Abstract：
OBJECTIVE: The primary aim was the validation of benign descriptors (BDs), followed by Assessment of Different NEoplasia\'s of the adneXa (ADNEX) (when BDs cannot be applied), in a two-step strategy to classify adnexal masses in pregnancy. The secondary aim was to describe the natural history of adnexal masses in pregnancy.
METHODS: Retrospective analysis of prospectively collected data of women with an adnexal mass on ultrasonography identified during pregnancy between 2017 and 2022. The study was conducted at Queen Charlotte\'s and Chelsea Hospital, UK. Relevant clinical and ultrasound data were extracted from the medical records and ultrasound software astraia. Adnexal masses were classified and managed according to expert subjective assessment (SA). Ultrasound features were recorded prospectively at the time of ultrasound examination. Borderline ovarian tumours (BOT) were classified as malignant. Benign Descriptors (BDs) were applied to classify adnexal masses, in cases where BDs were not applicable, the ADNEX model (using a risk of malignancy of >10%) was used, in a two-step strategy. The two-step strategy was applied retrospectively. The reference standard used was histology (where available) or expert SA at the postnatal ultrasound scan.
RESULTS: 291 women with a median age of 33 (IQR 29-36) years presented with an adnexal mass in pregnancy, at a median gestation of 12 (IQR 8-17) weeks. 267 (267/291, 91.8%) women were followed up to the postnatal period, as 24 women (24/291, 8.2%) were lost to follow up. Based on the reference standard, 4.1% of adnexal masses (11/267) were classified as malignant (all BOTs) and 95.9% (256/267) as benign (41 on histology and 215 based on expert SA at postnatal ultrasound). BDs could be applied to 68.9% of adnexal masses (184/267); of these only one mass (BOT) was misclassified as benign (1/184, 0.5%). ADNEX was used to classify the residual masses (83/267) and misclassified three BOTs as benign (3/10, 30.0%) and 25 benign masses (based on reference standard) as malignant (25/73, 34.2%), 13 (13/25, 52.0%) of these were classified as decidualised endometriomas on expert SA, with confirmed resolution of decidualisation in the postnatal period. The two-step strategy had a specificity of 90.2%, sensitivity of 63.6%, negative predictive value of 98.3% and positive predictive value of 21.9%. 56 (56/267, 21.0%) women had surgical intervention, four as an emergency during pregnancy (4/267, 1.5%,) and four (4/267, 1.5%) electively during caesarean section. 48 (48/267, 18.0%) women had surgical intervention in the post-natal period, 11 (11/267, 4.1%) in the first 12 weeks postnatal and 37 >12 weeks (37/267, 13.9%) postnatal. 64 (64/267, 24.0%) adnexal masses resolved spontaneously during follow up. Cyst-related complications occurred in four women (4/267, 1.5%) during pregnancy (ovarian torsion n=2, cyst rupture n=2) and six (6/267, 2.2%) in the postnatal period (all ovarian torsion). 196 (196/267, 73.4%) had a persistent adnexal mass, including one of the women who had an ovarian torsion and underwent de-torsion and had a persistent adnexal mass at postnatal ultrasound. Presumed decidualisation occurred in 31.1% (19/61) of endometriomas and had resolved in 89.5% (17/19) by the first postnatal ultrasound scan.
CONCLUSIONS: We found Benign Descriptors apply to most masses in pregnancy, however the small number of malignant tumours in the cohort (4.1%) restricted the evaluation of the ADNEX model, so expert subjective assessment should be used to classify adnexal masses in pregnancy, when BDs do not apply. A larger multicentre prospective study is required to evaluate the use of the ADNEX model to classify adnexal masses in pregnancy. Our data suggests that most adnexal masses can be managed expectantly during pregnancy given a large proportion of masses spontaneously resolved and the low risk of complications. This article is protected by copyright. All rights reserved.
METHODS: Retrospective analysis of prospectively collected data of women with an adnexal mass on ultrasonography identified during pregnancy between 2017 and 2022. The study was conducted at Queen Charlotte\'s and Chelsea Hospital, UK. Relevant clinical and ultrasound data were extracted from the medical records and ultrasound software astraia. Adnexal masses were classified and managed according to expert subjective assessment (SA). Ultrasound features were recorded prospectively at the time of ultrasound examination. Borderline ovarian tumours (BOT) were classified as malignant. Benign Descriptors (BDs) were applied to classify adnexal masses, in cases where BDs were not applicable, the ADNEX model (using a risk of malignancy of >10%) was used, in a two-step strategy. The two-step strategy was applied retrospectively. The reference standard used was histology (where available) or expert SA at the postnatal ultrasound scan.
