32 results on '"Moruzzi, M C"'
Search Results
2. Preliminary design of a short-medium range windowless aircraft
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Moruzzi, M. C. and Bagassi, S.
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- 2020
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3. Imaging in gynecological disease (27): clinical and ultrasound characteristics of recurrent ovarian stromal cell tumors.
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Moro, F., Giudice, M. T., Bolomini, G., Moruzzi, M. C., Mascilini, F., Quagliozzi, L., Ciccarone, F., Scambia, G., Fagotti, A., Valentin, L., and Testa, A. C.
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CELL tumors ,FEMALE reproductive organ diseases ,STROMAL cells ,ULTRASONIC imaging ,GRANULOSA cell tumors ,OVARIAN tumors - Abstract
Objective: To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli–Leydig cell tumors. Methods: This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center), Italy. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli–Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition. Results: We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli–Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli–Leydig tumors (6/7, 85.7%) were classified as solid or multilocular‐solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli–Leydig cell tumors were unilocular cysts and 9/55 (16.4%) recurrent granulosa cell tumors were multilocular cysts. The nine unilocular cysts had contents that were anechoic (n = 2) or had low‐level echogenicity (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged in largest diameter from 8 to 38 mm, with three being < 20 mm and five being 20–30 mm. On retrospective review of the images, two typical ultrasound patterns were described: small solid tumor measuring < 2 cm (15/62, 24.2%) and tumor with vascularized echogenic ground‐glass‐like content (12/62, 19.4%). Conclusions: Some granulosa cell and Sertoli–Leydig cell recurrences manifest one of two typical ultrasound patterns, while some appear as unilocular cysts. These are usually classified as benign, but in patients being followed up for a granulosa cell tumor or Sertoli–Leydig cell tumor, a unilocular cyst should be considered suspicious of recurrence. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]
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- 2024
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4. TRANSVAGINAL/TRANSABDOMINAL SONOGRAPHY FOR HISTOLOGICAL DIAGNOSIS IN ADVANCED OVARIAN CANCER PATIENTS: A SINGLE INSTITUTION PROSPECTIVE STUDY: EP918
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Mascilini, F, Quagliozzi, L, Moruzzi, M C, Albanese, M, Testa, A C, Scambia, G, and Fagotti, A
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- 2019
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5. Imaging in gynecological disease (12): clinical and ultrasound features of invasive and non‐invasive malignant serous ovarian tumors
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Moro, F., Baima Poma, C., Zannoni, G. F., Vidal Urbinati, A., Pasciuto, T., Ludovisi, M., Moruzzi, M. C., Carinelli, S., Franchi, D., Scambia, G., and Testa, A. C.
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- 2017
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6. A non-invasive prevention program model for the assessment of osteoporosis in the early postmenopausal period: a pilot study on FRAX® and QUS tools advantages
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Villa, P., Lassandro, A. P., Moruzzi, M. C., Amar, I. D., Vacca, L., Di Nardo, F., De Waure, C., Pontecorvi, A., and Scambia, G.
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- 2016
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7. ATTENUATION OF NOISE IN THE CABIN OF A REGIONAL AIRCRAFT BY METAMATERIAL TRIM PANELS
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Moruzzi M. C., Cinefra M., Bagassi S., Carrera E., Moruzzi M.C., Cinefra M., Bagassi S., and Carrera E.
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Finite element method ,Metamaterial ,Vibroacoustic analysis ,Cabin comfort ,Noise reduction - Abstract
Interior noise has always been an issue for aircraft manufacturers, even if only recently has it received equal importance to other design requirements. Passengers are increasingly concerned about cabin comfort, which they consider high priority for medium and long flights. In order to reach the challenging interior noise target set for the new generation small aircraft 80 OASPL dB, 70 dBA, 56 dBSIL3, a noise reduction plan must address and accurately identify noise sources. The main goal of this work is to evaluate acoustic comfort, by analysing sound pressure levels, in the cabin of a regional turboprop subjected to multiple broadband noise components, that simulates the noise generated inside the aircraft with monopolar sources. Sandwiches with metamaterial core are employed as trim panels of the cabin for improving sound absorption through the fuselage and the averaged interior noise level at seated person ear height is numerically evaluated with the Finite Element commercial software, Actran®. In particular, this work aims to show the higher acoustic performances of innovative passive Noise & Vibration technologies, such as acoustic metamaterials, with respect to classical soundproofing solutions.
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- 2021
8. Imaging in gynecological disease (8): ultrasound characteristics of recurrent borderline ovarian tumors
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FRANCHI, D., BOVERI, S., FRUSCIO, R., FISCHEROVA, D., GUERRIERO, S., MORUZZI, M. C., COLOMBO, N., TIMMERMAN, D., VALENTIN, L., and TESTA, A. C.
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- 2013
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9. Additively manufactured negative stiffness structures for shock absorber applications.
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Corsi, M., Bagassi, S., Moruzzi, M. C., and Weigand, F.
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SHOCK absorbers ,SELECTIVE laser sintering ,FUNCTIONAL integration ,MECHANICAL buckling ,MATERIALS compression testing ,FLEXIBLE structures - Abstract
Negative stiffness structures (NSS), as a branch of multi-stable mechanical metamaterials, exhibit multiple stable configurations. Their characteristics, such as bistability, snap-through and negative stiffness, make them particularly suitable for shock absorber applications. The majority of NSS is designed in a cuboidal shape and only recently few studies focused on cylindrical NSS. Lately, Fraunhofer for Additive Manufacturing Technologies IAPT, has started some studies to optimize these structures and to profit by their features in different applications, such as InspectionCopter project. During this study, three types of special-shaped NSS were designed, produced and tested. To determine the influence of dimensional parameters and materials on the functionality of these flexible structures, for each one of three concepts, five different versions in two different materials and techniques were realized. The specimens were fabricated in PEBA (PolyEther Block Amide) and TPU (Thermoplastic PolyUrethane) using, respectively, Selective Laser Sintering (SLS) and MultiJet Printing (MJP) technologies; the design freedom of Additive Manufacturing (AM) allows the production of complex structures and the possibility of functional integration, such as shock absorber functionality. To investigate the mechanical and NS properties of these structures and their deformation mechanisms, quasi-static compression tests were performed according to ASTM D695 − 15 regulation. The results, analyzed through force–displacement curves, highlighted the energy recovery of the specimens during deformation and the influence of dimensional parameters on the response to the applied loads. During the tests, it was also evident how the usage of different dimensions and materials can lead, for the same structure, to a symmetric or asymmetric buckling mode in the collapse of the layers and to prevent the structure from returning to its original shape once the load has been removed. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Fusion imaging in preoperative assessment of extent of disease in patients with advanced ovarian cancer: feasibility and agreement with laparoscopic findings.
