Nazar Amso - Academia.edu (original) (raw)

Papers by Nazar Amso

Human Reproduction, May 1, 2003

BACKGROUND: Initial reports from observational and randomized trials of uterine endometrial therm... more BACKGROUND: Initial reports from observational and randomized trials of uterine endometrial thermal balloon therapy (UBT) suggested good results as judged by return to eumenorrhoea or less and patient satisfaction. Longterm follow-up data remained limited by the small numbers of patients and duration of follow-up. We present longterm (4±6 years) follow-up data from a cohort of women previously treated with UBT for menorrhagia. METHODS: Of the 260 questionnaires sent to women eligible for long-term follow-up from 10 centres, 188 (72%) replies were received. The primary outcome measure was avoidance of hysterectomy. RESULTS: In women who responded to the questionnaire, 25 had undergone hysterectomy and 21 had had repeat ablation. At 4±6 years after UBT, the probability of avoiding hysterectomy was 86% of all women, and of avoiding re-ablation was 88% of nonhysterectomized women. Overall, the probability of avoiding any surgery was 75%. Women with an axial or retroverted uterus were at greater risk of hysterectomy or re-ablation. Among the participants, 47% of the non-hysterectomized women were amenorrhoeic, 30% were hypomenorrhoeic, 13.6% were eumenorrhoeic and 8.5% had heavy periods. CONCLUSIONS: This is the ®rst long-term follow-up report of a second-generation endometrial ablation procedure and con®rms our initial experience. The high rate of hysterectomy avoidance over 5 years or more is very encouraging for this technology.

Ultrasound in Obstetrics & Gynecology, Mar 1, 2013

Objective Transvaginal sonography (TVS) is core to any ovarian cancer screening strategy. General... more Objective Transvaginal sonography (TVS) is core to any ovarian cancer screening strategy. General-population screening involves older postmenopausal women in whom ovarian visualization is difficult because of decreasing ovarian size and lack of follicular activity. We report on factors affecting the visualization of postmenopausal ovaries in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Methods The UKCTOCS is a randomized controlled trial of 202 638 postmenopausal women with 50 639 women in the ultrasound scan arm. TVS is the primary screening modality in the ultrasound scan arm. Age, education, ethnicity, body mass index (BMI), previous pelvic surgery, lifestyle and reproductive factors, and a personal/family history of cancer were assessed for their effects on ovarian visualization at the initial TVS.

Bjog: An International Journal Of Obstetrics And Gynaecology, Jul 15, 2011

Objective To evaluate the malignant potential of ultrasounddetected ovarian inclusion cysts in th... more Objective To evaluate the malignant potential of ultrasounddetected ovarian inclusion cysts in the development of ovarian cancer (OC) in postmenopausal women. Design Prospective cohort study. Setting UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Population Postmenopausal women. Methods In UKCTOCS, women in the ultrasound group have annual scans. Women with inclusion cysts (single/multiple anechoic £10-mm ovarian cysts) and normal ovaries (both uniform hypoechogenicity) on their first scan were identified and followed up through cancer registry/questionnaires. Main outcome measures Relative risk (RR) of developing OC, invasive epithelial ovarian cancer (iEOC), breast cancer (BC) and endometrial cancer (EC) in women with inclusion cysts relative to those with normal ovaries. The incidence was compared with UK age-adjusted expected rates (Office for National Statistics, 2005). Results Postmenopausal women (n = 48 230) attended the year 1 (11 June 2001-6 December 2006) screen; 1234 (2.5%) had inclusion cysts alone and 22 914 had normal scans. By 1 November 2009 (median follow-up, 6.13 years; interquartile range, 4.96-6.98 years), four, three (one Type II), seven and 22 women with inclusion cysts and 32, 29 (20 Type II), 90 and 397 women with normal ovaries were diagnosed with OC, iEOC, EC and BC, respectively. The RR values for the respective cancers (OC [RR, 2.32; confidence interval [CI], 0.86-6.28], iEOC [RR, 1.92; CI, 0.62-5.92], EC [RR, 1.44; CI, 0.68-3.05], BC [RR, 1.12; CI, 0.73-1.73]) were not increased. There was no difference between the observed versus expected incidence rates for these cancers in women with inclusion cysts. Conclusions Postmenopausal women with ultrasound-detected inclusion cysts do not seem to be at increased risk of ovarian or breast/endometrial (hormone-dependent) cancers.

