Management of ovarian masses in pregnancy: patient selection for interventional treatment
Management of ovarian masses in pregnancy: patient selection for interventional treatment
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DOI：
10.1136/ijgc-2020-001996
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发表时间：
2021-06-01
影响因子：
4.8
通讯作者：
Fagotti, Anna
中科院分区：
文献类型：
--
作者：
Testa, Antonia Carla;Mascilini, Floriana;Fagotti, Anna
目的妊娠合并附件肿瘤的治疗仍然具有挑战性，文献中的数据很少。本研究的目的是描述妊娠期间发现卵巢肿块的患者的处理和结局。作为次要目的，我们评估了妊娠期间诊断的卵巢肿块的国际卵巢肿瘤分析（IOTA）形态学分类中恶性肿瘤的患病率，并创建了妊娠期间附件肿块患者的管理算法。方法这是一项回顾性单中心研究，包括2000年1月至2019年12月期间在妊娠期间任何妊娠期检测到附件包块的患者。从病历中检索临床、超声、手术和组织学数据以及管理信息（超声随访与手术）。根据超声检查者的模式识别或症状或预防并发症（如扭转、破裂或正常足月妊娠障碍），根据怀疑恶性肿瘤记录手术指征。使用IOTA术语描述所有肿块。结果共纳入113例患者进行分析。其中，48例（42%）患者接受了监测，65例（58%）患者接受了手术（11例原发性卵巢肿瘤，1例卵巢癌复发，4例卵巢转移，20例交界性肿瘤和29例良性病变）。41/65例（63.1%）的手术适应症为可疑恶性肿瘤，24/65例（36.9%）的手术适应症为症状或预防并发症。监测组所有患者在产后6个月时卵巢病变均无形态学改变。根据IOTA超声形态学分类，单房性囊肿组的恶性患病率为0%（0/37），多房性囊肿组为27%（4/15），单房性实性囊肿组为35%（11/31），多房性实性囊肿组为70%（14/20），实性囊肿组为70%（7/10）。监测组或良性、交界性或原发性上皮浸润性组织学患者均未报告产科或新生儿并发症。相反，在卵巢绒毛膜癌和卵巢转移患者中观察到两例新生儿死亡。4例卵巢转移患者中有3例在妊娠后死亡。结论IOTA超声形态学分型对妊娠期卵巢肿块的定性有一定的参考价值。设计了一种基于临床和形态学的算法，用于咨询患者。
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.