RESULTS: 291 women with a median age of 33 (IQR 29-36) years presented with an adnexal mass in pregnancy, at a median gestation of 12 (IQR 8-17) weeks. 267 (267/291, 91.8%) women were followed up to the postnatal period, as 24 women (24/291, 8.2%) were lost to follow up. Based on the reference standard, 4.1% of adnexal masses (11/267) were classified as malignant (all BOTs) and 95.9% (256/267) as benign (41 on histology and 215 based on expert SA at postnatal ultrasound). BDs could be applied to 68.9% of adnexal masses (184/267); of these only one mass (BOT) was misclassified as benign (1/184, 0.5%). ADNEX was used to classify the residual masses (83/267) and misclassified three BOTs as benign (3/10, 30.0%) and 25 benign masses (based on reference standard) as malignant (25/73, 34.2%), 13 (13/25, 52.0%) of these were classified as decidualised endometriomas on expert SA, with confirmed resolution of decidualisation in the postnatal period. The two-step strategy had a specificity of 90.2%, sensitivity of 63.6%, negative predictive value of 98.3% and positive predictive value of 21.9%. 56 (56/267, 21.0%) women had surgical intervention, four as an emergency during pregnancy (4/267, 1.5%,) and four (4/267, 1.5%) electively during caesarean section. 48 (48/267, 18.0%) women had surgical intervention in the post-natal period, 11 (11/267, 4.1%) in the first 12 weeks postnatal and 37 >12 weeks (37/267, 13.9%) postnatal. 64 (64/267, 24.0%) adnexal masses resolved spontaneously during follow up. Cyst-related complications occurred in four women (4/267, 1.5%) during pregnancy (ovarian torsion n=2, cyst rupture n=2) and six (6/267, 2.2%) in the postnatal period (all ovarian torsion). 196 (196/267, 73.4%) had a persistent adnexal mass, including one of the women who had an ovarian torsion and underwent de-torsion and had a persistent adnexal mass at postnatal ultrasound. Presumed decidualisation occurred in 31.1% (19/61) of endometriomas and had resolved in 89.5% (17/19) by the first postnatal ultrasound scan.
CONCLUSIONS: We found Benign Descriptors apply to most masses in pregnancy, however the small number of malignant tumours in the cohort (4.1%) restricted the evaluation of the ADNEX model, so expert subjective assessment should be used to classify adnexal masses in pregnancy, when BDs do not apply. A larger multicentre prospective study is required to evaluate the use of the ADNEX model to classify adnexal masses in pregnancy. Our data suggests that most adnexal masses can be managed expectantly during pregnancy given a large proportion of masses spontaneously resolved and the low risk of complications. This article is protected by copyright. All rights reserved.
