1
|
Pea J, Bryan J, Wan C, Oldfield AL, Ganga K, Carter FE, Johnson LM, Lujan ME. Ultrasonographic criteria in the diagnosis of polycystic ovary syndrome: a systematic review and diagnostic meta-analysis. Hum Reprod Update 2024; 30:109-130. [PMID: 37804097 PMCID: PMC10762001 DOI: 10.1093/humupd/dmad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/08/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Polycystic ovary morphology (PCOM) on ultrasonography is considered as a cardinal feature of polycystic ovarian syndrome (PCOS). Its relevance as a diagnostic criterion for PCOS was reaffirmed in the most recent International Evidence-Based Guideline for the Assessment and Management of PCOS. However, there remains a lack of clarity regarding the best practices and specific ultrasonographic markers to define PCOM. OBJECTIVE AND RATIONALE The aim of this systematic review and diagnostic meta-analysis was to assess the diagnostic accuracy of various ultrasonographic features of ovarian morphology in the diagnosis of PCOS. SEARCH METHODS Relevant studies published from 1 January 1990 to 12 June 2023 were identified by a systematic search in PubMed, Web of Science, Scopus, CINAHL, and CENTRAL. Studies that generated diagnostic accuracy measures (e.g. proposed thresholds, sensitivity, specificity) for PCOS using the following ultrasonographic markers met criteria for inclusion: follicle number per ovary (FNPO) or per single cross-section (FNPS), ovarian volume (OV), and stromal features. Studies on pregnant or post-menopausal women were excluded. Risk of bias and applicability assessment for diagnostic test accuracy studies were determined using the QUADAS-2 and QUADAS-C tool for a single index test or between multiple index tests, respectively. Diagnostic meta-analysis was conducted using a bivariate model of pooled sensitivity and specificity, and visualized using forest plots and summary receiver-operating characteristic (SROC) curves. OUTCOMES From a total of 2197 records initially identified, 31 studies were included. Data from five and two studies were excluded from the meta-analysis due to duplicate study populations or limited data for the index test, leaving 24 studies. Pooled results of 20 adult studies consisted of 3883 control participants and 3859 individuals with PCOS. FNPO was the most accurate diagnostic marker (sensitivity: 84%, CI: 81-87%; specificity: 91%, CI: 86-94%; AUC: 0.905) in adult women. OV and FNPS had similar pooled sensitivities (OV: 81%, CI: 76-86%; FNPS: 81%, CI: 70-89%) but inferior pooled specificities (OV: 81%, CI: 75-86%; FNPS: 83%, CI: 75-88%) and AUCs (OV: 0.856; FNPS: 0.870) compared to FNPO. Pooled results from four adolescent studies consisting of 210 control participants and 268 girls with PCOS suggested that OV may be a robust ultrasonographic marker for PCOS diagnosis albeit the current evidence remains limited. The majority of the studies had high risk of bias for the patient selection (e.g. lack of randomized/consecutive patient selection) and index test (e.g. lack of pre-proposed thresholds for comparison) domains across all ultrasonographic markers. As such, diagnostic meta-analysis was unable to determine the most accurate cutoff for ultrasonographic markers to diagnose PCOS. Subgroup analysis suggested that stratification based on previously proposed diagnostic thresholds, age, BMI, or technology did not account for the heterogeneity in diagnostic accuracy observed across the studies. Studies that diagnosed PCOS using the Rotterdam criteria had improved sensitivity for FNPO. Studies from North America had lower diagnostic accuracy when compared to Asian studies (FNPO: sensitivity) and European studies (OV: specificity, diagnostic odds ratio and positive likelihood ratio). Geographic differences in diagnostic accuracy may potentially be due to differences in age, BMI, and diagnostic criteria of the PCOS group across regions. WIDER IMPLICATIONS This diagnostic meta-analysis supports the use of FNPO as the gold standard in the ultrasonographic diagnosis of PCOS in adult women. OV and FNPS provide alternatives if total antral follicle counts cannot be accurately obtained. Our findings support the potential for ultrasonographic evidence of PCOM in adolescents as more data becomes available. Subgroup analysis suggests the need to investigate any relative contributions of geographical differences on PCOS phenotypes. These findings may provide the basis for the development of strategies and best practices toward a standardized definition of PCOM and a more accurate ultrasonographic evaluation of PCOS.
