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Diagnostics and Interventional Procedures in Gynecological Tumors

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (30 March 2022) | Viewed by 34277

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Prof. Giorgia Garganese

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1. Gynecology and Breast Care Center, Mater Olbia Hospital, Strada Statale 125 Orientale Sarda, 07026 Olbia, Italy
2. Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy
Interests: gynecologic oncology; vulvar pathology; breast cancer; oncoplastic surgery; invasive diagnostics
Special Issues, Collections and Topics in MDPI journals

Dr. Benedetta Gui

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Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia Generale ed Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
Interests: tumor; radiologic imaging; gynecologicic oncology

Dr. Simona Maria Fragomeni

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UOC Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Interests: breast cancer; gynecological oncology; gynecological ultrasound; ultrasound imaging; vulvar cancer

Special Issue Information

Dear Colleagues,

Gynecological cancers represent a heavy health, social and economic burden worldwide. They include a large compound of diseases that vary in etiology, biological behavior, and treatment. The five main types of gynecologic cancer are ovarian, uterine, cervical, vaginal, and vulvar cancer. Each of them requires a multidisciplinary management and an accurate diagnostic framework, which is crucial to provide adequate treatment. Furthermore, over the years, not a single method but the combination of several techniques has been proved necessary to achieve maximum accuracy. The topics covered in this Special Issue are closely related and highly dependent on each other. The continuous technological imaging evolution provides ever more accurate clinical staging and pathologic prediction, increasing the tailoring of disease treatment and improving patient outcomes. Moreover, different imaging modalities and their combinations (i.e., fusion ultrasound) are increasingly used to guide interventional and minimally invasive procedures performed for diagnostic and therapeutic purposes (as in interventional radiotherapy, electrochemotherapy, cryo or radioablation).

It is our pleasure to invite you to submit to this issue original articles or reviews highlighting milestones and new evidence in the gynecologic oncology field, regarding each diagnostic and interventional method and their related clinical practice algorithms and current recommendations.

Prof. Dr. Giorgia Garganese
Dr. Benedetta Gui
Dr. Simona Maria Fragomeni
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Personalized Medicine is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Ovarian cancer
Cervical cancer
Endometrial cancer
Vulvar cancer
Vaginal cancer
Imaging
Gynecological Ultrasound
Nodal ultrasound
PET/CT
MRI
CT scan
Personalized approach
Interventional Radiotherapy
Electrochemotherapy
Embolization

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Published Papers (10 papers)

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Research

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10 pages, 3152 KiB

Open AccessArticle

Clustering Molecular Subtypes in Breast Cancer, Immunohistochemical Parameters and Risk of Axillary Nodal Involvement

by Augusto Pereira, Jaime Siegrist, Santiago Lizarraga and Tirso Pérez-Medina

J. Pers. Med. 2022, 12(9), 1404; https://doi.org/10.3390/jpm12091404 - 29 Aug 2022

Cited by 5 | Viewed by 1494

Abstract

(1) Background: To establish similarities in the risk of axillary lymph node metastasis between different groups of women with breast cancer according to immunohistochemical (IHC) parameters. (2) Methods: Data was collected retrospectively, from 2000 to 2013, of 1058 node-positive breast tumours. All patients were divided according to the St Gallen 2013 criteria and IHC features. The proportion of axillary involvement (pN > pN0; pN > pN1mi; pN > pN1) was calculated for each group. Similarities in axillary nodal dissemination were explored by cluster analysis and association between IHC and risk of axillary disease was studied with multivariate analysis. (3) Results: Among clinico-pathological surrogates of intrinsic subtypes, axillary involvement was more frequent in Luminal-B like HER2 negative (45.8%) and less frequent in Luminal-B HER2 positive (33.8%; p = 0.044). Axillary macroscopic involvement was more frequent in Luminal-B like HER2 negative (37.9%) and HER2 positive (37.8%) and less frequent in Luminal-B HER2 positive (25.5%) and Luminal-A like (25.6%; p = 0.002). Axillary involvement ≥pN2 was significantly less frequent in Luminal-A like (7.4%; p < 0.001). Luminal-A with Luminal-B HER2 positive, and triple-negative with Erb-B2 overexpressing tumours were clustered together regarding any axillary involvement, macroscopic disease or ≥pN2. Among the defined subgroups, axillary metastases were more frequent when Ki67 was higher. In a multivariate analysis, Ki67>14% were associated with a risk of axillary metastases (HR: 1.31; 95% CI, 1.51–6.80; p < 0.037). (4) Conclusions: there are two lymphatic drainage pathways of the breast according to the expression of hormone receptor-related genes. Positive-ER tumors are associated with lower axillary involvement and negative-ER tumors and Ki67 > 14% with higher nodal involvement. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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13 pages, 453 KiB

