A C TA Obstetricia et Gynecologica Letter to the Editor
References 1. Bra€ uner CM, Attermann J. Reply to comments by Dr. Brind and Mr. Carroll on our study No evidence of an association between induced abortion and breast cancer among parous older women: Our conclusion remains valid. Acta Obstet Gynecol Scand. 2013;92:1429–30. 2. Carroll P. Induced abortion and breast cancer. Acta Obstet Gynecol Scand. 2013;92:1428. 3. Bra€ uner CM, Overvad K, Tjønneland A, Attermann J. Induced abortion and breast cancer among parous women:
a Danish cohort study. Acta Obstet Gynecol Scand. 2013;92:700–5. 4. Carroll PS. The breast cancer epidemic: modeling and forecasts based on abortion and other risk factors. J Am Phys Surg. 2007;12:72–8. 5. Huang Y, Zhang X, Li W, Song F, Dai H, Wang J et al. A meta-analysis of the association between induced abortion and breast cancer risk among Chinese females. Cancer Causes Control. 2013. 24 November. doi:10.1007/ s10552-013-0325-7. [Epub ahead of print].
Sonoelastography of the uterine cervix
Sir I have read with great interest Quantitive sonoelastography of the uterine cervix by interposition of a synthetic reference material written by Hee et al. (1). Quantitive elastography is a new technique which represents a promising new diagnosic tool for the uterine cervix, especially in diagnosing cervical insufficiency, premature deliveries and post-term pregnancies. In our study “Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assesment in pregnant women-preliminary report” published in 2013, we also used quantitive sonoelastography to assess the uterine cervix during pregnancy (2). I am very happy to hear that Hee et al. found independently from our team that stiffness of the anterior cervical lip is more reliable than stiffness of the posterior one. Our study was carried on 59 patients between 28 and 39 weeks of pregnancy, using the strain ratio index to measure stiffness of the cervix and evaluating the correlation between the length of the cervix and the strain ratio index. We also found a correlation between compressibility of the anterior cervical lip and cervical length. We were not able to explain this phenomenon and are therefore are very interested in the explanation published by Hee et al. Furthermore, their work is very important for us because we also had problems reproducing the cervical examination, as we did not know how to reproduce the same pressure on the cervix during following examinations. This problem is very common in contemporary studies of quantitive elastography (3,4). The idea of using reference material seems reasonable and could solve this problem, so we are keeping our fingers crossed that Hee et al. will continue their efforts to put this method into clinical practice. Furthermore, we think that by improving quantitive elastography in this way will result in a more accurate method than that proposed and described by SwiatkowskaFreund et al., where compression was generated by the woman’s breathing or arterial pulsation, making the measurement less predictable and less objective (5).
524
Tomasz Fuchs*, Michal Pomorski and Mariusz Zimmer Department of Obstetrics and Gynecology, Wroclaw Medical University, Wroclaw, Poland *Corresponding Author: Tomasz Fuchs E-mail: [email protected] DOI: 10.1111/aogs.12356
References 1. Hee L, Sandager P, Petersen O, Uldbjerg N. Quantitative sonoelastography of the uterine cervix by interposition of a synthetic reference material. Acta Obstet Gynecol Scand. 2013;92:1244–9. 2. Fuchs T, Woyton R, Pomorski M, Wiatrowski A, Slejman N, Tomialowicz M, et al. Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women – preliminary report. Ginekol Pol. 2013;84:12–6. 3. Molina FS, Gomez LF, Florido J, Padilla MC, Nicolaides KH. Quantification of cervical elastography: a reproducibility study. Ultrasound Obstet Gynecol. 2012;39:685–9. 4. Fruscalzo A, Schmitz R. Quantitative cervical elastography in pregnancy. Ultrasound Obstet Gynecol. 2012;40:612. 5. Swiatkowska-Freund M, Preis K. Elastography of the uterine cervix: implications for success of induction of labor. Ultrasound Obstet Gynecol. 2011;38:52–6.