Collapse
Affiliation(s)
- Jeffrey Pea
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Jahnay Bryan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Cynthia Wan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Alexis L Oldfield
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Kiran Ganga
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Faith E Carter
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | - Lynn M Johnson
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, USA
| | - Marla E Lujan
- Human Metabolic Research Unit, Division of Nutritional Sciences, Colleges of Human Ecology and Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| |
Collapse
|
2
|
An interpretable machine learning model for predicting the optimal day of trigger during ovarian stimulation. Fertil Steril 2022; 118:101-108. [PMID: 35589417 DOI: 10.1016/j.fertnstert.2022.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop an interpretable machine learning model for optimizing the day of trigger in terms of mature oocytes (MII), fertilized oocytes (2PNs), and usable blastocysts. DESIGN Retrospective study. SETTING A group of three assisted reproductive technology centers in the United States. PATIENT(S) Patients undergoing autologous in vitro fertilization cycles from 2014 to 2020 (n = 30,278). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Average number of MII oocytes, 2PNs, and usable blastocysts. RESULT(S) A set of interpretable machine learning models were developed using linear regression with follicle counts and estradiol levels. When using the model to make day-by-day predictions of trigger or continuing stimulation, possible early and late triggers were identified in 48.7% and 13.8% of cycles, respectively. After propensity score matching, patients with early triggers had on average 2.3 fewer MII oocytes, 1.8 fewer 2PNs, and 1.0 fewer usable blastocysts compared with matched patients with on-time triggers, and patients with late triggers had on average 2.7 fewer MII oocytes, 2.0 fewer 2PNs, and 0.7 fewer usable blastocysts compared with matched patients with on-time triggers. CONCLUSION(S) This study demonstrates that it is possible to develop an interpretable machine learning model for optimizing the day of trigger. Using our model has the potential to improve outcomes for many in vitro fertilization patients.
Collapse
|
3
|
Crespi B. Variation among human populations in endometriosis and PCOS A test of the inverse comorbidity model. EVOLUTION MEDICINE AND PUBLIC HEALTH 2021; 9:295-310. [PMID: 34659773 PMCID: PMC8514856 DOI: 10.1093/emph/eoab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
Evidence linking endometriosis to low prenatal testosterone, and evidence that risk of polycystic ovary syndrome (PCOS) is associated with high prenatal testosterone, have motivated the hypothesis that endometriosis and PCOS exhibit inverse comorbidity. The inverse comorbidity hypothesis predicts that populations exhibiting higher prevalence of one disorder should show lower prevalence of the other. To test this prediction, data were compiled from the literature on the prevalence of endometriosis and PCOS, levels of serum testosterone in women during pregnancy and digit ratios as indicators of prenatal testosterone, in relation to variation in inferred or observed population ancestries. Published studies indicate that rates of endometriosis are highest in women from Asian populations, intermediate in women from European populations and lowest in women from African populations (i.e. with inferred or observed African ancestry); by contrast, rates of PCOS show evidence of being lowest in Asian women, intermediate in Europeans and highest in individuals from African populations. Women from African populations also show higher serum testosterone during pregnancy (which may increase PCOS risk, and decrease endometriosis risk, in daughters), and higher prenatal testosterone (as indicated by digit ratios), than European women. These results are subject to caveats involving ascertainment biases, socioeconomic, cultural and historical effects on diagnoses, data quality, uncertainties regarding the genetic and environmental bases of population differences and population variation in the causes and symptoms of PCOS and endometriosis. Despite such reservations, the findings provide convergent, preliminary support for the inverse comorbidity model, and they should motivate further tests of its predictions. Lay Summary: Given that endometriosis risk and risk of polycystic ovary syndrome show evidence of having genetically, developmentally, and physiologically opposite causes, they should also show opposite patterns of prevalence within populations: where one is more common, the other should be more rare. This hypothesis is supported by data from studies of variation among populations in rates of endometriosis and PCOS and studies of variation among populations in levels of prenatal testosterone, which mediaterisks of both conditions.