Lancet Oncology, Apr 1, 2009

Background Ovarian cancer has a high case-fatality ratio, with most women not diagnosed until the... more Background Ovarian cancer has a high case-fatality ratio, with most women not diagnosed until the disease is in its advanced stages. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is a randomised controlled trial designed to assess the eff ect of screening on mortality. This report summarises the outcome of the prevalence (initial) screen in UKCTOCS. Methods Between 2001 and 2005, a total of 202 638 post-menopausal women aged 50-74 years were randomly assigned to no treatment (control; n=101 359); annual CA125 screening (interpreted using a risk of ovarian cancer algorithm) with transvaginal ultrasound scan as a second-line test (multimodal screening [MMS]; n=50 640); or annual screening with transvaginal ultrasound (USS; n=50 639) alone in a 2:1:1 ratio using a computer-generated random number algorithm. All women provided a blood sample at recruitment. Women randomised to the MMS group had their blood tested for CA125 and those randomised to the USS group were sent an appointment to attend for a transvaginal scan. Women with abnormal screens had repeat tests. Women with persistent abnormality on repeat screens underwent clinical evaluation and, where appropriate, surgery. This trial is registered as ISRCTN22488978 and with ClinicalTrials.gov, number NCT00058032. Findings In the prevalence screen, 50 078 (98•9%) women underwent MMS, and 48 230 (95•2%) underwent USS. The main reasons for withdrawal were death (two MMS, 28 USS), non-ovarian cancer or other disease (none MMS, 66 USS), removal of ovaries (fi ve MMS, 29 USS), relocation (none MMS, 39 USS), failure to attend three appointments for the screen (72 MMS, 757 USS), and participant changing their mind (483 MMS, 1490 USS). Overall, 4355 of 50 078 (8.7%) women in the MMS group and 5779 of 48 230 (12•0%) women in the USS group required a repeat test, and 167 (0•3%) women in the MMS group and 1894 (3•9%) women in the USS group required clinical evaluation. 97 of 50 078 (0•2%) women from the MMS group and 845 of 48 230 (1•8%) from the USS group underwent surgery. 42 (MMS) and 45 (USS) primary ovarian and tubal cancers were detected, including 28 borderline tumours (eight MMS, 20 USS). 28 (16 MMS, 12 USS) of 58 (48•3%; 95% CI 35•0-61•8) of the invasive cancers were stage I/II, with no diff erence (p=0•396) in stage distribution between the groups. A further 13 (fi ve MMS, eight USS) women developed primary ovarian cancer during the year after the screen. The sensitivity, specifi city, and positive-predictive values for all primary ovarian and tubal cancers were 89•4%, 99•8%, and 43•3% for MMS, and 84•9%, 98•2%, and 5•3% for USS, respectively. For primary invasive epithelial ovarian and tubal cancers, the sensitivity, specifi city, and positive-predictive values were 89•5%, 99•8%, and 35•1% for MMS, and 75•0%, 98•2%, and 2•8% for USS, respectively. There was a signifi cant diff erence in specifi city (p<0•0001) but not sensitivity between the two screening groups for both primary ovarian and tubal cancers as well as primary epithelial invasive ovarian and tubal cancers. Interpretation The sensitivity of the MMS and USS screening strategies is encouraging. Specifi city was higher in the MMS than in the USS group, resulting in lower rates of repeat testing and surgery. This in part refl ects the high prevalence of benign adnexal abnormalities and the more frequent detection of borderline tumours in the USS group. The prevalence screen has established that the screening strategies are feasible. The results of ongoing screening are awaited so that the eff ect of screening on mortality can be determined.

Journal für Menopause, Mar 16, 2004

Objective To describe the factors that contributed to successful recruitment of more than 200 000... more Objective To describe the factors that contributed to successful recruitment of more than 200 000 women to the UK Collaborative Trial of Ovarian Cancer Screening, one of the largest ever randomised controlled trials. Design Descriptive study. Setting 13 NHS trusts in England, Wales, and Northern Ireland. Participants Postmenopausal women aged 50-74; exclusion criteria included ovarian malignancy, bilateral oophorectomy, increased risk of familial ovarian cancer, active non-ovarian malignancy, and participation in other ovarian cancer screening trials. Main outcome measures Achievement of target recruitment, acceptance rates of invitation, and recruitment rates. Results The trial was set up in 13 centres with 27 adjoining local health authorities. The coordinating centre team was led by one of the senior investigators, who was closely involved in planning and day to day trial management. Of 1 243 282 women invited, 23.2% (288 955) replied that they were eligible and would like to participate. Of those sent appointments, 73.6% (205 090) attended for recruitment. The acceptance rate varied from 19% to 33% between trial centres. Measures to ensure target recruitment included named coordinating centre staff supporting and monitoring each centre, prompt identification and resolution of logistic problems, varying the volume of invitations by centre, using local nonattendance rates to determine the size of recruitment clinics, and organising large ad hoc clinics supported by coordinating centre staff. The trial randomised 202 638 women in 4.3 years. Conclusions Planning and trial management are as important as trial design and require equal attention from senior investigators. Successful recruitment needs constant monitoring by a committed proactive management team that is willing to explore individual solutions for different centres and use central resources to improve local recruitment. Automation of trial processes with web based trial management systems is crucial in large multicentre randomised controlled trials. Recruitment can be further enhanced by using information videos and group discussions. Trial registration Current Controlled Trials ISRCTN22488978.