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Moro, F., Bertoldo, V., Avesani, G., Moruzzi, M. C., Mascilini, F., Bolomini, G., Caliolo, G., Esposito, R., Moroni, R., Zannoni, G. F., Fagotti, A., Manfredi, R., Scambia, G., and Testa, A. C.
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OVARIAN cancer ,IMAGE fusion ,ULTRASONIC imaging ,MAGNETIC resonance imaging ,COMPUTED tomography ,POSITRON emission tomography ,PERITONEAL cancer - Abstract
Objectives: Fusion imaging is an emerging technique that combines real-time ultrasound examination with images acquired previously using other modalities, such as computed tomography (CT), magnetic resonance imaging and positron emission tomography. The primary aim of this study was to evaluate the feasibility of fusion imaging in patients with suspicion of ovarian or peritoneal cancer. Secondary aims were: to compare the agreement of findings on fusion imaging, CT alone and ultrasound imaging alone with laparoscopic findings, in the assessment of extent of intra-abdominal disease; and to evaluate the time required for the fusion imaging technique.Methods: Patients with clinical and/or radiographic suspicion of advanced ovarian or peritoneal cancer who were candidates for surgery were enrolled prospectively between December 2019 and September 2020. All patients underwent a CT scan and ultrasound and fusion imaging to evaluate the presence or absence of the following abdominal-cancer features according to the laparoscopy-based scoring model (predictive index value (PIV)): supracolic omental disease, visceral carcinomatosis on the liver, lesser omental carcinomatosis and/or visceral carcinomatosis on the lesser curvature of the stomach and/or spleen, involvement of the paracolic gutter(s) and/or anterior abdominal wall, involvement of the diaphragm and visceral carcinomatosis on the small and/or large bowel (regardless of rectosigmoid involvement). The feasibility of the fusion examination in these patients was evaluated. Agreement of each imaging method (ultrasound, CT and fusion imaging) with laparoscopy (considered as reference standard) was calculated using Cohen's kappa coefficient.Results: Fifty-two patients were enrolled into the study. Fusion imaging was feasible in 51 (98%) of these patients (in one patient, it was not possible for technical reasons). Two patients were excluded because laparoscopy was not performed, leaving 49 women in the final analysis. Kappa values for CT, ultrasound and fusion imaging, using laparoscopy as the reference standard, in assessing the PIV parameters were, respectively: 0.781, 0.845 and 0.896 for the great omentum; 0.329, 0.608 and 0.847 for the liver surface; 0.472, 0.549 and 0.756 for the lesser omentum and/or stomach and/or spleen; 0.385, 0.588 and 0.795 for the paracolic gutter(s) and/or anterior abdominal wall; 0.385, 0.497 and 0.657 for the diaphragm; and 0.336, 0.410 and 0.469 for the bowel. The median time needed to perform the fusion examination was 20 (range, 10-40) min.Conclusion: Fusion of CT images and real-time ultrasound imaging is feasible in patients with suspicion of ovarian or peritoneal cancer and improves the agreement with surgical findings when compared with ultrasound or CT scan alone. © 2021 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]- Published
- 2021
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11. Imaging of gynecological disease: clinical and ultrasound characteristics of uterine sarcomas
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Ludovisi, Manuela, Moro, Francesca, Pasciuto, Tina, Di Noi, Silvia, Giunchi, S, Savelli, L, Pascual, M A, Sladkevicius, P, Alcazar, J L, Franchi, D, Mancari, R, Moruzzi, M C, Jurkovic, D, Chiappa, V, Guerriero, S, Exacoustos, C, Epstein, E, Frühauf, P, Fischerova, D, Fruscio, R, Ciccarone, F, Zannoni, Gian Franco, Scambia, Giovanni, Valentin, L, and Testa, Antonia Carla
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endometrial stromal ,leiomyosarcoma ,pattern recognition ,sarcoma ,ultrasonography ,Settore MED/40 - GINECOLOGIA E OSTETRICIA - Published
- 2019
12. Vibroacoustic analysis of an innovative windowless cabin with metamaterial trim panels in regional turboprops.
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Moruzzi, M. C., Cinefra, M., and Bagassi, S.
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ACOUSTIC vibrations , *NOISE control , *SOUND pressure , *VACATION homes , *MODEL airplanes - Abstract
The purpose of this work is to study the possible noise reduction, in terms of sound pressure level, in the passenger cabin of a regional turboprop aircraft under multiple tonal and broadband noise components characterizing the noise generated by the engines during cruise flight conditions. In particular, we want to show the acoustic performances of innovative passive noise and vibration technologies, such as acoustic metamaterials applied to the trim panel of the cabin, in the low-frequency range, from 100 to 300 Hz. Moreover, the removal of windows from the passenger cabin is evaluated, in acoustic terms. Analyses are performed using a numerical tool, Actran, a finite element based software, and a numerical model of a regional aircraft fuselage. According to the results, metamaterials seem to have significant acoustic performances that lead to a reduction in noise and therefore an increase in passenger comfort. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Preliminary design of a long range windowless aircraft concept
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Bagassi, S., Lucchi, F., Moruzzi, M. C., Bagassi, S., Lucchi, F., and Moruzzi, M.C.
