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Introduction: To assess the clinical impact of preoperative fludeoxyglucose (FDG) with positron emission tomography (PET) and computed tomography (CT) in women with ovarian, fallopian tube, or peritoneal cancer with focus on consequences of added findings (AFs).Material and Methods: FDG-PET/CT was implemented as a standard imaging modality for women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer at our institution in 2008. After full implementation, all preoperative scans were reviewed and AFs were evaluated from January 2011 to December 2012. Decisions regarding further examination made at the first multidisciplinary team conference were recorded. Subsequent procedures were tracked via medical records, and the impact of AFs on additional examinations, delay, and change in treatment plans was evaluated.Results: Forty-four (21.1%) of 209 women presented with AFs. Further examination was performed in 35/44 (79.5%). Malignancy was identified in 15/35 (42.9%), revealing metastases from ovarian, fallopian tube, or peritoneal cancer in 11, a synchronous primary cancer in 3, and recurrence of a previous cancer in 1 woman. The ovarian, fallopian tube, or peritoneal cancer metastases were localized in the lungs, uterus, colon, vagina, and breasts. The remaining 20 AFs revealed 2 benign lesions and 1 pre-malignant lesion, whereas no abnormality was found in 17. Further examination of AFs resulted in a significant time delay until treatment start of median 4 days (range 1-83 days, P < 0.004).Conclusions: Further examinations of AFs by FDG-PET/CT delayed time to start of treatment by median 4 days in women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer in a contemporary institution with fast-track access to additional diagnostics. The clinical implications of this must be balanced against the gain of detecting unrecognized malignancy in 15 of 209 women (7.2%). [ABSTRACT FROM AUTHOR]

Background: Although detecting ovarian cancer at early stage is a highly meaningful clinical goal, no studies have evaluated early stage disease presentation in a large community‐based population and how it differs from that of late stage disease. Methods: Electronic medical records were evaluated for women diagnosed with ovarian or fallopian tube cancer in 2016 and 2017 to identify the first imaging study to detect disease. Women being followed prior to diagnosis for known genetic risk from BRCA or other mutation were excluded. The visit in which the imaging test was ordered and related encounters were reviewed to determine the indication for imaging. Patient characteristics, presenting symptoms and duration, and modality of first abnormal imaging were compared for early vs late stage ovarian cancer and by provider specialty. Results: Of 540 women with ovarian cancer, 190 (35%) were diagnosed with early stage disease, of whom 141 (74%) were symptomatic, with 45% of women presenting to internists, 33% to gynecologists, and 20% to emergency medicine physicians. Pelvic ultrasonography detected only 23% of late stage cases whereas pelvic ultrasonography and abdominal pelvic computed tomography (CT) each detected 47% of early stage cases. While abdominal pain and bloating were common to both women with early and late stage cancer, women with early stage disease were younger (58 vs 64 years, P < .0001), more likely to present to gynecologists (33% vs 15%, P < .001) and complained more often of a palpable mass (17% vs 6%, P < .0001) or postmenopausal bleeding (11% vs 5%, P < .001). Conclusions: Excluding women with genetic predisposition to ovarian cancer known prior to diagnosis, approximately three out of four cases of early stage ovarian cancer are detected as the result of evaluation of symptoms and one in four cases are detected incidentally. Abdominal pelvic CT and pelvic ultrasonography each detect an equal proportion of early stage cases. In contrast to late stage presentation, women diagnosed with early stage disease present more often with complaints of a palpable mass or postmenopausal bleeding, particularly to gynecologists. [ABSTRACT FROM AUTHOR]

Objectives: Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer (ET) in women undergoing assisted reproduction techniques. However, the persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. The present systematic review aimed at identifying, appraising and summarizing the available evidence regarding the effectiveness and safety of using Essure prior to ET for women with hydrosalpinx.Methods: We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and the reference lists of eligible studies. All studies including at least 10 women with hydrosalpinx who received Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction and evaluation of the risk of bias were performed independently by two authors. Study outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth and live birth/ongoing pregnancy and clinical pregnancy per ET. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% CIs, using a random-effects model.Results: Our electronic search of databases was performed on 7 November 2015, and 26 studies with 43 study arms were considered eligible: eight study arms evaluating Essure; seven assessing tubal aspiration; seven appraising effects of no treatment; 12 evaluating salpingectomy; two assessing tubal division; and seven evaluating tubal occlusion. When compared with women who had no intervention, women with Essure had a higher clinical pregnancy rate per ET (36% (95% CI, 0-43%) vs 13% (95% CI, 9-17%)). When compared with women who had other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy (38% (95% CI, 27-49%) vs 15% (95% CI, 10-19%)).Conclusions: The available evidence suggests that, although Essure prior to ET in women with hydrosalpinx improves the chance of achieving a clinical pregnancy compared with no intervention, it is associated with a higher rate of miscarriage when compared with the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible for videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible for surgery, and randomized controlled trials are needed to clarify which is the best treatment alternative in such a scenario. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Key content: Advances in histopathology, immunohistochemistry and molecular genetics have led to evidence that the fimbrial end of the fallopian tube may be the source of origin of non‐uterine high‐grade pelvic serous carcinoma (HGPSC).Most of the evidence comes from studies in risk‐reducing salpingo‐oophorectomy in BRCA carriers.A proportion of these high‐grade tumours have been proven to develop from specific precursor lesions, such as serous tubal intraepithelial carcinoma (STIC), before transformation into invasive high‐grade pelvic serous carcinoma.Detailed sectioning of the fallopian tube is suggested using the SEE‐FIM protocol (Sectioning and Extensively Examining the Fimbriated end of the fallopian tube).Clinical management of STIC in the absence of malignancy is not yet clearly defined. Learning objectives: To review the various theories of pathogenesis of non‐uterine HGPSC.To discuss the clinical management of STIC.Preventative strategies for HGPSC. Ethical issues: Role for salpingectomy as a mode of sterilisation in women with completed family and salpingectomy during hysterectomy for benign cases.Could risk‐reducing salpingectomy be recommended instead of risk‐reducing salpingo‐oophorectomy in young women, to avoid menopausal side effects? [ABSTRACT FROM AUTHOR]