Collapse
Affiliation(s)
- Bernard Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
4
|
Kim JJ, Hwang KR, Chae SJ, Yoon SH, Choi YM. Impact of the newly recommended antral follicle count cutoff for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2021; 35:652-659. [PMID: 32211797 DOI: 10.1093/humrep/deaa012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 11/17/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the impact of the newly recommended antral follicle count (AFC) cutoff for polycystic ovary (PCO) on the diagnostic status of polycystic ovary syndrome (PCOS)? SUMMARY ANSWER Among patients with phenotypes requiring the presence of PCO for diagnosis, approximately half (48.2%) were excluded from having PCOS based on the new AFC cutoff, although these excluded women had worse metabolic and hormonal profiles than the controls and were indistinguishable from the remaining patients with regard to major hormonal and metabolic parameters. WHAT IS KNOWN ALREADY In the Rotterdam criteria, PCO is defined as either 12 or more follicles measuring 2-9 mm in diameter or an increased ovarian volume >10 cm3. Recently, an international PCOS guideline development group recommended an AFC threshold for PCO of ≥20 in adult women when using transducers with a high-resolution frequency, including 8 MHz. STUDY DESIGN, SIZE, DURATION The current study used a case control design. PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was diagnosed according to the Rotterdam criteria. Ultrasonography examinations were conducted with wide band frequency (5-9 MHz) transvaginal transducers and the centre frequency was 8 MHz. In patients who show both irregular menstruation and hyperandrogenism (HA), a diagnosis of PCOS can be made irrespective of the ovarian criteria change. Patients who were diagnosed according to HA and PCO (n = 86) or irregular menstruation and PCO (n = 443) were initially included among a total of 1390 adult women with PCOS (aged 20-40 years). Regardless of the AFC, if the ovarian volume is ≥10 cm3, a diagnosis of PCO can still be made. Thus, only patients who had an ovarian volume of <10 cm3 were analysed. Subjects who had an AFC of 12-19 and an ovarian volume <10 cm3 were designated as the 'low AFC group' (n = 255) and were the main focus of the study because they were excluded from having PCOS based on the new cutoff. Subjects with an AFC ≥20 and an ovarian volume <10 cm3 were designated as the 'high AFC group' (n = 101). A total of 562 premenopausal women without PCOS were enrolled as controls. MAIN RESULTS AND THE ROLE OF CHANCE Among patients with irregular menstruation and PCO or HA and PCO phenotypes, approximately half (48.2%, 255/529) were excluded from having PCOS, which corresponded to one-fifth (18.3%, 255/1390) of the total adult patients. However, compared to the control group, these excluded women had worse metabolic profiles and were more androgenised. Notably, they were indistinguishable from the 'high AFC group' with regard to major hormonal and metabolic parameters (BMI and diabetic classification status, and the prevalence of insulin resistance, metabolic syndrome and HA). LIMITATIONS, REASONS FOR CAUTION We cannot exclude the possibility of inter- and intraobserver variation in the evaluation of AFC. WIDER IMPLICATIONS OF THE FINDINGS With the newly recommended follicle count cutoff, a substantial proportion of women with PCOS might be classified as not having PCOS despite visiting a hospital due to irregular menstruation or hyperandrogenic symptoms. A practical approach to them would involve controlling the menstrual or hyperandrogenic symptoms in hand and regularly evaluating them regarding newly developed or worsening PCOS-related symptoms or metabolic abnormalities. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a grant from the Seoul National University Hospital Research Fund (No. 2520140090), Republic of Korea. The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, 07061, Korea
| | - Soo Jin Chae
- Department of Obstetrics and Gynecology, Maria Fertility Hospital, Seoul, 02586, Korea
| | - Sang Ho Yoon
- Department of Obstetrics and Gynecology, School of Medicine, Dongguk University, Seoul, 04620, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Korea
| |
Collapse
|
5
|
Bergsma M, Obdeijn MC, Janssen SJ, Bain GI, Jaarsma RL, Doornberg JN. Influence of training on dorsal tangential radiographic view to detect screw protrusion after anterior plating of the distal radius: a cadaveric study. J Hand Surg Eur Vol 2020; 45:864-870. [PMID: 32041470 DOI: 10.1177/1753193419898060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this cadaveric study of anterior plating of the distal radius, we aimed to determine the interobserver agreement and diagnostic performance for detecting dorsally protruding screws using the dorsal tangential radiographic view before and after specific training. Without prior instruction, 13 observers interpreted the dorsal tangential view of cadaveric specimens, in which anterior radial plates were placed. After seeing a training video on the dorsal tangential view, they repeated the task. Though we found that accuracy and interobserver agreement was lower than described in some other clinical series, training led to statistically significant improvements of (1) the interobserver agreement on the decision to exchange screws, (2) the self-confidence of the surgeon in obtaining adequate views, and (3) the number of fluoroscopic images required to obtain these views. After training, the number of protruding screws missed was reduced by 36%, but 7% of dorsally protruding screws was still missed.