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Control and Systems Engineering ,Windowless configuration ,Aircraft preliminary design ,Weight reduction ,Aerospace Engineering ,ComputerApplications_COMPUTERSINOTHERSYSTEMS ,Materials Science (all) ,Electrical and Electronic Engineering ,Fuselage design - Abstract
The objective of this paper is to describe the preliminary design of a windowless configuration of a long-range aircraft and to analytically assess the achieved weight reduction. As a matter of fact, the reduction of weight is directly linked with reduction of fuel consumption; consequently there are advantages in terms of aircraft operative costs and emissions of carbon dioxide. A feasibility study will bring to the assessment of weight and cost reduction in consideration to the introduction of innovative screens, to give passengers the possibility to see through the fuselage itself. The proposed methodology consists in the preliminary design of a long-range aircraft, considering some defined design parameters and constraints. The activity will finally lead to weight reduction evaluation, in case the same aircraft will be designed windowless. In the end the methodology is applied to two existing aircrafts to estimate potential benefits of the windowless configuration if compared to the traditional one: the Airbus 340-500 and the Being 777-300.
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- 2018
14. How to perform lung ultrasound in pregnant women with suspected COVID-19.
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Moro, F., Buonsenso, D., Moruzzi, M. C., Inchingolo, R., Smargiassi, A., Demi, L., Larici, A. R., Scambia, G., Lanzone, A., and Testa, A. C.
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COVID-19 ,PREGNANT women ,LUNGS ,RESPIRATORY infections ,RADIATION exposure - Abstract
Under certain circumstances, such as during the current COVID-19 outbreak, pregnant women can be a target for respiratory infection, and lung examination may be required as part of their clinical evaluation, ideally while avoiding exposure to radiation. We propose a practical approach for obstetricians/gynecologists to perform lung ultrasound examination, discussing potential applications, semiology and practical aspects, which could be of particular importance in emergency situations, such as the current pandemic infection of COVID-19. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma.
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Ludovisi, M., Moro, F., Pasciuto, T., Di Noi, S., Giunchi, S., Savelli, L., Pascual, M. A., Sladkevicius, P., Alcazar, J. L., Franchi, D., Mancari, R., Moruzzi, M. C., Jurkovic, D., Chiappa, V., Guerriero, S., Exacoustos, C., Epstein, E., Frühauf, F., Fischerova, D., and Fruscio, R.
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SARCOMA ,UTERINE hemorrhage ,LEIOMYOSARCOMA ,ULTRASONIC imaging ,MYOMETRIUM - Abstract
Objective: To describe the clinical and ultrasound characteristics of uterine sarcomas.Methods: This was a retrospective multicenter study. From the databases of 13 ultrasound centers, we identified patients with a histological diagnosis of uterine sarcoma with available ultrasound reports and ultrasound images who had undergone preoperative ultrasound examination between 1996 and 2016. As the first step, each author collected information from the original ultrasound reports from his/her own center on predefined ultrasound features of the tumors and by reviewing the ultrasound images to identify information on variables not described in the original report. As the second step, 16 ultrasound examiners reviewed the images electronically in a consensus meeting and described them using predetermined terminology.Results: We identified 116 patients with leiomyosarcoma, 48 with endometrial stromal sarcoma and 31 with undifferentiated endometrial sarcoma. Median age of the patients was 56 years (range, 26-86 years). Most patients were symptomatic at diagnosis (164/183 (89.6%)), the most frequent presenting symptom being abnormal vaginal bleeding (91/183 (49.7%)). Patients with endometrial stromal sarcoma were younger than those with leiomyosarcoma and undifferentiated endometrial sarcoma (median age, 46 years vs 57 and 60 years, respectively). According to the assessment by the original ultrasound examiners, the median diameter of the largest tumor was 91 mm (range, 7-321 mm). Visible normal myometrium was reported in 149/195 (76.4%) cases, and 80.0% (156/195) of lesions were solitary. Most sarcomas (155/195 (79.5%)) were solid masses (> 80% solid tissue), and most manifested inhomogeneous echogenicity of the solid tissue (151/195 (77.4%)); one sarcoma was multilocular without solid components. Cystic areas were described in 87/195 (44.6%) tumors and most cyst cavities had irregular walls (67/87 (77.0%)). Internal shadowing was observed in 42/192 (21.9%) sarcomas and fan-shaped shadowing in 4/192 (2.1%). Moderate or rich vascularization was found on color-Doppler examination in 127/187 (67.9%) cases. In 153/195 (78.5%) sarcomas, the original ultrasound examiner suspected malignancy. Though there were some differences, the results of the first and second steps of the analysis were broadly similar.Conclusions: Uterine sarcomas typically appear as solid masses with inhomogeneous echogenicity, sometimes with irregular cystic areas but only very occasionally with fan-shaped shadowing. Most are moderately or very well vascularized. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2019
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16. Role of CA125/CEA ratio and ultrasound parameters in identifying metastases to the ovaries in patients with multilocular and multilocular-solid ovarian masses.