F1000Research, Aug 10, 2018

We report on a unique audit of seven sonographers Background: self-reporting high visualization r... more We report on a unique audit of seven sonographers Background: self-reporting high visualization rates of normal postmenopausal ovaries in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). This audit was ordered by the trial's Ultrasound Management Subcommittee after an initiative taken in 2008 to improve the quality of scanning and the subsequent increase in the number of sonographers claiming very high ovary visualisation rates. Seven sonographers reporting high rates (>89%) of visualizing Methods: normal postmenopausal ovaries in examinations performed between 1 January and 31 December 2008 were identified. Eight experts in gynaecological scanning reviewed a random selection of exams performed by these sonographers and assessed whether visualization of both ovaries could be confirmed (cVR-Both) in the examinations. A random effects bivariate probit model was fitted to analyse the results. The eight experts reviewed images from 357 examinations performed Results: on 349 postmenopausal women (mean age 60.0 years, range 50.2-73.3) by the seven sonographers. The mean cVR-Both obtained from the model for these sonographers was 67.2% with a range of 47.6-86.5% (95%CI 63.9-70.5%). The range of cVR-Both between the experts was 47.3-88.3% and the intra-class correlation coefficient (ICC) for left and right ovary confirmation was 0.39. The audit suggests that self-reported visualization of Conclusions: postmenopausal ovaries is unreliable, as visualisation of both ovaries could not be confirmed in almost a third of examinations. The agreement for visualization of both ovaries based on review of a static image between experts and sonographers and between expert reviewers alone was only moderate. Further 1 2 3 report report report

Journal of Clinical Oncology, Jun 20, 2015

Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnorma... more Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates. Patients and Methods In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 46,237 women, age 50 years or older underwent incidence screening by using the multimodal strategy (MMS) in which annual serum cancer antigen 125 (CA-125) was interpreted with the risk of ovarian cancer algorithm (ROCA). Women were triaged by the ROCA: normal risk, returned to annual screening; intermediate risk, repeat CA-125; and elevated risk, repeat CA-125 and transvaginal ultrasound. Women with persistently increased risk were clinically evaluated. All participants were followed through national cancer and/or death registries. Performance characteristics of a single-threshold rule and the ROCA were compared by using receiver operating characteristic curves. Results After 296,911 women-years of annual incidence screening, 640 women underwent surgery. Of those, 133 had primary invasive epithelial ovarian or tubal cancers (iEOCs). In all, 22 interval iEOCs occurred within 1 year of screening, of which one was detected by ROCA but was managed conservatively after clinical assessment. The sensitivity and specificity of MMS for detection of iEOCs were 85.8% (95% CI, 79.3% to 90.9%) and 99.8% (95% CI, 99.8% to 99.8%), respectively, with 4.8 surgeries per iEOC. ROCA alone detected 87.1% (135 of 155) of the iEOCs. Using fixed CA-125 cutoffs at the last annual screen of more than 35, more than 30, and more than 22 U/mL would have identified 41.3% (64 of 155), 48.4% (75 of 155), and 66.5% (103 of 155), respectively. The area under the curve for ROCA (0.915) was significantly (P ϭ .0027) higher than that for a single-threshold rule (0.869). Conclusion Screening by using ROCA doubled the number of screen-detected iEOCs compared with a fixed cutoff. In the context of cancer screening, reliance on predefined single-threshold rules may result in biomarkers of value being discarded.