Collapse
Affiliation(s)
- Minke Bergsma
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia.,Department of Orthopaedic Surgery and Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
| | - Miryam C Obdeijn
- Department of Orthopaedic Surgery and Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
| | - Ruurd L Jaarsma
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.,Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia.,Department of Orthopaedic Surgery and Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.,University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Kim JJ, Hwang KR, Lee D, Choi YM. Reply: Impact of the newly recommended antral follicle count cut-off for polycystic ovary in adult women with polycystic ovary syndrome. Hum Reprod 2020; 35:2167-2169. [PMID: 32756986 DOI: 10.1093/humrep/deaa170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jin Ju Kim
- Department of Obstetrics and Gynecology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Korea.,The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Dayong Lee
- Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Young Min Choi
- The Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea
| |
Collapse
|
7
|
Kazemi M, Jarrett BY, Vanden Brink H, Lin AW, Hoeger KM, Spandorfer SD, Lujan ME. Obesity, Insulin Resistance, and Hyperandrogenism Mediate the Link between Poor Diet Quality and Ovarian Dysmorphology in Reproductive-Aged Women. Nutrients 2020; 12:nu12071953. [PMID: 32629978 PMCID: PMC7399845 DOI: 10.3390/nu12071953] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
The relationship between diet quality and ovarian morphology has biological plausibility yet remains unclear and was therefore evaluated. In a multicenter cross-sectional analysis, four dietary patterns were scored for 111 consecutive reproductive-aged women (18–45 years) using (1) Healthy Eating Index (HEI-2015); (2) alternative HEI-2010; (3) alternate Mediterranean Diet (aMED); (4) and Dietary Approaches to Stop Hypertension (DASH) indices. Ovarian volume (OV) and follicle number per ovary (FNPO) were evaluated on transvaginal ultrasonography. Relationships between dietary and ovarian morphology indices were evaluated by linear regression and mediation analyses. Associations between aMED and DASH scores and OV/FNPO were completely mediated by obesity, insulin resistance, and hyperandrogenism (All: p < 0.05), unlike direct associations (All: p ≥ 0.89). Namely, a 1-standard deviation [SD] increase in aMED score was associated with decreases in OV (0.09 SD; 0.4 mL) through reducing waist circumference. Likewise, a 1 SD increase in aMED and DASH score was associated with decreases in OV (0.07 SD; 0.3 mL) by reducing glucose response to a 75 g glucose tolerance test. A 1 SD increase in DASH score was associated with decreased FNPO (0.07 SD; 2 follicles) by reducing free androgen index (All: p < 0.05). Adherence to aMED and DASH eating plans was indirectly associated with significant improvements in ovarian form, providing novel mechanistic insights for future interventions about contributions of diet quality on ovarian function.
Collapse
Affiliation(s)
- Maryam Kazemi
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (M.K.); (B.Y.J.); (H.V.B.)
| | - Brittany Y. Jarrett
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (M.K.); (B.Y.J.); (H.V.B.)
| | - Heidi Vanden Brink
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; (M.K.); (B.Y.J.); (H.V.B.)