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Moro, F., Pasciuto, T., Djokovic, D., Di Legge, A., Granato, V., Moruzzi, M. C., Mancari, R., Zannoni, G. F., Fischerova, D., Franchi, D., Scambia, G., Testa, A. C., and Annoni, G F
- Abstract
Objectives: To investigate ultrasound features and the best cut-off value of the cancer antigen 125/carcinoembryonic antigen (CA125/CEA) ratio to discriminate ovarian metastases from benign and primary malignant ovarian neoplasms in two selected groups of morphological ovarian masses, namely multilocular masses with five or more locules and multilocular-solid masses.Methods: Patients with multilocular (five or more locules) or multilocular-solid ovarian masses, operated on within 3 months of ultrasound examination, and with tumor markers (CEA and CA125) available at diagnosis, were identified retrospectively from three ultrasound centers. The masses were described using the International Ovarian Tumor Analysis (IOTA) terminology. Ultrasound and clinical characteristics were compared between those with an ovarian neoplasm (including benign and primary malignant neoplasms) and those with an ovarian metastasis. Receiver-operating characteristics curve (ROC) analysis was used to evaluate the ability of CA125, CEA and CA125/CEA to differentiate between ovarian neoplasms and ovarian metastases, and their predictive performance was assessed.Results: In total, 350 (88.4%) patients with an ovarian neoplasm (including 99 benign, 43 borderline and 197 primary epithelial ovarian carcinomas, seven malignant rare tumors and four other types of invasive ovarian tumor) and 46 (11.6%) patients with an ovarian metastasis were analyzed. On ultrasound examination, ovarian neoplasms were smaller than ovarian metastases (median largest diameter, 97 (range, 20-387) mm vs 146 (range, 43-259) mm, respectively; P < 0.0001) and presented with a lower number of cysts with > 10 locules (18.9% vs 54.3%; P < 0.0001). ROC curve analysis showed that the best cut-off value of CEA for distinguishing between ovarian neoplasms and ovarian metastases was 2.33 ng/mL. The predictive performance of this CEA cut-off value was: area under the curve (AUC), 0.791 (95% CI, 0.711-0.870); accuracy, 73.7%; sensitivity, 73.1%; specificity, 78.3%; positive predictive value (PPV), 96.2%; and negative predictive value (NPV), 27.7%. The best cut-off value of CA125/CEA for distinguishing between ovarian neoplasms and ovarian metastases was 11.92. The predictive performance of this CA125/CEA cut-off value was: AUC, 0.758 (95% CI, 0.683-0.833); accuracy, 79.8%; sensitivity, 82.3%; specificity, 60.9%; PPV, 94.1%; and NPV, 31.1%.Conclusions: CA125/CEA ratio and CEA alone did not show any significant difference in their ability to distinguish between ovarian neoplasms (including benign and malignant) and ovarian metastases in masses with multilocular and those with multilocular-solid morphology. Therefore, in this morphological subgroup of ovarian masses, CEA alone is sufficient to differentiate between ovarian neoplasms and ovarian metastases. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2019
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17. Imaging in gynecological disease (13): clinical and ultrasound characteristics of endometrioid ovarian cancer.
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Moro, F., Pasciuto, T., Mascilini, F., Moruzzi, M. C., Scambia, G., Chiappa, V., Guerriero, S., Zannoni, G. F., Valentin, L., Magoga, G., Testa, A. C., Fischerova, D., Savelli, L., Giunchi, S., Mancari, R., Franchi, D., Czekierdowski, A., Froyman, W., Timmerman, D., and Verri, D.
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OVARIAN cancer ,OVARIAN diseases ,CARCINOMA ,ADENOCARCINOMA ,ULTRASONIC imaging ,ASCITES ,COMPARATIVE studies ,ENDOMETRIOSIS ,RESEARCH methodology ,MEDICAL cooperation ,OVARIAN tumors ,RESEARCH ,ENDOMETRIAL tumors ,EVALUATION research ,COLOR Doppler ultrasonography ,RETROSPECTIVE studies - Abstract
Objective: To describe the clinical and ultrasound characteristics of ovarian pure endometrioid carcinomas.Methods: This was a retrospective multicenter study of patients with a histological diagnosis of pure endometrioid carcinoma. We identified 161 patients from the International Ovarian Tumor Analysis (IOTA) database who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 1999 and 2016, and another 78 patients from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. In addition, one author reviewed all available ultrasound images and described them using pattern recognition.Results: Median age of the 239 patients was 55 years (range, 19-88 years). On ultrasound examination, two (0.8%) endometrioid carcinomas were described as unilocular cysts, three (1.3%) as multilocular cysts, 37 (15.5%) as unilocular-solid cysts, 115 (48.1%) as multilocular-solid cysts and 82 (34.3%) as solid masses. Median largest tumor diameter was 102.5 mm (range, 20-300 mm) and median largest diameter of the largest solid component was 63 mm (range, 9-300 mm). Papillary projections were present in 70 (29.3%) masses. Most cancers (188 (78.7%)) were unilateral. In 49 (20.5%) cases, the cancer was judged by the pathologist to develop from endometriosis. These cancers, compared with those without evidence of tumor developing from endometriosis, more often manifested papillary projections on ultrasound (46.9% (23/49) vs 24.7% (47/190)), were less often bilateral (8.2% (4/49) vs 24.7% (47/190)) and less often associated with ascites (6.1% (3/49) vs 28.4% (54/190)) and fluid in the pouch of Douglas (24.5% (12/49) vs 48.9% (93/190)). Retrospective analysis of available ultrasound images using pattern recognition revealed that many tumors without evidence of tumor developing from endometriosis (36.3% (41/113)) had a large central solid component entrapped within locules, giving the tumor a cockade-like appearance.Conclusions: Endometrioid cancers are usually large, unilateral, multilocular-solid or solid tumors. The ultrasound characteristics of endometrioid carcinomas developing from endometriosis differ from those without evidence of tumor developing from endometriosis, the former being more often unilateral cysts with papillary projections and no ascites. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2018
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18. Prospective multimodal imaging assessment of locally advanced cervical cancer patients administered by chemoradiation followed by radical surgery. The PRICE (PRospective Imaging of CErvical cancer and neoadjuvant treatment) study 2: the role of ultrasound after chemoradiation to assess residual tumor.
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Testa, A. C., Moro, F., Pasciuto, T., Moruzzi, M. C., Di Legge, A., Fuoco, G., Autorino, R., Collarino, A., Gui, B., Zannoni, G. F., Gambacorta, A., Miccò, M., Rufini, V., Scambia, G., Ferrandina, G., Testa, Antonia Carla, Moro, Francesca, Pasciuto, Tina, Moruzzi, Maria Cristina, and Di Legge, Alessia
- Abstract
Objective: To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery.Methods: Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference.Results: Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response.Conclusions: Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2018
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19. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to predict partial response in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery.
