Hum. Reprod. Advance Access originally published online on July 17, 2007
Human Reproduction 2007 22(9):2501-2508; doi:10.1093/humrep/dem202
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Ultrasound in polycystic ovary syndrome—the measuring of ovarian stroma and relationship with circulating androgens: results of a multicentric study
1 Dipartimento Chirurgico Materno Infantile e di Scienze delle Immagini, Sezione Ostetrica e Ginecologica, Università degli Studi di Cagliari, Via Ospedale 46, 09124 Cagliari, Italy 2 Dipartimento di Ginecologia ed Ostetricia, Università Cattolica del Sacro Cuore, Largo Gemelli 2, 00168 Roma, Italy 3 Clinica Medica 3, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Padova, Via Giustiniani 2, 35128 Padova, Italy 4 Dipartimento di Farmacologia, Ostetricia e Ginecologia, Università degli Studi di Sassari, Viale S. Pietro, 07100 Sassari, Italy 5 Dipartmento di Medicina della Procreazione e dell' Età Evolutiva, Università degli Studi di Pisa, Via Roma 67, 56126 Pisa, Italy 6 Dipartimento di Igiene e Sanità Pubblica, Università degli Studi di Cagliari, Via Porcell 4, 09124 Cagliari, Italy 7 OASI, Institute of Research, Troina (EN), Italy
8 Correspondence address. Viale Poetto 194, 09126 Cagliari, Italy. Tel: +39-335-6622192; Fax: +39-070-6092231; E-mail: fulgh{at}tiscali.it
BACKGROUND: The introduction of transvaginal approach in ultrasound (US) has enabled the accurate evaluation of the structure of the ovary and stroma. Stroma represents an acknowledged US marker for polycystic ovary syndrome (PCOS). The proportion revealed between the stroma and the ovary surface in the median section (S/A ratio) had been indicated as a reliable marker for hyperandrogenism. In order to verify the feasibility of this determination in routine use and to confirm the efficacy of S/A ratio in predicting hyperandrogenism in PCOS, a multicentric study was performed in association with five Italian research groups.
METHODS: A total of 418 subjects of fertile age presenting oligomenorrhoea or secondary amenorrhoea, enlarged ovaries measuring >10 cm3 and/or >12 follicles measuring 2–9 mm in diameter took part in the study. Clinical, US and hormonal evaluations were performed in the early follicular phase or on random days in amenorrhoeic subjects. US assessment included ovarian volume, follicle number, ovarian and stroma area in median section. The hormonal study included a baseline plasma determination of LH, FSH, estradiol (E2), androstenedione (A), testosterone (T), dehydroepiandrosteronesulphate, 17-hydroxy-progesterone, sex hormone-binding globulin and prolactin. Correlations and receiver operator curves were used in statistical analysis of data.
RESULTS: S/A was found to be the best significant predictor of elevated A and T levels. In order to ascertain significant cut-off values in relation to A and T levels Youden indexes were calculated and indicated 0.32 as the best cut-off for the S/A ratio.
CONCLUSIONS: This work underlines the importance of stroma measure in improving US diagnosis of PCOS and suggest that this parameter may be used in routine clinical practice. In fact, multicentre study demonstrated the easy feasibility of such procedure without need of sophisticated machines or intensive training for operators.
Key words: PCOS/ovarian stroma/S/A ratio/androgen
Submitted on November 3, 2006; resubmitted on March 20, 2007; accepted on May 8, 2007.
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