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News
Expert Ultrasound Can Reduce Surgery for Suspected Ovarian Cancer
January 28, 2008 Many women who undergo major surgery for suspected ovarian cancer turn out to have benign ovarian disease, but the number of these unnecessary operations can be reduced significantly if the preoperative ultrasound examination is carried out by experts, a new study shows.
The study, published in the January 21 Online First issue of Lancet Oncology, concludes that "the quality of gynaecological ultrasonography has a significant effect on the choices made by gynaecological oncologists in the management of patients with suspected ovarian cancer."
Joseph Yazbek, MD, of King's College Hospital in London, United Kingdom, and colleagues compared the results of ultrasound examinations carried out by experts with those carried out routinely by nonspecialist ultrasonographers. The experts were gynecologists with a special interest and more than 10 years' experience of gynecological ultrasound, and worked in a tertiary referral unit. Although the 2 groups used different machines, both were similar high quality and "there is no reason to believe that the performance of the machines contributed the differences" that were seen, the researchers comment.
The study was conducted in 150 women with suspected adnexal tumors, of whom only 18 (12%) were eventually diagnosed with ovarian cancer. Routine ultrasound examination provided clinicians with a likely histologic diagnosis in only 38 (52%) of 73 patients, in contrast to the expert ultrasound scan, which did so in practically every case (76 [99%] of 77).
This led to significantly more major surgical staging procedures being carried out for suspected ovarian cancer in the routine group (27 [37%] of
73) vs the expert group (17 [22%] of 77), with a relative risk (RR) of 1.68 (P = .049). In addition, the hospital stay after surgery was longer in the routine vs the expert group (6 vs 5 days; P = .01).
Dr Yazbek and colleagues point out that the routine and expert operators had different approaches to obtaining a diagnosis from ultrasonography.
Nonspecialist ultrasonographers "tend to provide a summary of morphological characteristics of adnexal tumors, but infrequently attempt to differentiate between benign and malignant tumors or attempt to predict a histological diagnosis. The interpretation of ultrasonography findings is, thus, left to clinicians with little or no experience in ultrasound diagnosis, who feel compelled to undertake surgery to ensure that patients with cancer are not managed incorrectly," they write.
The researchers conclude that preoperative ultrasound examinations had a sensitivity of 2 (40%) of 5 and a specificity of 10 (100%) of 10 when carried out by routine operators, but had a sensitivity of 7 (88%) of 8 and a specificity of 27 (96%) of 28 when carried out by expert operators.
Improving the quality of ultrasonography has a measurable effect on the management of patients with suspected ovarian cancer, resulting in a significant decrease in the number of major staging procedures and a shorter inpatient hospital stay, the researchers conclude.
This study was funded by King's College Hospital National Health Service Foundation Trust. The study authors have disclosed no relevant financial relationships.
Lancet Oncol. Published online January 21, 2008.
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