摘要：
目的：主要目的是验证良性描述符（BD），然后是对ADneXa（ADNEX）的不同增生的评估（当BD无法应用时），采用两步策略对妊娠期附件肿块进行分类。次要目的是描述怀孕期间附件肿块的自然史。
方法：回顾性分析前瞻性收集的2017年至2022年孕期超声检查发现附件包块的女性数据。这项研究是在夏洛特皇后医院和切尔西医院进行的，英国。从病历和超声软件astrica中提取相关的临床和超声数据。根据专家主观评估（SA）对附件肿块进行分类和管理。在超声检查时前瞻性地记录超声特征。卵巢边缘性肿瘤（BOT）被归类为恶性。应用良性描述符(BD)对附件肿块进行分类，在BD不适用的情况下，使用ADNEX模型(使用>10%的恶性肿瘤风险)，在一个两步走的战略。回顾性应用两步策略。使用的参考标准是组织学（如果可用）或产后超声扫描的专家SA。
结果：291名妇女，年龄中位数为33岁（IQR29-36岁），在怀孕期间出现附件包块，在中位妊娠12周（IQR8-17周）。267名(267/291,91.8%)妇女进行了产后随访,24名女性(24/291,8.2%)失访.根据参考标准，附件肿块的4.1％（11/267）被分类为恶性（所有BOT），而95.9％（256/267）被分类为良性（组织学41例，产后超声专家SA为215例）。BD可应用于68.9％的附件肿块（184/267）；其中只有一个质量（BOT）被错误分类为良性（1/184，0.5％）。使用ADNEX对残余肿块进行分类（83/267），并将三个BOT错误分类为良性（3/10，30.0％）和25个良性肿块（基于参考标准）为恶性（25/73，34.2％），其中13例（13/25，52.0%）在专家SA上被归类为蜕膜化子宫内膜瘤，与确定的决议蜕膜化在出生后的时期。两步策略的特异性为90.2%，灵敏度为63.6%，阴性预测值为98.3%,阳性预测值为21.9%。56名（56/267，21.0%）女性接受了手术干预，怀孕期间有四个紧急情况（4/267，1.5％，)和四例(4/267，1.5%)在剖腹产期间选择性。48名（48/267，18.0%）妇女在产后接受了手术干预，11(11/267,4.1%)产后前12周和37>12周(37/267,13.9%)。64（64/267，24.0%）附件肿块在随访期间自发消退。妊娠期间发生囊肿相关并发症4例（4/267，1.5％）（卵巢扭转n=2，囊肿破裂n=2），产后期间发生囊肿相关并发症6例（6/267，2.2％）（所有卵巢扭转）。196（196/267，73.4%）有持续性附件肿块，包括其中一名患有卵巢扭转并接受去扭转且在产后超声检查时持续存在附件肿块的女性。推测蜕膜化发生在31.1％（19/61）的子宫内膜瘤中，通过首次产后超声扫描解决了89.5％（17/19）。
结论：我们发现良性描述符适用于怀孕期间的大多数肿块，然而，队列中恶性肿瘤的数量较少（4.1％）限制了ADNEX模型的评估，因此，应使用专家主观评估来对怀孕期间的附件肿块进行分类，当BD不适用时。需要更大的多中心前瞻性研究来评估使用ADNEX模型对妊娠附件肿块进行分类。我们的数据表明，鉴于大部分肿块可以自发解决，并且并发症的风险较低，因此可以在怀孕期间对大多数附件肿块进行预期管理。本文受版权保护。保留所有权利。
方法：回顾性分析前瞻性收集的2017年至2022年孕期超声检查发现附件包块的女性数据。这项研究是在夏洛特皇后医院和切尔西医院进行的，英国。从病历和超声软件astrica中提取相关的临床和超声数据。根据专家主观评估（SA）对附件肿块进行分类和管理。在超声检查时前瞻性地记录超声特征。卵巢边缘性肿瘤（BOT）被归类为恶性。应用良性描述符(BD)对附件肿块进行分类，在BD不适用的情况下，使用ADNEX模型(使用>10%的恶性肿瘤风险)，在一个两步走的战略。回顾性应用两步策略。使用的参考标准是组织学（如果可用）或产后超声扫描的专家SA。
结果：291名妇女，年龄中位数为33岁（IQR29-36岁），在怀孕期间出现附件包块，在中位妊娠12周（IQR8-17周）。267名(267/291,91.8%)妇女进行了产后随访,24名女性(24/291,8.2%)失访.根据参考标准，附件肿块的4.1％（11/267）被分类为恶性（所有BOT），而95.9％（256/267）被分类为良性（组织学41例，产后超声专家SA为215例）。BD可应用于68.9％的附件肿块（184/267）；其中只有一个质量（BOT）被错误分类为良性（1/184，0.5％）。使用ADNEX对残余肿块进行分类（83/267），并将三个BOT错误分类为良性（3/10，30.0％）和25个良性肿块（基于参考标准）为恶性（25/73，34.2％），其中13例（13/25，52.0%）在专家SA上被归类为蜕膜化子宫内膜瘤，与确定的决议蜕膜化在出生后的时期。两步策略的特异性为90.2%，灵敏度为63.6%，阴性预测值为98.3%,阳性预测值为21.9%。56名（56/267，21.0%）女性接受了手术干预，怀孕期间有四个紧急情况（4/267，1.5％，)和四例(4/267，1.5%)在剖腹产期间选择性。48名（48/267，18.0%）妇女在产后接受了手术干预，11(11/267,4.1%)产后前12周和37>12周(37/267,13.9%)。64（64/267，24.0%）附件肿块在随访期间自发消退。妊娠期间发生囊肿相关并发症4例（4/267，1.5％）（卵巢扭转n=2，囊肿破裂n=2），产后期间发生囊肿相关并发症6例（6/267，2.2％）（所有卵巢扭转）。196（196/267，73.4%）有持续性附件肿块，包括其中一名患有卵巢扭转并接受去扭转且在产后超声检查时持续存在附件肿块的女性。推测蜕膜化发生在31.1％（19/61）的子宫内膜瘤中，通过首次产后超声扫描解决了89.5％（17/19）。
结论：我们发现良性描述符适用于怀孕期间的大多数肿块，然而，队列中恶性肿瘤的数量较少（4.1％）限制了ADNEX模型的评估，因此，应使用专家主观评估来对怀孕期间的附件肿块进行分类，当BD不适用时。需要更大的多中心前瞻性研究来评估使用ADNEX模型对妊娠附件肿块进行分类。我们的数据表明，鉴于大部分肿块可以自发解决，并且并发症的风险较低，因此可以在怀孕期间对大多数附件肿块进行预期管理。本文受版权保护。保留所有权利。