Open AccessArticle

History of Endometriosis Is Independently Associated with an Increased Risk of Ovarian Cancer

by Antonio Sarría-Santamera, Zaukiya Khamitova, Arnur Gusmanov, Milan Terzic, Mar Polo-Santos, Miguel A. Ortega and Angel Asúnsolo

J. Pers. Med. 2022, 12(8), 1337; https://doi.org/10.3390/jpm12081337 - 20 Aug 2022

Cited by 4 | Viewed by 2313

Abstract

Background: Endometriosis is a complex gynecologic disorder that has been associated with a higher risk of ovarian cancer. The purpose of this work is to determine to what extent a history of endometriosis is a risk factor for ovarian cancer in a Spanish population. Methods: A retrospective case–control study was conducted using de-identified data from the Spanish National Health System’s “Primary Care Clinical Database” and “Hospital Minimum Basic Data Set” for the period 2013–2017. Multiple logistics regression analysis was conducted to determine associations between ovarian cancer and endometriosis controlled by sociodemographic characteristics and comorbidities. Results: Data from 608,980 women were analyzed, with 4505 presenting ovarian cancer. Endometriosis patients were shown to have a 2.66-fold increased risk of ovarian cancer when compared to those who did not have endometriosis by controlling age and other relevant comorbidities. Conclusions: This case–control study based on clinical administrative data has found that a history of endometriosis is independently associated with an increased risk of ovarian cancer. More research is needed to determine if a history of endometriosis affects survival results in ovarian cancer patients. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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14 pages, 2930 KiB

Open AccessArticle

A Comparison of Dynamic Contrast-Enhanced Magnetic Resonance Imaging and T2-Weighted Imaging in Determining the Depth of Myometrial Invasion in Endometrial Carcinoma—A Retrospective Study

by Idris Nurdillah, Iqbal Hussain Rizuana, Aziz Suraya and Sharis Osman Syazarina

J. Pers. Med. 2022, 12(8), 1268; https://doi.org/10.3390/jpm12081268 - 31 Jul 2022

Cited by 5 | Viewed by 2589

Abstract

This study aims to compare dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with T2-weighted imaging (T2WI) in defining the depth of myometrial invasion in endometrial carcinoma. This retrospective study included 32 subjects with endometrial carcinoma who underwent 3.0T magnetic resonance imaging (MRI) prior to hysterectomy. DCE-MRI and T2WI were evaluated to determine the depth of myometrial invasion in endometrial carcinoma. A set of data consisting of the sensitivity, specificity, predictive values, and accuracy of DCE-MRI and T2WI were obtained and compared with the histopathological results. Out of the 32 cases included, the histopathological examination revealed that 50% myometrial invasion was found in 11 patients and ≥50% myometrial invasion was found in 21 patients. In the assessment of the tumor invasion, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of T2WI were 45.45%, 90.48 %, 71.43%, 76.0%, and 75.0%, respectively. The corresponding values for DCE-MRI were 81.82%, 76.19%, 64.29%, 88.89 %, and 78.12%, respectively. When T2WI were read together with DCE-MRI, the values were 90.91%, 90.48%, 83.33%, 95.0%, and 90.62%, respectively. Thus, the sensitivity and accuracy of DCE-MRI were greater compared to T2WI in defining the depth of myometrial invasion. However, the merging of T2WI and DCE-MRI increased the specificity and PPV value and improved the sensitivity, NPV and accuracy in detecting myometrial invasion. DCE-MRI was more sensitive but less specific than T2WI in defining the depth of myometrial invasion. In conclusion, combining DCE-MRI and T2WI further improves the diagnostic performance for myometrial invasion in endometrial carcinoma. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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12 pages, 8257 KiB

