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Accuracy of Doppler assessment of the uterine arteries in healthy girls for the diagnosis of pubertal onset

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Abstract

Purpose

To evaluate the accuracy of the uterine artery pulsatility index (PI) for the diagnosis of pubertal onset in girls.

Methods

Cross-sectional study of girls with normal pubertal development. Puberty was diagnosed by the presence of Tanner breast development score ≥2. All girls underwent pelvic ultrasound and Doppler imaging of the uterine arteries. We evaluated the uterine artery PI and uterine, endometrial, and ovarian measurements. We used ROC curves with cutoffs determined by Youden index for data analysis.

Results

We included 169 girls aged 5–16 years who underwent 202 pelvic ultrasound examinations. Prepubertal girls had a significantly higher mean PI (6.70 ± 2.15) than girls in initial puberty (4.14 ± 1.55) and in late puberty (2.81 ± 1.05) (P < 0.001 for all comparisons), which reflects a progressive increase in blood flow to the uterus with the progression of puberty. ROC curve analysis showed that the PI was able to identify the onset of puberty with a mean area under the curve of 0.838 ± 0.04 (P < 0.001), and the PI cutoff point of 5.05 had a sensitivity of 77%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 79%. The combination of PI < 5.05 plus uterine volume >3.75 cm³ had a sensitivity of 73%, specificity of 95%, PPV of 97%, and accuracy of 79% to detect initial puberty.

Conclusions

We found a significant reduction in the PI during pubertal development, which can possibly be a valuable noninvasive tool in the evaluation of pubertal disorders, alone or in combination with uterine and ovarian volumes.

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Data availability

Data and material are available from the authors upon request.

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Acknowledgements

Hospital de Clínicas de Porto Alegre Research and Events Support Fund and Universidade Federal do Rio Grande do Sul Medical Science Program: Endocrinology.

Funding

This work was supported by grants from Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Programa de Apoio a Núcleos de Excelência (PRONEX process number 16/2551-0000-476-5), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and Fundo de Incentivo à Pesquisa e Eventos (FIPE) Hospital de Clínicas de Porto Alegre.

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Authors and Affiliations

  1. Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Amanda Veiga Cheuiche, Letícia Guimarães da Silveira, Gustavo Monteiro Escott, Leila Pedroso de Paula & Sandra Pinho Silveiro

  2. Radiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Iara Regina Siqueira Lucena

  3. Instituto da Criança com Diabetes and Hospital Criança Conceição, Grupo Hospitalar Conceição, Porto Alegre, Brazil

    Márcia Puñales

  4. Endocrine Division, Hospital Moinhos de Vento, Porto Alegre, Brazil

    Fabíola Costenaro

  5. Pediatric Endocrinology Division, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

    Cristiane Kopacek

  6. Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Leila Pedroso de Paula & Sandra Pinho Silveiro

Authors
  1. Amanda Veiga Cheuiche
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  2. Letícia Guimarães da Silveira
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  3. Gustavo Monteiro Escott
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  9. Sandra Pinho Silveiro
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Corresponding author

Correspondence to Sandra Pinho Silveiro.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

The study protocol was approved by the Hospital de Clínicas de Porto Alegre Research Ethics Committee (GPPG number 2019-0468).

Informed consent

The researchers signed a term of commitment for the use of data collected from medical records. They also agreed that this information would be used solely and exclusively for the execution of this project. The pediatric endocrinologists have signed a document authorizing the use of data from their patients’ medical records. Written informed consent was waived by the Institutional Review Board because of the retrospective nature of the study.

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Cheuiche, A.V., da Silveira, L.G., Escott, G.M. et al. Accuracy of Doppler assessment of the uterine arteries in healthy girls for the diagnosis of pubertal onset. Endocrine 76, 172–178 (2022). https://doi.org/10.1007/s12020-021-02948-y

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  • DOI: https://doi.org/10.1007/s12020-021-02948-y

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