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 521–524
References 1. Bra€ uner CM, Attermann J. Reply to comments by Dr. Brind and Mr. Carroll on our study No evidence of an association between induced abortion and breast cancer among parous older women: Our conclusion remains valid. Acta Obstet Gynecol Scand. 2013;92:1429–30. 2. Carroll P. Induced abortion and breast cancer. Acta Obstet Gynecol Scand. 2013;92:1428. 3. Bra€ uner CM, Overvad K, Tjønneland A, Attermann J. Induced abortion and breast cancer among parous women:
a Danish cohort study. Acta Obstet Gynecol Scand. 2013;92:700–5. 4. Carroll PS. The breast cancer epidemic: modeling and forecasts based on abortion and other risk factors. J Am Phys Surg. 2007;12:72–8. 5. Huang Y, Zhang X, Li W, Song F, Dai H, Wang J et al. A meta-analysis of the association between induced abortion and breast cancer risk among Chinese females. Cancer Causes Control. 2013. 24 November. doi:10.1007/ s10552-013-0325-7. [Epub ahead of print].
Sonoelastography of the uterine cervix
Sir I have read with great interest Quantitive sonoelastography of the uterine cervix by interposition of a synthetic reference material written by Hee et al. (1). Quantitive elastography is a new technique which represents a promising new diagnosic tool for the uterine cervix, especially in diagnosing cervical insufficiency, premature deliveries and post-term pregnancies. In our study “Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assesment in pregnant women-preliminary report” published in 2013, we also used quantitive sonoelastography to assess the uterine cervix during pregnancy (2). I am very happy to hear that Hee et al. found independently from our team that stiffness of the anterior cervical lip is more reliable than stiffness of the posterior one. Our study was carried on 59 patients between 28 and 39 weeks of pregnancy, using the strain ratio index to measure stiffness of the cervix and evaluating the correlation between the length of the cervix and the strain ratio index. We also found a correlation between compressibility of the anterior cervical lip and cervical length. We were not able to explain this phenomenon and are therefore are very interested in the explanation published by Hee et al. Furthermore, their work is very important for us because we also had problems reproducing the cervical examination, as we did not know how to reproduce the same pressure on the cervix during following examinations. This problem is very common in contemporary studies of quantitive elastography (3,4). The idea of using reference material seems reasonable and could solve this problem, so we are keeping our fingers crossed that Hee et al. will continue their efforts to put this method into clinical practice. Furthermore, we think that by improving quantitive elastography in this way will result in a more accurate method than that proposed and described by SwiatkowskaFreund et al., where compression was generated by the woman’s breathing or arterial pulsation, making the measurement less predictable and less objective (5).
524
Tomasz Fuchs*, Michal Pomorski and Mariusz Zimmer Department of Obstetrics and Gynecology, Wroclaw Medical University, Wroclaw, Poland *Corresponding Author: Tomasz Fuchs E-mail: [email protected] DOI: 10.1111/aogs.12356
References 1. Hee L, Sandager P, Petersen O, Uldbjerg N. Quantitative sonoelastography of the uterine cervix by interposition of a synthetic reference material. Acta Obstet Gynecol Scand. 2013;92:1244–9. 2. Fuchs T, Woyton R, Pomorski M, Wiatrowski A, Slejman N, Tomialowicz M, et al. Sonoelastography of the uterine cervix as a new diagnostic tool of cervical assessment in pregnant women – preliminary report. Ginekol Pol. 2013;84:12–6. 3. Molina FS, Gomez LF, Florido J, Padilla MC, Nicolaides KH. Quantification of cervical elastography: a reproducibility study. Ultrasound Obstet Gynecol. 2012;39:685–9. 4. Fruscalzo A, Schmitz R. Quantitative cervical elastography in pregnancy. Ultrasound Obstet Gynecol. 2012;40:612. 5. Swiatkowska-Freund M, Preis K. Elastography of the uterine cervix: implications for success of induction of labor. Ultrasound Obstet Gynecol. 2011;38:52–6.
ª 2014 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 93 (2014) 521–524