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Testa, A. C., Ferrandina, G., Moro, F., Pasciuto, T., Moruzzi, M. C., De Blasis, I., Mascilini, F., Foti, E., Autorino, R., Collarino, A., Gui, B., Zannoni, G. F., Gambacorta, M. A., Valentini, A. L., Rufini, V., and Scambia, G.
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RADIOTHERAPY ,CANCER treatment ,CANCER chemotherapy ,CERVICAL cancer diagnosis ,CERVICAL cancer treatment ,ULTRASONIC imaging - Abstract
Objective: Chemoradiation-based neoadjuvant treatment followed by radical surgery is an alternative therapeutic strategy for locally advanced cervical cancer (LACC), but ultrasound variables used to predict partial response to neoadjuvant treatment are not well defined. Our goal was to analyze prospectively the potential role of transvaginal ultrasound in early prediction of partial pathological response, assessed in terms of residual disease at histology, in a large, single-institution series of LACC patients triaged to neoadjuvant treatment followed by radical surgery.Methods: Between October 2010 and June 2014, we screened 108 women with histologically documented LACC Stage IB2-IVA, of whom 88 were included in the final analysis. Tumor volume, three-dimensional (3D) power Doppler indices and contrast parameters were obtained before (baseline examination) and after 2 weeks of treatment. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (microscopic and/or macroscopic residual tumor at pathological examination). Complete-response and partial-response groups were compared and receiver-operating characteristics (ROC) curves were generated for ultrasound variables that were statistically significant on univariate analysis to evaluate their diagnostic ability to predict partial pathological response.Results: There was a complete pathological response to neoadjuvant therapy in 40 (45.5%) patients and a partial response in 48 (54.5%). At baseline examination, tumor volume did not differ between the two groups. However, after 2 weeks of neoadjuvant treatment, the tumor volume was significantly greater in patients with partial response than it was in those with complete response (P = 0.019). Among the 3D vascular indices, the vascularization index (VI) was significantly lower in the partial-response compared with the complete-response group, both before and after 2 weeks of treatment (P = 0.037 and P = 0.024, respectively). At baseline examination in the contrast analysis, women with partial response had lower tumor peak enhancement (PE) as well as lower tumor wash-in rate (WiR) and longer tumor rise time (RT) compared with complete responders (P = 0.006, P = 0.003, P = 0.038, respectively). There was no difference in terms of contrast parameters after 2 weeks of treatment. ROC-curve analysis of baseline parameters showed that the best cut-offs for predicting partial pathological response were 41.5% for VI (sensitivity, 63.6%; specificity, 66.7%); 16123.5 auxiliary units for tumor PE (sensitivity, 47.9%; specificity, 84.2%); 7.8 s for tumor RT (sensitivity, 68.8%; specificity, 57.9%); and 4902 for tumor WiR (sensitivity, 77.1%; specificity, 60.5%). ROC curves of parameters after 2 weeks of treatment showed that the best cut-off for predicting partial pathological response was 18.1 cm3 for tumor volume (sensitivity, 70.8%; specificity 60.0%) and 39.5% for VI (sensitivity; 62.5%; specificity, 73.5%).Conclusions: Ultrasound and contrast parameters differ between LACC patients with complete response and those with partial response before and after 2 weeks of neoadjuvant treatment. However, neither ultrasound parameters before treatment nor those after 2 weeks of treatment had cut-off values with acceptable sensitivity and specificity for predicting partial pathological response to neoadjuvant therapy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]- Published
- 2018
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20. Ovarian masses with papillary projections diagnosed and removed during pregnancy: ultrasound features and histological diagnosis.
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Mascilini, F., Savelli, L., Scifo, M. C., Exacoustos, C., Timor‐tritsch, I. E., De Blasis, I., Moruzzi, M. C., Pasciuto, T., Scambia, G., Valentin, L., and Testa, A. C.
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OVARIAN cysts ,ULTRASONIC imaging ,PAPILLARY carcinoma ,DIAGNOSIS of endometrial cancer ,CANCER treatment ,DIAGNOSIS - Abstract
ABSTRACT: Objective: To elucidate the ultrasound features that can discriminate between benign and malignant ovarian cysts with papillary projections but no other solid component in pregnant women. Methods: Thirty‐four women with an ultrasound diagnosis of an ovarian cyst with papillary projections but no other solid component that had been removed surgically during pregnancy were identified from the databases of four ultrasound units. Some clinical and ultrasound information was collected prospectively. Missing information was obtained retrospectively from ultrasound images, ultrasound reports and patient records. Using prospectively and retrospectively collected data, the ultrasound appearance of the tumors was described using the terms and definitions of the International Ovarian Tumor Analysis group. The ultrasound characteristics were compared with the histological diagnosis. Results: Of the 34 cases included, 19 (56%) lesions were benign (16 decidualized endometriomas, one cystadenofibroma, one simple cyst, one struma ovarii), 12 (35%) were borderline tumors and three (9%) were primary invasive tumors (two immature teratomas, one endometrioid cystadenocarcinoma). The contour of the cyst papillations was smooth in 79% (15/19) of benign tumors vs 27% (4/15) of malignant tumors (P = 0.002). The cystic content showed ground‐glass echogenicity in 74% (14/19) of benign tumors vs 13% (2/15) of malignant tumors (P = 0.0006). All ovarian masses with smooth papillations and ground‐glass content (n = 12) were decidualized endometriomas. The papillary projections were vascularized and the color score was 3 or 4 in 88% (14/16) of decidualized endometriomas vs 42% (5/12) of borderline tumors (P = 0.013). Conclusions: In pregnant women, ovarian cysts with ground‐glass echogenicity and papillations with a smooth contour on ultrasound are most likely to be decidualized endometriomas. Cysts with anechoic or low‐level echogenicity and papillations with an irregular contour suggest borderline malignancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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21. Non-hormonal treatment of vulvo-vaginal atrophy-related symptoms in post-menopausal women.