| | - Annie W. Lin
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL 60611, USA;
| | - Kathleen M. Hoeger
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14623, USA;
| | - Steven D. Spandorfer
- Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Marla E. Lujan
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL 60611, USA;
- Correspondence: ; Tel.: +1-607-255-3153; Fax: +1-607-255-1033
| |
Collapse
|
8
|
Lin AW, Kazemi M, Jarrett BY, Vanden Brink H, Hoeger KM, Spandorfer SD, Lujan ME. Dietary and Physical Activity Behaviors in Women with Polycystic Ovary Syndrome per the New International Evidence-Based Guideline. Nutrients 2019; 11:nu11112711. [PMID: 31717369 PMCID: PMC6893689 DOI: 10.3390/nu11112711] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023] Open
Abstract
Lifestyle modifications are recommended as first-line therapy in polycystic ovary syndrome (PCOS). However, usual dietary and physical activity (PA) behaviors of women with PCOS remain uncertain, likely owing to controversy in diagnostic criteria. Our objective was to contrast the usual dietary and PA behaviors of women with PCOS (n = 80) diagnosed by the 2018 International Evidence-based Guideline for the Assessment and Management of PCOS to that of controls (n = 44). Study outcomes were dietary intake, diet quality (Healthy Eating Index-2015), and PA (questionnaire, waist-worn accelerometers). Women with PCOS met the acceptable macronutrient distribution ranges for carbohydrate, fat, and protein, but did not meet the recommended dietary reference intakes for vitamin D (mean (95% confidence interval); 6 (5–7) μg/d), vitamin B9 (275 (252–298) μg/d), total fiber (24 (22–26) g/d), or sodium (4.0 (3.6–4.4) g/d). Women with PCOS also met the US recommendations for PA. No differences were detected in dietary intake, diet quality, or PA levels between groups (p ≥ 0.11). In conclusion, women with and without PCOS have comparable dietary and PA behaviors. A lack of unique targets for dietary or PA interventions supports the position of the new guideline to foster healthy lifestyle recommendations for the management of PCOS.
Collapse
Affiliation(s)
- Annie W. Lin
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL 60611, USA
| | - Maryam Kazemi
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | | | - Heidi Vanden Brink
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Kathleen M. Hoeger
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14623, USA
| | - Steven D. Spandorfer
- Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marla E. Lujan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
- Correspondence: ; Tel.: +1-607-255-3153; Fax: +1-607-255-1033
| |
Collapse
|
9
|
Impact of right-left differences in ovarian morphology on the ultrasound diagnosis of polycystic ovary syndrome. Fertil Steril 2019; 112:939-946. [PMID: 31395310 DOI: 10.1016/j.fertnstert.2019.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess right-left differences in ultrasonographic markers of ovarian morphology and determine the impact on the diagnosis of polycystic ovarian morphology (PCOM). DESIGN A cross-sectional study of data collected from 2006 to 2018. SETTING Academic clinical research centers. PATIENT(S) Women with polycystic ovary syndrome (PCOS; n = 87) and controls (n = 67). INTERVENTION(S) None. MAIN OUTCOMES MEASURE(S) Follicle number per ovary (FNPO), follicle number per cross-section (FNPS), and ovarian volume (OV) were assessed in both ovaries using transvaginal ultrasonography. PCOM was identified based on recent international consensus guidelines or proposed diagnostic thresholds. RESULT(S) Overall, mean right-left differences were two follicles for FNPO, one follicle for FNPS, and 2 mL for OV. FNPO showed the strongest correlation between ovaries. Its assessment in a single ovary did not impact the diagnosis of PCOM in women with PCOS. However, there were differences in the probability of unilateral versus bilateral PCOM based on FNPS and OV in both groups. CONCLUSION(S) FNPO is the most reliable unilateral marker of PCOM in light of right-left differences in ovarian morphology. Use of FNPS or OV to define PCOM is discouraged when only one ovary is visualized.
Collapse
|
10
|
|
11
|
Sonographic markers of ovarian morphology, but not hirsutism indices, predict serum total testosterone in women with regular menstrual cycles. Fertil Steril 2016; 105:1322-1329.e1. [PMID: 26794423 DOI: 10.1016/j.fertnstert.2015.12.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/24/2015] [Accepted: 12/28/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine whether sonographic markers of ovarian morphology or male pattern hair growth scores predict androgen levels in women with regular or irregular menstrual cycles. DESIGN Cross-sectional observational study. SETTING Clinical research unit. PATIENT(S) Seventy-six women of reproductive age (18-39 years) were evaluated for male-pattern hair growth (using a modified Ferriman-Gallwey scoring system), ovarian morphology (by transvaginal ultrasonography), and total serum testosterone (T) (by liquid chromatography tandem mass spectrometry). INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Regional and total modified Ferriman-Gallwey scores, number of follicles per follicle size category, follicle number per ovary, ovarian volume, ovarian area, stromal to ovarian area ratio, stromal echogenicity index, total testosterone (total T), and menstrual cycle length. RESULT(S) Neither regional nor total modified Ferriman-Gallwey scores correlated with total T concentrations in women with regular or irregular menstrual cycles, as judged by the Least Absolute Shrinkage and Selection Operator technique. By contrast, a sonographic marker (follicle number per ovary 6-9 mm) significantly predicted total T concentrations in women with regular menstrual cycles but not in women with irregular menstrual cycles. CONCLUSION(S) Sonographic markers of ovarian morphology, but not hirsutism scores, predicted total T levels. However, the predictive value of ovarian morphology for total T differed by menstrual cycle status. That sonographic markers did not predict androgen levels in a diverse cohort of women with cycle irregularity suggests the potential for distinct variations in ovarian morphology for androgenic and nonandrogenic types of cycle irregularity. Overall, our findings support that an assessment of ovarian morphology may be helpful in reflecting total T levels.