Open AccessArticle

Intravoxel Incoherent Motion (IVIM) MR Quantification in Locally Advanced Cervical Cancer (LACC): Preliminary Study on Assessment of Tumor Aggressiveness and Response to Neoadjuvant Chemotherapy

by Miriam Dolciami, Silvia Capuani, Veronica Celli, Alessandra Maiuro, Angelina Pernazza, Innocenza Palaia, Violante Di Donato, Giusi Santangelo, Stefania Maria Rita Rizzo, Paolo Ricci, Carlo Della Rocca, Carlo Catalano and Lucia Manganaro

J. Pers. Med. 2022, 12(4), 638; https://doi.org/10.3390/jpm12040638 - 15 Apr 2022

Cited by 7 | Viewed by 2392

Abstract

The aim of this study was to determine whether quantitative parameters obtained from intravoxel incoherent motion (IVIM) model at baseline magnetic resonance imaging (MRI) correlate with histological parameters and response to neoadjuvant chemotherapy in patients with locally advanced cervical cancer (LACC). Methods: Twenty patients with biopsy-proven cervical cancer, staged as LACC on baseline MRI and addressed for neoadjuvant chemotherapy were enrolled. At treatment completion, tumor response was assessed with a follow-up MRI evaluated using the revised response evaluation criteria in solid tumors (RECIST; version 1.1), and patients were considered good responders (GR) if they had complete response or partial remission, and poor responders/non-responders (PR/NR) if they had stable or progressive disease. MRI protocol included conventional diffusion-weighted imaging (DWI; b = 0 and 1000 s/mm²) and IVIM acquisition using eight b-values (range: 0–1500 s/mm²). MR-images were analyzed using a dedicated software to obtain quantitative parameters: diffusion (D), pseudo-diffusion (D*), and perfusion fraction (fp) from the IVIM model; apparent diffusion coefficient (ADC) from conventional DWI. Histologic subtype, grading, and tumor-infiltrating lymphocytes (TILs) were assessed in each LACC. Results: D showed significantly higher values in GR patients (p = 0.001) and in moderate/high TILs (p = 0.018). Fp showed significantly higher values in squamous cell tumors (p = 0.006). Conclusions: D extracted from the IVIM model could represent a promising tool to identify tumor aggressiveness and predict response to therapy. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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19 pages, 991 KiB

Open AccessArticle

Retrospective Analysis of Patients with Gynaecological Uterine Sarcomas in a Tertiary Hospital

by Maria Ruiz-Minaya, Elsa Mendizabal-Vicente, Wenceslao Vasquez-Jimenez, Laura Perez-Burrel, Irene Aracil-Moreno, Carolina Agra-Pujol, Mireia Bernal-Claverol, Beatriz L. Martínez-Bernal, Mercedes Muñoz-Fernández, Melanie Morote-Gonzalez, Miguel A. Ortega, Santiago Lizarraga-Bonelli and Juan A. De Leon-Luis

J. Pers. Med. 2022, 12(2), 222; https://doi.org/10.3390/jpm12020222 - 6 Feb 2022

Cited by 2 | Viewed by 1830

Abstract

Uterine sarcomas are rare and heterogeneous malignancies accounting for 1% to 3% of all gynaecological tumours. There are many histological subtypes recognised, including leiomyosarcomas, endometrial stromal sarcoma, and uterine carcinosarcoma, although the latest has been recently discarded in this group. Despite its low incidence, these types of cancer currently entail multiple challenges, either in diagnostics or clinical management, with a poor prognosis associated. The present work aimed to complete a comparative analysis of the different histological subtypes based on the clinicopathological characteristics of our population, the therapeutic characteristics, and associated prognosis in 161 patients treated in our centre during the period between 1985 and 2020. Moreover, a systematic review grouped a total of 2211 patients with a diagnosis of uterine sarcoma from 19 articles published in 16 countries from 2002 to 2021 was performed, all with retrospective analyses. Our results showed that apart from uterine carcinosarcoma, leiomyosarcoma is the most frequent subtype of uterine sarcoma, with unique clinical, demographic, and survival parameters. To our knowledge, this is the first systematic review conducted in this field and, thus, it shows the difficulties of collecting a significant number of patients per year, a valid reason why multicentre or national registries are recommended to allow a more exhaustive analysis of this pathology. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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13 pages, 1013 KiB