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Tersigni, C., Di Simone, N., Tempestilli, E., Cianfrini, F., Russo, R., Moruzzi, M. C., Amar, I. D., Fiorelli, A., Scambia, G., and Villa, P.
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VAGINAL diseases ,ATROPHY ,POSTMENOPAUSE ,HORMONE therapy ,SYMPTOMS ,QUALITY of life ,THERAPEUTICS ,CLINICAL trials ,COLPOSCOPY ,COMPARATIVE studies ,EPITHELIUM ,RESEARCH methodology ,MEDICAL cooperation ,RESEARCH ,VAGINA ,VAGINAL medication ,VULVAR diseases ,EVALUATION research - Abstract
In post-menopausal period vulvo-vaginal atrophy (VVA)-related symptoms may seriously affect women's quality of life. Hormonal replacement therapy effectively relieves these symptoms but it is not always safe or accepted, and a non-hormonal treatment is often needed instead. Over a period of 12 weeks, we tested the effect of a twice-a-week vulvo-vaginal application of a hyaluronic acid, AC collagen, isoflavones and vitamins-based cream (Perilei Pausa®) on 35 women in post-menopausal period, reporting VVA-related symptoms. After 12 weeks of treatment with Perilei Pausa®a significant improvement in vaginal dryness, vulvo-vaginal itching, dyspareunia (P< 0.001), dysuria (P= 0.02), nocturia (P= 0.009) and pollakiuria (P= 0.005) was reported by the women. Colposcopical score assessing the intensity of atrophic colpitis, cervico-vaginal paleness and petechiae was also reduced (P= 0.037,P= 0.016 andP= 0.032, respectively). No significant difference in terms of maturation value of cervico-vaginal epithelium was observed. In conclusion, Perilei Pausa®may represent an effective and safe alternative treatment of symptomatic VVA in post-menopausal women. [ABSTRACT FROM PUBLISHER]
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- 2015
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22. OP07.07: Role of ultrasound in advanced ovarian cancer staging during pregnancy: a case report.
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Moruzzi, M. C., Esposito, R., Beneduce, G., Arciuolo, D., Vegni, F., Quagliozzi, L., Biscione, A., Bertoldo, V., Landolfo, C., and Testa, A.C.
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- *
ULTRASONIC imaging , *OVARIAN cancer , *TUMOR classification , *PREGNANCY , *TRANSVAGINAL ultrasonography , *DIAGNOSIS - Abstract
Therefore, an ultrasound guided biopsy on the omentum was performed and the histology was positive for an ovarian Müllerian carcinoma. After two cycles of carboplatin/paclitaxel-based chemotherapy, the serum value of CA125 was 80 U/mL and the ultrasound examination at 32 weeks showed a progression of abdominal peritoneal disease. [Extracted from the article]
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- 2021
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23. Repeat twisting of ovary in young woman with ribbon-like contralateral ovary and absence of contralateral Fallopian tube.
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Bolomini, G., Moruzzi, M. C., Moro, F., Lavecchia, D., Esposito, R., Scambia, G., and Testa, A. C.
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- *
PELVIC examination , *FALLOPIAN tubes , *OVARIES , *YOUNG women , *ADNEXAL diseases , *COVID-19 pandemic , *PELVIC pain - Abstract
The second transvaginal ultrasound examination, performed when the patient was asymptomatic, showed normal right ovarian parenchyma (c) and a small left ovary with a ribbon-like appearance (d). Transvaginal ultrasound examination showed an enlarged right ovary with stromal edema and peripherally displaced antral follicles, corpus luteum within the parenchyma (Figure 1e) and free fluid in the pelvis. [Extracted from the article]
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- 2021
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24. Ultrasound features of appendiceal adenoneuroendocrine carcinoma metastatic to ovaries.
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Codecà, C., Moruzzi, M. C., Spina, M. R., Moro, F., Scambia, G., and Testa, A. C.
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- *
ULTRASONIC imaging , *APPENDIX (Anatomy) , *OVARIES , *CARCINOMA , *METASTASIS - Abstract
A 15-year-old patient was referred to our center after ascites, increased ovarian volume and pleural and pericardial effusion were diagnosed on computed tomography (CT). This case is an example of metastasis to the ovary from a mixed appendiceal adenoneuroendocrine carcinoma presenting ultrasound features different from those observed in other metastases to the ovaries, such as metastases from the colon or biliary tract, as well as those from other histotypes of appendiceal carcinoma. [Extracted from the article]
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- 2021
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25. Ultrasound features of ovarian recurrence of medullary thyroid carcinoma.
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Codecà, C., Moruzzi, M. C., Paris, V., Moro, F., Scambia, G., and Testa, A. C.
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MEDULLARY thyroid carcinoma , *DOPPLER ultrasonography , *COMPUTED tomography , *THYROXINE - Abstract
Thyroid- and parathyroid-gland function tests revealed normal thyroid stimulating hormone and T4 levels, and calcitonin was > 20 000 pg/mL (reference range, < 10 pg/mL) and parathormone was 2.3 pg/mL (reference range, 14.0-72.0 pg/mL). Excluding thyroid cancer arising from a struma ovarii, only a few cases of ovarian metastasis from primary thyroid carcinoma have been described in the literature, presenting a papillary or follicular histotype in all cases4. [Extracted from the article]
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- 2021
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26. Intraoperative ultrasound assistance during myomectomy in pregnant woman.
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Moruzzi, M. C., Moro, F., Bolomini, G., Macchi, C., Cavaliere, A. F., Fagotti, A., Scambia, G., and Testa, A. C.