Collapse
|
12
|
Coelho Neto MA, Roncato P, Nastri CO, Martins WP. True Reproducibility of UltraSound Techniques (TRUST): systematic review of reliability studies in obstetrics and gynecology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:14-20. [PMID: 25175693 DOI: 10.1002/uog.14654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/15/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To examine the quality of methods used and the accuracy of the interpretation of agreement in existing studies that examine the reliability of ultrasound measurements and judgments in obstetrics and gynecology. METHODS A systematic search of MEDLINE was performed on 25 March 2014, looking for studies that examined the reliability of ultrasound measurements and judgments in obstetrics and gynecology with evaluation of concordance (CCC) or intraclass (ICC) correlation coefficients or kappa as a main objective. RESULTS Seven hundred and thirty-three records were examined on the basis of their title and abstract, of which 141 full-text articles were examined completely for eligibility. We excluded 29 studies because they did not report CCC/ICC/kappa, leaving 112 studies that were included in our analysis. Two studies reported both ICC and kappa and were counted twice, therefore, the number used as the denominator in the analyses was 114. Only 16/114 (14.0%) studies were considered to be well designed (independent acquisition and blinded analysis) and to have interpreted the results properly. Most errors occurring in the studies are likely to overestimate the reliability of the method examined. CONCLUSIONS The vast majority of published studies examined had important flaws in design, interpretation and/or reporting. Such limitations are important to identify as they might create false confidence in the existing measurements and judgments, jeopardizing clinical practice and future research. Specific guidelines aimed at improving the quality of reproducibility studies that examine ultrasound methods should be encouraged.
Collapse
Affiliation(s)
- M A Coelho Neto
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - P Roncato
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
- School of Health Technology - Ultrasonography School of Ribeirao Preto (FATESA-EURP), Ribeirao Preto, Brazil
| | - C O Nastri
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil
| |
Collapse
|
13
|
Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, Escobar-Morreale HF. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update 2013; 20:334-52. [DOI: 10.1093/humupd/dmt061] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
14
|
Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome. Fertil Steril 2013; 101:280-287.e1. [PMID: 24188871 DOI: 10.1016/j.fertnstert.2013.10.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 10/01/2013] [Accepted: 10/01/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the diagnostic potential of ultrasonographic markers of ovarian morphology, used alone or in combination, to predict polycystic ovary syndrome (PCOS). DESIGN A diagnostic test study using cross-sectional data collected from 2006-2011. SETTING Academic hospital and clinical research unit. PATIENT(S) Eighty-two women with PCOS and 60 healthy female volunteers. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Follicle number per ovary (FNPO), ovarian volume (OV), follicle number per single cross-section (FNPS), follicle distribution pattern, stromal area, ovarian area, stromal-to-ovarian area ratio (S:A), and stromal index (SI). RESULT(S) Follicle number per ovary best predicted PCOS (R(2) = 67%) with 85% sensitivity and 98% specificity, followed by OV (R(2) = 44%), and FNPS (R(2) = 36%). Neither S:A nor SI had predictive power for PCOS. In combination, FNPO+S:A and FNPO+SI most significantly predicted PCOS (R(2) = 74% vs. 73%, respectively). The diagnostic potentials of OV and FNPS were substantially improved when used in combination (OV+FNPO, R(2) = 55%). CONCLUSION(S) As a single metric, FNPO best predicted PCOS. Although the addition of S:A or SI improved the predictive power of FNPO, gains were marginal, suggesting limited use in clinical practice. When image quality precludes a reliable estimation of FNPO, measurements of OV+FNPS provide the next closest level of diagnostic potential.
