Ole Mogensen

Objectives: To systematically validate and compare ultrasonography, using the ultrasound‐based International Ovarian Tumor Analysis – Assessment of Different NEoplasias in the adneXa (IOTA‐ADNEX) model, with magnetic resonance imaging (MRI), using the MRI‐based ADNEX MR scoring system, as second‐line imaging modalities for estimating the risk of adnexal malignancy in patients identified as being at risk of malignancy on first‐line ultrasound examination. Methods: This was a prospective, single‐center diagnostic accuracy study designed as a head‐to‐head comparison. All patients referred to a tertiary referral center at Aarhus University Hospital, Aarhus, Denmark, for suspected adnexal malignancy on first‐line imaging between May 2021 and December 2022 were offered second‐line diagnostic testing. This comprised both a systematic expert ultrasound examination, including IOTA‐ADNEX risk estimation, and a systematic MRI scan with ADNEX MR scores assigned by expert radiologists. The imaging assessments were performed prospectively, with ultrasound examiners and radiologists blinded to the results of other imaging modalities and to the reference standard (tumor outcome). The reference standard was a histopathological diagnosis of the primary adnexal mass or, in a small number of cases, clinical follow‐up. Borderline tumors, invasive adnexal malignancy and metastases to the adnexa were grouped as malignancies. Diagnostic performance of the IOTA‐ADNEX model, ADNEX MR scoring system and CA 125 for predicting malignancy was evaluated using the area under the receiver‐operating‐characteristics curve (AUC), and AUCs were compared using DeLong's test. Diagnostic metrics were estimated at clinically relevant cut‐offs and scores. Agreement between modalities was assessed for the identification of morphological features and overall risk estimation using Cohen's kappa statistics, intraclass correlation coefficients (ICC) and Bland–Altman plots. For the IOTA‐ADNEX model, calibration and the ability to discriminate between tumor subtypes were evaluated. Results: The included cohort comprised 342 patients (342 lesions analyzed). In the final cohort, 78.1% of patients were postmenopausal and the overall prevalence of malignancy was 58.8%. The AUC for distinguishing patients with benign tumors from those with malignant tumors was 0.96 (95% CI, 0.94–0.98) for the IOTA‐ADNEX model (with or without CA 125) compared with an AUC of 0.93 (95% CI, 0.91–0.96) for ADNEX MR. Agreement between ultrasound and MRI ranged from moderate to substantial for key morphological features (κ = 0.46–0.75) and from good to excellent for lesion‐size measurements (ICC = 0.78–0.92). The IOTA‐ADNEX model performed similarly to the ADNEX MR scoring system regardless of lesion morphology or size. The IOTA‐ADNEX model had good calibration. Furthermore, its multinomial discriminative ability between tumor subtypes was generally high, although performance was reduced when distinguishing borderline tumors from Stage‐I invasive malignancy (AUC, 0.71 (95% CI, 0.56–0.82)). Conclusions: The IOTA‐ADNEX model and ADNEX MR scoring system demonstrated comparable diagnostic accuracy for differentiating benign from malignant adnexal masses in this study. Results appeared to be consistent when stratified by lesion morphology. Both modalities may be used for second‐line assessment of masses deemed at risk of malignancy in the first‐line ultrasound examination, depending on resources in specific centers. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objectives: The primary aims of this study were to validate externally the diagnostic performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model for distinguishing between malignant and benign adnexal masses, when used by non‐expert ultrasound examiners in general gynecological settings with a low prevalence of ovarian cancer, and to compare the performance of ADNEX with that of the Risk of Malignancy Index (RMI) and serum CA 125 alone. The secondary aim was to assess model performance in detecting early‐stage ovarian malignancy. Methods: This was a prospective multicenter external validation study conducted in all gynecological departments (five hospitals) in the Central Denmark Region between May 2021 and December 2022, including all consecutive patients diagnosed with a non‐physiological adnexal mass on transvaginal and/or transabdominal ultrasound. Standardized ultrasound terminology developed by the International Ovarian Tumor Analysis (IOTA) group was implemented uniformly across study sites, all of which received training in IOTA terminology before and during the study period. IOTA certification was offered to clinicians performing the ultrasound examinations. Sonographic features according to IOTA terminology were recorded systematically using a structured electronic form integrated into the medical record, which automatically calculated the RMI score and ADNEX risk estimates. The reference standard was histopathological diagnosis within 12 months after the inclusion scan. For patients managed expectantly, the reference standard was determined by follow‐up during a 1‐year observation period. This included serial ultrasound examinations and review of medical records and national histopathology records. Ovarian cancer, borderline tumors and metastases to the ovary were considered malignant. Areas under the receiver‐operating‐characteristic curve (AUCs) for ADNEX, RMI and CA 125 were calculated and compared using meta‐analysis of center‐specific results and DeLong's test. Diagnostic metrics were estimated at different cut‐offs for any‐stage and early‐stage malignancy. Clinical utility for guiding referral was assessed by decision‐curve analysis, with net benefit calculated over a range of risk thresholds (1–50%). Results: A total of 1815 patients diagnosed with an adnexal mass on ultrasound examination were included, of whom 1656 were examined by non‐experts in general gynecological settings (59.2% postmenopausal, 8.3% prevalence of malignancy). The AUC of the ADNEX model (0.93 (95% CI, 0.90–0.95) with CA 125 and 0.92 (95% CI, 0.89–0.94) without CA 125) was significantly greater than that of the RMI (0.88 (95% CI, 0.85–0.91)) and CA 125 alone (0.82 (95% CI, 0.77–0.87)). Including CA 125 did not improve the discriminative ability of ADNEX for identifying malignancy. For diagnosing early‐stage malignancy, ADNEX without CA 125 had an AUC of 0.90 (95% CI, 0.85–0.94), which was significantly greater than that of the RMI (0.82 (95% CI, 0.76–0.88)) and CA 125 alone (0.73 (95% CI, 0.65–0.80)). At a cut‐off of 5%, the ADNEX model without CA 125 detected 84.4% (95% CI, 69.0–93.0%) of early‐stage ovarian malignancies, with a specificity of 81.6% (95% CI, 76.9–85.6%). Clinical‐decision curves showed that ADNEX had clinical utility superior to that of the RMI at a cut‐off score of 200 over the entire range of risk thresholds. Conclusions: The ADNEX model demonstrated excellent diagnostic performance for identifying adnexal malignancy when used prospectively in routine clinical practice in a general gynecological setting by non‐expert ultrasound examiners trained in IOTA terminology. ADNEX significantly outperformed the RMI and serum CA 125 alone, including in the detection of early‐stage ovarian malignancy. Including CA 125 in the ADNEX model did not provide additional diagnostic benefit for estimating the likelihood of malignancy. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Recurrence of endometrial cancer is not routinely registered in the Danish national health registers. The aim of this study was to develop and validate a register-based algorithm to identify women ...