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- *
MYOMECTOMY , *PREGNANT women , *SURGICAL complications , *SURGICAL site , *TRANSVAGINAL ultrasonography , *FETAL monitoring , *ULTRASONIC imaging , *MEDICAL illustration , *UTERINE tumors , *UTERINE fibroids , *GYNECOLOGIC surgery , *PREGNANCY complications , *FETAL ultrasonic imaging - Abstract
Intraoperative ultrasound (IUS) can provide diagnostic information to guide and assist surgeons during medical procedures. Although myomectomy is a feasible procedure during pregnancy, the increased uterine blood flow and volume during pregnancy increases the risk of hemorrhage or miscarriage[1]. Other studies have shown that, during open myomectomy, IUS with direct application of the probe onto the uterine serosa is more efficient than palpation in evaluating residual myomas at the end of the surgery[5]. [Extracted from the article]
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- 2020
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27. Ultrasound appearance of breast cancer metastatic to uterine leiomyoma.
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Ludovisi, M., Moruzzi, M. C., Ferrandina, G., Scambia, G., and Testa, A. C.
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- *
UTERINE fibroids , *ULTRASONIC imaging , *METASTASIS , *BREAST cancer - Abstract
The article presents a case study of a 67-year-old female suffering from breast carcinoma. The patient underwent radiotherapy and chemotherapy as well as administered with selective estrogen receptor modulator Tamoxifen. She was also diagnosed with uterine leiomyoma which was detected during ultrasound.
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- 2018
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28. Management of Unusual Not Scar Ectopic Pregnancy: A Multicentre Retrospective Case Series
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Isabel Peterlunger, Antonino Farulla, Piero Malorgio, C. Alboni, G. Bolomini, Enrico Fontana, Silvia Ficarelli, Federico Ferrari, Franco Odicino, Benedetta Cornelli, Anna Chiara Boschi, Enrico Sartori, Giuseppe Ricci, Martina Leombroni, Giovanni Scambia, Antonio Simone Laganà, Filippo Alberto Ferrari, Giuliana Beneduce, Massimo Franchi, Marianna Roccio, Maria Cristina Moruzzi, Danilo Buca, Ferrari, F., Ficarelli, S., Cornelli, B., Ferrari, F. A., Farulla, A., Alboni, C., Fontana, E., Roccio, M., Boschi, A. C., Buca, D., Leombroni, M., Peterlunger, I., Moruzzi, M. C., Beneduce, G., Bolomini, G., Lagana, A. S., Malorgio, P., Ricci, G., Franchi, M., Scambia, G. -V., Sartori, E., and Odicino, F.
- Subjects
Ectopic pregnancy ,cornual pregnancy ,interstitial pregnancy ,cervical pregnancy ,ovarian pregnancy ,abdominal pregnancy ,hepatic pregnancy ,angular pregnancy ,intramural pregnancy ,medicine.medical_specialty ,Series (stratigraphy) ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,medicine ,business - Abstract
Background: Management of unusual not scar ectopic pregnancies (UNSEPs) is an unexplored clinical field because of their low incidence and lack of guidelines. Objective: To report the clinical presentation, the first- and second-line treatment and outcomes of UNSEPs. Methods: We retrospectively collected patients treated for UNSEP (namely cervical, interstitial, ovarian, angular, abdominal, cornual and intramural), their baseline characteristics, risk factors, symptoms, diagnostic pathway and the type of first-line treatment (medical, surgical or combined). We further collected treatment failures and the type of second- line treatment. We assessed treatment outcomes, time to serum beta human chorionic gonadotropin (β-hCG) level negativity, length of recovery, follow up and return to a normal menstrual cycle. Results: From 2009 to 2019, we collected 79 cases. Of them, 27 (34%), 23 (29%), 12 (15%), 8 (10%), 6 (8%) and 3 (4%) were cervical, interstitial, ovarian, angular, abdominal and cornual, respectively. Forty women (50.6%) were submitted to medical treatment, mostly methotrexate based; conversely, 36 patients (45.6%) underwent surgery and only 3 women (3.8%) received a combined treatment. The success of first-line treatment rate, regardless of UNSEP location, was 53% and 89% for medical and surgical treatment, respectively. Treatment failures (21 patients) were submitted to second-line treatment, respectively 47.6% and 52.4% to medical and surgical approach. Of interest, cervical pregnancies achieved the lowest rate of first-line medical treatment success (22%) and received more frequently (69%) a subsequent surgical approach with no hysterectomy. Interstitial pregnancies were submitted to surgery mostly for a matter of urgency (71%), otherwise, they were treated with a medical approach both at first- and second-line treatment. Ovarian pregnancies were treated with ovariectomy in 44% of the cases submitted to surgery. Angular pregnancies underwent surgery more often, while all the abdominal pregnancies underwent endoscopic or open surgery. Cornual pregnancies received cornuostomy in 75% of the cases. Overall, the need for blood transfusion was 23.1% among the patients submitted to surgery. The median length of hospitalisation was shorter for women submitted to surgical first-line treatment (5 vs. 10 days; p = 0.002). In case of first-line medical treatment and in case of failure, we found an increase of 3 days (CI95% 0.6-5.5; p = 0.01) and of 3.6 days (CI95% 0.89-6.30; p = 0.01) in the length of hospitalisation, respectively. Negative β-HCG levels were obtained earlier in the surgical group (median 25 vs. 51 days; p = 0.001), as well as the return to normal menstrual cycle (median 31 vs. 67 days; p < 0.000). Post-treatment follow-up, regardless of the failure of first-line treatment was shorter in the surgical group (median 32 versus 68 days; p= 0.003). Conclusion: Cervical pregnancies were successfully managed with a surgical approach without hysterectomy, and hence, we suggest avoiding medical treatment. No consensus emerged for other UNSEPs. Ovarian, angular and interstitial pregnancies are burdened by a non-conservative approach on the utero-ovarian structures. The surgical approach led to shorter recovery, earlier β-hCG negativity and shorter follow-up, even though there is an increased risk for blood transfusion.