Obstetrical & Gynecological Survey, Sep 1, 2009

BMJ, Nov 13, 2008

Cambridge University Press eBooks, Nov 16, 2016

Fertility and Sterility, Sep 1, 2001

Objective: To test a new software package (Color Quantifier, Kinetic Imaging, Liverpool, United K... more Objective: To test a new software package (Color Quantifier, Kinetic Imaging, Liverpool, United Kingdom) that quantifies power Doppler energy and to determine its reproducibility. Design: Intraobserver and interobserver reproducibility study. Setting: University tertiary referral center. Patient(s): Transvaginal power Doppler ultrasound images were recorded from women taking part in a study evaluating the physiological vascular changes in the uterus and ovaries during the normal menstrual cycle. Intervention(s): Nineteen consecutive frames of regions of interest in the uterus, ovary, and follicle, respectively, were analyzed by each of four observers on 10 occasions. Main Outcome Measure(s): Analysis of variance to determine the image and observer effect as well as the intraobserver and interobserver coefficients of variation. Result(s): Significant image and observer effects were found. However, the image effect was by far the largest component of the total variation. The large image-to-image variability was expected because the cardiac cycle was included within the 19 frames (images) analyzed. The combined intraobserver and interobserver variation, expressed as the coefficients of variation, was found to be small for the above indices (as low as 1.9%), particularly for total ovary and endometrium. Conclusion(s): The indices obtained with this color quantification software are reproducible in an in vitro setting using prerecorded images. Its applicability as a useful assay in the clinical setting requires further evaluation.

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Ultrasound has become an important tool for the management of subfertile women (Hacckelor, 1984).... more Ultrasound has become an important tool for the management of subfertile women (Hacckelor, 1984). Demonstration of pelvic organs with accuracy and clear definition has been made possible with the introduction of high resolution sector ultrasound machines. Between June 1986 and February 1987, 103 women underwent a "menstrual phase" pelvic ultrasound scan. Uterine and adnexal abnormalities noticed on ultrasound scans were correlated with laparoscopic findings and biochemical results. Abnormal scan findings were present in 15 women and were confirmed in 13 of them at laparoscopy. Fifteen women with normal scans were found to have a pelvic pathology at laparoscopy, mostly of minor degree. Polycystic ovaries were diagnosed in 34 women on ultrasound imaging, 50% of whom had no biochemical evidence of the disease. An up-to-date presentation of results and their significance is discussed

CRC Press eBooks, Jun 22, 2022

Ultrasound in Assisted Reproduction and Early Pregnancy, 2020

International Journal of Gynecologic Cancer, 2006

Facts, views & vision in obgyn, 2019

Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and genera... more Laparoscopy is widely utilised to diagnose and treat acute and chronic, gynaecological and general surgical conditions. It has only been in recent years that laparoscopy has become an acceptable surgical alternative to open surgery in pregnancy. To date there is little clinical guidance pertaining to laparoscopic surgery in pregnancy. This is why the BSGE commissioned this guideline. MEDLINE, EMBASE, CINAHL and the Cochrane library were searched up to February 2017 and evidence was collated and graded following the NICE-approved process. The conditions included in this guideline are laparoscopic management of acute appendicitis, acute gall bladder disease and symptomatic benign adnexal tumours in pregnancy. The intended audience for this guideline is obstetricians and gynaecologists in secondary and tertiary care, general surgeons and anaesthetists. However, only laparoscopists who have adequate laparoscopic skills and who perform complex laparoscopic surgery regularly should undert...

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020

Borderline ovarian tumours (BOTs) are difficult to diagnose preoperatively. The ability to distin... more Borderline ovarian tumours (BOTs) are difficult to diagnose preoperatively. The ability to distinguish between BOTs and other ovarian cancer types prior to surgery could have a profound impact on patient childbearing counselling and surgical planning. Ultrasound (US) pattern recognition by an expert examiner can be an excellent tool for the discrimination of benign and malignant ovarian masses. With respect to US features, most studies were based on well-known risk models. Nevertheless, very few studies have solely evaluated the utility of ultrasound in diagnosing BOTs. We aimed to evaluate the use of US in identifying BOTs solely from benign and malignant ovarian tumours in isolation from risk models. We performed a systematic literature review to identify publications that evaluated the use of US to differentiate between BOTs and malignant and/or benign ovarian tumours using Pubmed, Web of Science and the Cochrane Library. We performed a meta-analysis of the diagnostic sensitivity and specificity studies. We computed the summary estimates for sensitivity and specificity of US in diagnosing BOTs using the bivariate approach of Reitsma in the mada package in R. The initial search resulted in 24,737 publications. Hundred and seven publications were screened, and five studies contained diagnostic data. Different US criteria applied to identify BOTs. Four out of five studies including 244 women with BOTs and 965 women with benign or malignant tumours were suitable for the meta-analysis. Pooling of the results from four studies showed an overall sensitivity of 0.660 (95 % CI: 0.597-0.718) and specificity of 0.854 (95 % CI: 0.728-0.927). The overall US accuracy was uniform in sensitivity and variable in specificity. A low false positive rate, 0.146 (95 % CI: 0.073-0.272) was observed. US correctly identified BOTs in more than six out of 10 women for potential ovarian sparing surgery, whereas it correctly identified the absence of BOTs in more than eight out of 10 symptomatic women. More carefully designed studies are needed to evaluate the use of pre-operative US for the diagnosis of BOTs.