Open AccessArticle

Elevated Interleukin-6 Levels in the Circulation and Peritoneal Fluid of Patients with Ovarian Cancer as a Potential Diagnostic Biomarker: A Systematic Review and Meta-Analysis

by Hina Amer, Apriliana E. R. Kartikasari and Magdalena Plebanski

J. Pers. Med. 2021, 11(12), 1335; https://doi.org/10.3390/jpm11121335 - 9 Dec 2021

Cited by 18 | Viewed by 2988

Abstract

Ovarian cancer (OC) is one of the most lethal cancers, largely due to a late diagnosis. This study aimed to provide a comprehensive meta-analysis on the diagnostic performance of IL6 in the blood and ascites separately for advanced and early-stage OC. We included 37 studies with 6948 participants detecting serum or plasma IL6. The plasma/serum IL6 mean level in the late-stage OC was 23.88 pg/mL (95% CI: 13.84–41.23), and the early-stage OC was 16.67 pg/mL (95% CI: 510.06–27.61), significantly higher than the healthy controls at 3.96 pg/mL (95% CI: 2.02–7.73), but not significantly higher than those found in the controls with benign growths in the ovary, which was 9.63 pg/mL (95% CI: 4.16–22.26). To evaluate IL6 in ascites as a diagnostic marker, we included 26 studies with 1590 participants. The mean level of ascitic IL6 in the late-stage OC was 3676.93 pg/mL (95% CI: 1891.7–7146.7), and the early-stage OC was 1519.21 pg/mL (95% CI: 604.6–3817.7), significantly higher than the benign controls at 247.33 pg/mL (95% CI: 96.2–636.0). There was no significant correlation between the levels of circulating and ascitic IL6. When pooling all OC stages for analysis, we found that serum/plasma IL6 provided 76.7% sensitivity (95% CI: 0.71–0.92) and 72% specificity (95% CI: 0.64–0.79). Ascitic IL6 provided higher sensitivity at 84% (95% CI: 0.710–0.919) and specificity at 74% (95% CI: 0.646–0.826). This study highlights the utility of ascitic IL6 for early detection of OC. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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16 pages, 8790 KiB

Open AccessReview

Patterns of Recurrent Disease in Cervical Cancer

by Maura Miccò, Michela Lupinelli, Matteo Mangialardi, Benedetta Gui and Riccardo Manfredi

J. Pers. Med. 2022, 12(5), 755; https://doi.org/10.3390/jpm12050755 - 6 May 2022

Cited by 15 | Viewed by 8302

Abstract

Uterine cervical cancer is one of the most common causes of cancer-related deaths among women worldwide. Patients with cervical cancer are at a high risk of pelvic recurrence or distant metastases within the first few years after primary treatment. However, no definitive agreement exists on the best post-treatment surveillance in these patients. Imaging may represent an accurate method of detecting relapse early, right when salvage treatment could be effective. In patients with recurrent cervical cancer, the correct interpretation of imaging may support the surgeon in the proper selection of patients prior to surgery to assess the feasibility of radical surgical procedure, or may help the clinician plan the most adaptive curative therapy. MRI can accurately define the extension of local recurrence and adjacent organ invasion; CT and 18F-FDG PET/CT may depict extra-pelvic distant metastases. This review illustrates different patterns of recurrent cervical cancer and how imaging, especially MRI, accurately contributes towards the diagnosis of local recurrence and the assessment of the extent of disease in patients with previous cervical cancer. Normal post-therapy pelvic appearance and possible pitfalls related to tissue changes for prior treatments will be also illustrated. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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14 pages, 552 KiB

Open AccessReview

Granulomatosis with Polyangiitis-Mimicking Advanced Gynecological Cancer: A Case Report and Systematic Review of the Literature

by Augusto Pereira, Javier F. Magrina, Paul M. Magtibay, Beatriz G. Stamps, Elena Muñoz-Nuñez and Tirso Perez-Medina