Early diagnosis and rapid treatment are deemed essential in relation to cancer. In 2007, Denmark implemented accelerated cancer patient pathways with predetermined time frames to reduce waiting time. In this article, based on fieldwork with observations at two hospitals and ethnographic interviews, we examine temporal experiences of the cancer patient pathway for endometrial cancer of the uterus at stage I. Results show that while the cancer patient pathway helps suspend thoughts of death it also brings a sense of timely confusion and concerns about whether disease has spread. This ambivalence is linked to a political discourse of cancer in general as acute and a clinical, biomedical framing of endometrial cancer in particular as “good” due to its slow growth. We demonstrate how women customize their temporal experiences to accelerate or decelerate time and argue that waiting is not necessarily a passive state. We emphasize the need for professionals to be aware that the cancer patient pathway time and subjective patient time are not always synchronized.

Objective The aim was to investigate the association between clinically significant uterine fibroids and preterm birth, caesarean section (CS), postpartum haemorrhage (PPH), placental abruption, intrauterine growth restriction (IUGR) and uterine rupture. Methods, participants and setting A historical cohort study based on data from the Danish National Birth Cohort, the Danish National Patient Registry and the Danish National Birth Registry (DNBR). The final study population consisted of 92 696 pregnancies and was divided into four groups for comparison. Group 1: pregnancies of women without a fibroid diagnosis code or fibroid operation code; group 2: pregnancies of women with a fibroid diagnosis code before pregnancy, during pregnancy or up to 1 year after delivery, and no fibroid operation code before pregnancy; group 3: pregnancies of women with a fibroid diagnosis code given more than 1 year after delivery; and group 4: pregnancies of women with a fibroid operation code given before pregnancy. Results A diagnosis of fibroids before pregnancy yielded an increased risk of preterm birth (gestational age (GA) ≤37 weeks) (OR 2.27 (1.30─3.96)) and extreme preterm birth (GA 22+0─27+6 weeks, OR 20.09 (8.04─50.22)). The risk of CS was increased (OR 1.83 (1.23─2.72)) for women with a fibroid diagnosis code given before pregnancy; significantly increased risk of elective CS (OR 1.92 (1.11─3.32)), but not acute CS (OR 1.54 (0.94─2.52)). The risks of PPH, placental abruption or IUGR were not increased in any of the groups. Conclusion We found a strong association between clinically significant uterine fibroids and preterm birth, and an association between clinically significant uterine fibroids and CS. In contrast, no association between clinically significant uterine fibroids and PPH, placental abruption or IUGR was seen.