Collapse
|
15
|
Buijze GA, Guitton TG, van Dijk CN, Ring D. Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement. Clin Orthop Relat Res 2012; 470:2029-34. [PMID: 22290132 PMCID: PMC3369105 DOI: 10.1007/s11999-012-2260-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability. QUESTIONS/PURPOSES We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans. METHODS Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel's multirater kappa and the Z-test was used to test for significance. RESULTS There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups. CONCLUSIONS Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.
Collapse
Affiliation(s)
- Geert A. Buijze
- Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Thierry G. Guitton
- Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - C. Niek van Dijk
- Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
| | | |
Collapse
|
16
|
Lujan ME, Podolski AJ, Chizen DR, Lehotay DC, Pierson RA. Digit ratios by computer-assisted analysis confirm lack of anatomical evidence of prenatal androgen exposure in clinical phenotypes of polycystic ovary syndrome. Reprod Biol Endocrinol 2010; 8:156. [PMID: 21189149 PMCID: PMC3022844 DOI: 10.1186/1477-7827-8-156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 12/29/2010] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We recently showed that women with four clinical phenotypes of polycystic ovary syndrome (PCOS) do not demonstrate anatomical evidence of elevated prenatal androgen exposure as judged by a lower ratio of the index (2D) to ring (4D) finger. However, those findings conflicted with a previous study where women with PCOS had lower right hand 2D:4D compared to healthy female controls. Both these studies used Vernier calipers to measure finger lengths--a method recently shown to be less reliable at obtaining finger length measurements than computer-assisted analysis. METHODS Ninety-six women diagnosed with PCOS according to the 2003 Rotterdam criteria had their finger lengths measured with computer-assisted analysis. Participants were categorized into four recognized phenotypes of PCOS and their 2D:4D compared to healthy female controls (n = 48) and men (n = 50). RESULTS Digit ratios assessed by computer-assisted analysis in women with PCOS did not differ from female controls, but were significantly lower in men. When subjects were stratified by PCOS phenotype, 2D:4D did not differ among phenotypes or when compared to female controls. CONCLUSION Computer-assisted measurements validated that digit ratios of women with PCOS do not show anatomical evidence of increased prenatal androgen exposure.
Collapse
Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, College of Agriculture of Life Sciences, Ithaca, NY 14853, USA
| | - Amanda J Podolski
- Division of Nutritional Sciences, College of Agriculture of Life Sciences, Ithaca, NY 14853, USA
| | - Donna R Chizen
- Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| | - Denis C Lehotay
- Pathology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| | - Roger A Pierson
- Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada
| |
Collapse
|
17
|
Lujan ME, Kepley AL, Chizen DR, Lehotay DC, Pierson RA. Development of morphologically dominant follicles is associated with fewer metabolic disturbances in amenorrheic women with polycystic ovary syndrome: a pilot study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:759-766. [PMID: 20645396 DOI: 10.1002/uog.7751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine if amenorrheic women with polycystic ovary syndrome (PCOS) demonstrate ultrasonographically detectable changes in follicle population. METHODS Sixteen women with PCOS reporting the absence of menses for more than 3 months were enrolled in the study. Subjects had a physical examination, fasting blood tests and two transvaginal ultrasound scans spaced 1 month apart. In cases where evidence of a morphologically dominant follicle (≥ 10 mm in diameter) occurred, subsequent ultrasound scans were performed to determine the fate of the dominant follicle. Differences in total follicle population, maximum follicle diameter and clinical, hormonal and metabolic features were determined. RESULTS Forty-four percent of subjects showed changes in follicle population of 6-10 follicles and 37% showed changes in follicle population of > 10. Maximum follicle diameters ranged between 5.4 and 33.0 mm. Four subjects demonstrated follicle diameters ≥ 10 mm. Of those who developed dominant follicles, two subjects ovulated, one subject developed a persistent anovulatory follicle and the dominant follicle regressed in the remaining subject. Diagnostic criteria for PCOS were similar among women that did or did not develop dominant follicles (menstrual cycle length, P = 0.880; hirsutism score, P = 0.809; free androgen index, P = 0.991; total follicle count, P = 0.199). However, lower glycosylated hemoglobin (P = 0.047) and insulin levels (P = 0.049) and better insulin sensitivity (P = 0.048) were noted in women who attained dominant follicles. CONCLUSION Amenorrheic women with PCOS demonstrate changes in follicle population that are consistent with active follicle growth and regression despite prolonged periods of anovulation. Morphologic selection occurs in amenorrheic women and attainment of dominant follicles is associated with improved metabolic status.