J. Pers. Med. 2022, 12(2), 289; https://doi.org/10.3390/jpm12020289 - 16 Feb 2022

Cited by 4 | Viewed by 2256

Abstract

(1) Background: Granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis that mimics gynecologic cancer. In GPA patients, the genitourinary system is affected in <1%. The objective of the study was to provide a systematic review of the literature of GPA patients with gynecological involvement. (2) Methods: PubMed and Embase were searched from inception to July 2021 for GPA patients with gynecological involvement Medical Subject Headings (MeSH) and free-text terms. Exclusion criteria were other language, review articles, pregnancy, fertility, or male patients. Data were extracted on clinical evolution, symptoms, examinations findings, diagnosis delay, treatment, outcome, patient status, and follow-up. (3) Results: Seventeen studies included data from patients with GPA and primary or relapsed gynecological involvement. 68% of the authors of this review thought the patient had cancer. The main gynecological symptom is bleeding, but exclusive gynecologic symptomatology is rare (ENT: 63%, lungs: 44%, kidneys-urinary tract: 53%). GPA could affect all areas of the genital tract, but the most frequent location is the uterine cervix. Medical treatment for GPA is effective. (4) Conclusions: GPA of the female genital tract must be considered when biopsies of an ulcerated malignant-appearing cervical or vaginal mass are negative for malignancy even when they are unspecific. Rheumatology consultation is indicated. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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20 pages, 9059 KiB

Open AccessFeature PaperReview

MRI Staging in Locally Advanced Vulvar Cancer: From Anatomy to Clinico-Radiological Findings. A Multidisciplinary VulCan Team Point of View

by Benedetta Gui, Salvatore Persiani, Maura Miccò, Vincenza Pignatelli, Elena Rodolfino, Giacomo Avesani, Valerio Di Paola, Camilla Panico, Luca Russo, Simona Maria Fragomeni, Giorgia Garganese, Luca Tagliaferri, Giovanni Scambia and Riccardo Manfredi

J. Pers. Med. 2021, 11(11), 1219; https://doi.org/10.3390/jpm11111219 - 18 Nov 2021

Cited by 9 | Viewed by 5999

Abstract

MR imaging provides excellent spatial and contrast resolution to stage locally advanced vulvar cancer (LAVC) for tumor and nodal evaluation in order to facilitate the planning of treatment. Although there are no standard indications for how to estimate the clinical stage of International Federation of Gynecology and Obstetrics at diagnosis, MR imaging can depict the tumor and its extension to the vulvar region and adjacent organs, such as the vagina, urethra, and anus. Optimizing the MR imaging protocol and technique is fundamental for correct staging. The aim of this overview was to focus on the role of MR imaging in LAVC staging. We define vulvar anatomy and corresponding MR imaging findings, MR imaging protocol, and technique. Moreover, we describe the MR imaging findings of LAVC with example cases stage by stage. Key imaging findings based on signal intensity, diffusion restriction, and enhancement are portrayed to correctly identify and stage vulvar cancer. A structured report for LAVC staging is reported in order to give all necessary information to the clinicians and to facilitate MR imaging comprehension. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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9 pages, 932 KiB

Open AccessReview

Radiomics and Artificial Intelligence in Uterine Sarcomas: A Systematic Review

by Gloria Ravegnini, Martina Ferioli, Alessio Giuseppe Morganti, Lidia Strigari, Maria Abbondanza Pantaleo, Margherita Nannini, Antonio De Leo, Eugenia De Crescenzo, Manuela Coe, Alessandra De Palma, Pierandrea De Iaco, Stefania Rizzo and Anna Myriam Perrone

J. Pers. Med. 2021, 11(11), 1179; https://doi.org/10.3390/jpm11111179 - 11 Nov 2021

Cited by 11 | Viewed by 2864

Abstract

Background: Recently, artificial intelligence (AI) with computerized imaging analysis is attracting the attention of clinicians, in particular for its potential applications in improving cancer diagnosis. This review aims to investigate the contribution of radiomics and AI on the radiological preoperative assessment of patients with uterine sarcomas (USs). Methods: Our literature review involved a systematic search conducted in the last ten years about diagnosis, staging and treatments with radiomics and AI in USs. The protocol was drafted according to the systematic review and meta-analysis preferred reporting project (PRISMA-P) and was registered in the PROSPERO database (CRD42021253535). Results: The initial search identified 754 articles; of these, six papers responded to the characteristics required for the revision and were included in the final analysis. The predominant technique tested was magnetic resonance imaging. The analyzed studies revealed that even though sometimes complex models included AI-related algorithms, they are still too complex for translation into clinical practice. Furthermore, since these results are extracted by retrospective series and do not include external validations, currently it is hard to predict the chances of their application in different study groups. Conclusion: To date, insufficient evidence supports the benefit of radiomics in USs. Nevertheless, this field is promising but the quality of studies should be a priority in these new technologies. Full article

(This article belongs to the Special Issue Diagnostics and Interventional Procedures in Gynecological Tumors)

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