- Published
- 2022
29. New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique.
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Catena U, Campo R, Bolomini G, Moruzzi MC, Verdecchia V, Nardelli F, Romito I, Camolo F, La Manna V, Ianieri MM, Scambia G, and Testa AC
- Abstract
T-shaped uterus is a congenital uterine malformation (CUM), only recently defined by the ESGE ESHRE classification as Class U1a. The uterus is characterised by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix. Although the significance of this dysmorphic malformation on reproductive performance has been questioned, recent studies reported significant improvement of life birth rates after surgical correction in patients with failed in-vitro fertilisation (IVF) or recurrent miscarriage. The classical surgical technique to treat a T-shaped uterus is by performing a sidewall incision with the micro scissor or bipolar needle, resulting in a triangular cavity. In this video article, we describe a new surgical technique with a step-by-step method combining three- dimensional ultrasound (3D-US) and hysteroscopic metroplasty in an office setting, using a 15 Fr office resectoscope (Karl Storz, Tuttlingen, Germany), to treat a T-shaped uterus by resecting the lateral fibromuscular tissue of the uterine walls. No complications occurred and the postoperative hysteroscopy showed a triangular and symmetrical uterine cavity without any adhesions., (Copyright © 2021 Facts, Views & Vision.)
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- 2021
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30. Minimal residual disease at primary debulking surgery versus complete tumor resection at interval debulking surgery in advanced epithelial ovarian cancer: A survival analysis.
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Ghirardi V, Moruzzi MC, Bizzarri N, Vargiu V, D'Indinosante M, Garganese G, Pasciuto T, Loverro M, Scambia G, and Fagotti A
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- Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bevacizumab administration & dosage, Carboplatin administration & dosage, Carcinoma, Ovarian Epithelial drug therapy, Carcinoma, Ovarian Epithelial pathology, Chemotherapy, Adjuvant, Cytoreduction Surgical Procedures methods, Cytoreduction Surgical Procedures statistics & numerical data, Female, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Neoplasm, Residual, Ovarian Neoplasms drug therapy, Ovarian Neoplasms pathology, Paclitaxel administration & dosage, Prognosis, Progression-Free Survival, Retrospective Studies, Survival Rate, Carcinoma, Ovarian Epithelial mortality, Carcinoma, Ovarian Epithelial surgery, Ovarian Neoplasms mortality, Ovarian Neoplasms surgery
- Abstract
Objectives: To compare survival outcomes and peri-operative complications in patients with advanced ovarian cancer with 1-10 mm residual disease (RD) at primary debulking surgery (PDS) versus those achieving no gross residual disease (NGR) at interval debulking surgery (IDS)., Methods: Patients operated with the intent of complete cytoreduction for epithelial ovarian/fallopian tube/primary peritoneal cancer, FIGO stage IIIC-IV, RD 1-10 mm at PDS and NGR at IDS, between 01/2010 and 12/2016, were retrospectively included. All patients had at least 2-years of follow-up completed., Results: 207 patients were included (59 PDS and 148 IDS). Patients in PDS group were younger and had a higher surgical complexity score. There was a higher rate of intra- and major early post-operative complications in the group of PDS vs IDS (16.9% vs 1.3% and 28.8% vs 2.0%, p < 0.0001 respectively). After a median follow up of 56.4 months (range 59.2-65.4), 117 (56.5%) patients died of disease in the whole population. Forty-eight (81.4%) patients had progression/recurrent disease in the PDS group and 120 (81.1%) in the IDS group. Median PFS was 16.2 months and 18.9 months for PDS and IDS group, respectively (p = 0.111). Median OS was 41.4 months and 52.4 months for PDS and IDS group, respectively (p = 0.022)., Conclusions: IDS should be considered the preferred treatment in case millimetric residual disease is expected at PDS in view of the superimposable PFS and the reduced number of perioperative complications., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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31. PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery.
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Testa AC, Moro F, Pasciuto T, Moruzzi MC, Di Legge A, Fuoco G, Autorino R, Collarino A, Gui B, Zannoni GF, Gambacorta A, Miccò M, Rufini V, Scambia G, and Ferrandina G
- Subjects
- Adult, Aged, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Female, Humans, Middle Aged, Neoplasm, Residual pathology, Prospective Studies, Reproducibility of Results, Sensitivity and Specificity, Uterine Cervical Neoplasms pathology, Uterine Cervical Neoplasms therapy, Young Adult, Carcinoma, Squamous Cell diagnostic imaging, Chemoradiotherapy, Hysterectomy, Neoadjuvant Therapy, Neoplasm, Residual diagnostic imaging, Ultrasonography, Doppler, Color, Uterine Cervical Neoplasms diagnostic imaging
- Abstract
Objective: To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery., Methods: Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference., Results: Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response., Conclusions: Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd., (Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.)
- Published
- 2018
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32. Early and late onset complications of gynaecologic surgery: a multimodality imaging approach.
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De Blasis I, Vinci V, Sergi ME, Capozza F, Saldari M, Moro F, Moruzzi MC, Testa AC, and Manganaro L
- Abstract
The role of imaging after surgery is pivotal to drive clinical management of early and/or late onset complications. Most frequently used imaging technique after pelvic surgery is Ultrasound (US), Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). While Ultrasound is a standard procedure, using grey scale and/or colour Doppler evaluation, MRI and CT scan protocols should be derived on the basis of the specific indication of the exam. Correct evaluation of female pelvis after gynaecologic surgery, having in mind the most frequent complications, is based on the correct use of the instruments and on the experience of the examiner, who should be aware of the history of the patient, type of surgery and clinical symptoms for which the exam is required; the clinician should be aware of the possibilities and limits of the different techniques, in order to choose the most appropriate imaging modality and promptly make a correct diagnosis.
- Published
- 2017
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