Collapse
Affiliation(s)
- M E Lujan
- Department of Nutritional Sciences, Cornell University, College of Agriculture and Life Sciences, Ithaca, NY 14853, USA.
| | | | | | | | | |
Collapse
|
18
|
Ríos-Díaz J, Groot Ferrando AD, Martínez-Payá JJ, Baño Aledo MED. Fiabilidad y reproducibilidad de un nuevo método de análisis morfotextural de imágenes ecográficas del tendón rotuliano. ACTA ACUST UNITED AC 2010; 6:278-84. [DOI: 10.1016/j.reuma.2010.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Revised: 01/10/2010] [Accepted: 01/17/2010] [Indexed: 11/30/2022]
|
19
|
Women's perceptions of polycystic ovary syndrome following participation in a clinical research study: implications for knowledge, feelings, and daily health practices. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:453-459. [PMID: 20500954 DOI: 10.1016/s1701-2163(16)34499-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that affects 6% to 10% of reproductive aged women. It is a poorly understood and often undiagnosed condition that has implications for the health of affected women. We assessed changes in knowledge, feelings, and daily health practices related to PCOS in clinical research study participants. METHODS Sixty-eight women who had received counselling and education about PCOS while participating in a clinical research study were invited to complete an online survey that assessed levels of concern, knowledge, healthy dieting, active living, and health care satisfaction before and after the study. Differences and associations between scores were analyzed by paired t tests and Pearson correlation. RESULTS Forty-three women (63%) completed the survey. After taking part in a clinical research study, participants believed they had increased knowledge of (P < 0.001) and concern about (P = 0.029) the etiology and health consequences of PCOS, better lifestyle practices (P < 0.001), and improved health care satisfaction (P = 0.045). Enhanced knowledge of PCOS was positively associated with changes in concern (P = 0.045), healthy dietary habits (P = 0.04), activity levels (P = 0.003), and health care satisfaction (P < 0.001). After the study, women felt empowered to participate in the management of their condition and communicate with their primary care providers. CONCLUSION Women with PCOS felt that they had more knowledge and motivation to implement preventive health strategies after participating in a clinical research study. Education about how PCOS affects their immediate and long-term health enabled women with PCOS to feel physical and psychological benefits and to engage more with their health care providers.
Collapse
|
20
|
Lujan ME, Brooks ED, Kepley AL, Chizen DR, Pierson RA, Peppin AK. Grid analysis improves reliability in follicle counts made by ultrasonography in women with polycystic ovary syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:712-718. [PMID: 20381953 PMCID: PMC2893214 DOI: 10.1016/j.ultrasmedbio.2010.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/19/2010] [Accepted: 02/22/2010] [Indexed: 05/29/2023]
Abstract
Poor reliability has been reported when counting the total number of follicles in polycystic ovaries using conventional two-dimensional (2-D) ultrasound viewing methods. In the current study, we report good reliability in follicle counts when observers imposed a programmable grid system over the viewing window. Four observers estimated total follicle counts in 45 ovarian ultrasound scans by compartmentalizing the ovary into 9 to 12 grid sections and performing focused follicle counts per section. The mean number of follicles counted per ovary was 44.6 +/- 2.3. The level of inter-observer agreement when making follicle counts was 0.82 and total follicle counts did not differ among observers. The level of intra-observer agreement was 0.93 which further corroborated the utility of this method for making dependable follicle counts. In summary, the ability to obtain reproducible follicle counts will help to establish reliable diagnostic criteria for polycystic ovarian morphology.
Collapse
Affiliation(s)
- Marla E Lujan
- Division of Nutritional Sciences, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York 14853, USA.
| | | | | | | | | | | |
Collapse
|