Key content Introduction to preoperative classification of ovarian and tubal neoplasms., A discussion of existing guidelines by professional societies., Updated evidence and new strategies for preoperative diagnosis of ovarian cancer., Evidence-based recommendations for the diagnosis and characterisation of adnexal masses., Areas of future interest in the field of adnexal tumour diagnosis., Learning objectives To understand the importance of accurate preoperative discrimination of adnexal tumours to ensure optimal patient management., To critically appraise current guidelines by professional societies., To discuss findings from a recent systematic review and meta-analysis, and two diagnostic accuracy studies comparing different types of prediction models for ovarian cancer diagnosis., To understand the advantages and disadvantages of different International Ovarian Tumour Analysis ( IOTA) prediction models., Ethical issues Consequences of misclassification of ovarian and tubal masses., Inappropriate use of IOTA prediction models. [ABSTRACT FROM AUTHOR]

Key content The pathogenesis of infertility is multi-factorial; investigative and treatment approaches should therefore be individualised., There are many tests for tubal patency with their relative usefulness, but none address all aspects of tubal function., There is often a clear need for in vitro fertilisation (IVF) in the management of infertility., This article reviews the current best available evidence and provides an expert insight on the role of tubal patency tests in the era of assisted reproductive techniques (ART)., Learning objectives To understand the relative advantages and limitations of laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, selective salpingography and tubal catheterisation, trans-vaginal hydrolaparoscopy, salpingoscopy and fertiloscopy as tests for tubal patency., To understand the role of Chlamydia trachomatis serology in tubal patency testing., To evaluate the role of tubal patency test in the hierarchy of investigations for infertility., To understand the role of tubal surgery in modern management of infertility., To understand the importance of medical history taking in infertility., Ethical issues Counselling patients about benefits and risks of tests, surgery and need for assisted conception., Should primary care trusts fund tubal surgery in patients who are not otherwise eligible for IVF?, There may be psychosocial issues or anxiety so a multidisciplinary approach is important. [ABSTRACT FROM AUTHOR]

Key content Assisted conception technology such as in vitro fertilisation ( IVF) is the first-line treatment of many causes of female subfertility and surgery is offered primarily to optimise the outcome of such treatments., An awareness and understanding of the evidence about the different surgical interventions used prior to assisted conception is essential in achieving the best possible outcome., Learning objectives To assess the fertility needs of women including the need for surgery., To understand the role of different surgical interventions prior to assisted conception for the management of hydrosalpinx, uterine fibroids, uterine pathology such as a uterine septum and intrauterine adhesions, and the treatment of endometriosis and ovarian endometriomas., Ethical issues Women should be counselled about the benefits and risks of surgery including the risk of delay to their assisted conception., A sympathetic approach is needed for women who are already emotionally and physically stressed., There are financial implications involved in IVF treatment., Psychosocial issues and anxiety require a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Worldwide, 5%-10% of infertility patients have FGTB. 24 infertile women with a pathological diagnosis of FGTB between April 2013 and Feb 2019 were identified and the clinical features and findings on transvaginal sonography (TVS) were investigated. Endometrial TB was pathological diagnosed in 15 women, the sonographic features were as follows: intrauterine adhesions 46.67% (7/15), endometrial polyps 13.33% (2/15), heterogeneous endometrium with subendometrial calcification 13.33% (2/15), and normal 26.67% (4/15). [Extracted from the article]

Background: To establish the value of a new technique called transvaginal hydrolaparoscopy for exploration of the tubo-ovarian structures in the management of patients with unexplained infertility.Methods: A total of 120 women with primary or secondary infertility, and without obvious pelvic pathology, were included in the study. The first 14 patients received general anesthesia and underwent transvaginal laparoscopy immediately before standard laparoscopy. The remaining 106 patients had transvaginal laparoscopy performed under local anesthesia, with standard laparoscopy performed only on those with pathology, which required operative intervention. Information on pathology, complications, and successful access to the pouch of Douglas were recorded.Results: The successful rate of access was 93%. Pathology was found in 29 patients, of whom 15 required operative laparoscopy. Also, out of 19 patients with adhesions, 11 (58%) had normal dye test bilateral, and only two (11%) had bilateral occlusion of the tubes. No complications were observed.Conclusion: Transvaginal hydrolaparoscopy is a safe and well-tolerated method for investigating the tubo-ovarian structures in unexplained infertility. It is superior to hysterosalpingography for diagnosis of adhesions. [ABSTRACT FROM AUTHOR]

To evaluate the microanatomy of gynecological specimens using microtomography (micro-CT). The construction process of 3D accurate virtual models starts with the 3D modeling volume built through the micro-CT slices sequentially mounted, followed by the segmentation process of selection of parts to be analysed. [Extracted from the article]

An abstract of the article "Ultrasonographic features of Fallopian tube cancer," by L. Hereter, M. Pascual, F. Tresserra, B. Graupera, M. Martínez, and C. Pedrero is presented.