. However, efficacy in excluding disease beyond the ovary remains limited. This review provides an update of the literature and schematic outline for the counseling and management of patients with the desire for fertility preservation. [ABSTRACT FROM AUTHOR]

Background A radical surgical approach represents the mainstay treatment for gynecological malignancy, and preoperative staging of ovarian cancer is crucial. Ultrasound evaluation is widely recognized as the gold standard technique for the characterization of ovarian masses due to a high sensitivity for malignancy. In addition, its accuracy in defining intra-abdominal ovarian cancer spread has been previously proposed. Primary objective To analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease using six parameters as described by Fagotti's score. Study hypothesis When performed by expert examiners, ultrasound can be an accurate technique to assess tumor spread in ovarian cancer and therefore to predict surgical resectability. Trial design This is a single-center prospective observational study. Patients with clinical and/or radiological suspicion of advanced ovarian or peritoneal cancer will be assessed with preoperative ultrasound and assigned a score based on the six Fagotti's laparoscopic score parameters. Each parameter will then be correlated with laparoscopic findings. Major inclusion/exclusion criteria Eligible patients include women 18-75 years of age with clinical and/or imaging suggestive of advanced ovarian or peritoneal cancer, and an ECOG performance status 0-3. Primary endpoints Sensitivity and specificity of ultrasound in detecting carcinomatosis, using the parameters of Fagotti's score as a reference standard. Agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease as described in Fagotti's score. Sample size 240 patients. Estimate dates for completing accrual and presenting results The accrual started in January 2019. Enrollment should be completed approximately by October 2020 and the results will be analyzed by December 2020. Trial registration The study received the Ethical Committee approval on July 19 2018 (Protocol 28967/18 ID:2172). [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: Ovarian cancer is commonly diagnosed at an advanced stage. Complete macroscopic eradication of the disease is associated with improved prognosis. In this setting, the surgical resection of enlarged cardiophrenic lymph nodes (CPLNs) can help to achieve cytoreduction to no gross residual disease. During surgery, CPLN removal is usually performed either via video-assisted thoracic surgery or through a large transdiaphragmatic or subxiphoid incision. In the present case, we propose the use of an intraoperative transdiaphragmatic ultrasound to confirm preoperative imaging and to obtain a precise localization of the suspicious CPLNs. Methods: A 50-year-old woman without peritoneal carcinomatosis was diagnosed with bilateral ovarian cancer and enlarged inguinal, pelvic, aortic, and cardiophrenic nodes. She underwent primary debulking surgery, including radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and bulky nodes resection, at the iliac, inguinal, and lumboaortic regions. Results: After obtaining complete abdominal cytoreduction, an intraoperative ultrasound scan was performed. Two enlarged CPLNs were ultrasonographically visualized using a convex contact probe through a transhepatic window, and their exact location was identified. After complete mobilization of the right liver, the right diaphragm was incised, proximal to the site of the lymphadenopathies. The 2 lymph nodes were identified, grasped, and removed by transdiaphragmatic approach. Absence of other residual disease was confirmed by thoracic inspection, palpation, and by a subsequent intraoperative ultrasound control. At final histology, CPLNs were positive for infiltration of high-grade serous ovarian carcinoma. Conclusions: Intraoperative transdiaphragmatic ultrasound represents a possible approach to localize suspicious CPLNs and to guide their surgical eradication. [ABSTRACT FROM AUTHOR]

The article describes the laparoscopic intra-operative ultrasound-guided bilateral salpingo-oophorectomy in a 55-year-old female BRCA2 mutated patient. Highlights include the patient's bilateral ovarian transposition to the psoas muscle, identification of the left adnexum on the psoas muscle, and the presence of healthy ovarian tissue confirmed by final histology.