Background It is assumed that conventional laparoscopy (LAP) and robotic‐assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS. Methods Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMG_max). The static, median and peak levels of muscle activity were calculated, and an exposure variation analysis undertaken. Postural observations were carried out every 10 min, and ratings of perceived physical exertion before and after surgery were recorded. Results The study included 13 surgeons. Surgeons performing LAP showed higher static, median, and peak forearm muscle activity than those undertaking RALS. Muscle activity at peak level was higher during RALS than LAP. Exposure variation analysis demonstrated long‐lasting periods of low‐level intensity muscle activity in the shoulders for LAP, in the forearms for RALS, and in the neck for both procedures. Postural observations revealed a greater need for a change in work posture when performing LAP compared with RALS. Perceived physical exertion was no different between the surgical modalities. Conclusion Minimally invasive surgery requires long‐term static muscle activity with a high physical workload for surgeons. RALS is less demanding on posture.

Objectives: The primary purpose of the study was to investigate a possible association between uterine fibroids and time to pregnancy (TTP), and, secondly, to explore the effect of myomectomy on TTP. Methods: This historical cohort study used data from the Danish National Birth Cohort and the Danish National Patient Registry. The study population consisted of 86,323 women with 92,696 pregnancies. The main outcome was TTP; groups were compared using a binary outcome: TTP >12 months or TTP ≤12 months. Results: Women who had a fibroid diagnosis code before attempting to conceive (n = 92) had an increased risk of TTP >12 months compared with women without a fibroid diagnosis code (n = 87,358) (adjusted odds ratio [OR] 1.67; 95% confidence interval [CI] 1.05, 6.68). Women who had a fibroid diagnosis code after pregnancy (n = 963) also had an increased risk of TTP >12 months compared with women without a fibroid diagnosis code (adjusted OR 1.24; 95% CI 1.04, 1.47). Conclusion: We found an association between having a uterine fibroid diagnosis code and TTP >12 months. We were not able to make a valid assessment of the effect of myomectomy on TTP.

Introduction: To assess the clinical impact of preoperative fludeoxyglucose (FDG) with positron emission tomography (PET) and computed tomography (CT) in women with ovarian, fallopian tube, or peritoneal cancer with focus on consequences of added findings (AFs).Material and methods: FDG‐PET/CT was implemented as a standard imaging modality for women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer at our institution in 2008. After full implementation, all preoperative scans were reviewed and AFs were evaluated from January 2011 to December 2012. Decisions regarding further examination made at the first multidisciplinary team conference were recorded. Subsequent procedures were tracked via medical records, and the impact of AFs on additional examinations, delay, and change in treatment plans was evaluated.Results: Forty‐four (21.1%) of 209 women presented with AFs. Further examination was performed in 35/44 (79.5%). Malignancy was identified in 15/35 (42.9%), revealing metastases from ovarian, fallopian tube, or peritoneal cancer in 11, a synchronous primary cancer in 3, and recurrence of a previous cancer in 1 woman. The ovarian, fallopian tube, or peritoneal cancer metastases were localized in the lungs, uterus, colon, vagina, and breasts. The remaining 20 AFs revealed 2 benign lesions and 1 pre‐malignant lesion, whereas no abnormality was found in 17. Further examination of AFs resulted in a significant time delay until treatment start of median 4 days (range 1‐83 days, P < 0.004).Conclusions: Further examinations of AFs by FDG‐PET/CT delayed time to start of treatment by median 4 days in women with newly diagnosed ovarian, fallopian tube, or peritoneal cancer in a contemporary institution with fast‐track access to additional diagnostics. The clinical implications of this must be balanced against the gain of detecting unrecognized malignancy in 15 of 209 women (7.2%).