High-Quality Preop Ultrasound Improves Evaluation of Adnexal Masses

By Charles Bankhead
LONDON, Jan. 21 -- For suspected ovarian cancer, high-quality ultrasonography can double the sensitivity of accurate diagnoses, help reduce major staging procedures, and shorten hospital stays, investigators here concluded.
Action Points --->
Explain to interested patients that physicians' ability to evaluate adnexal masses, including ovarian cancer, improves significantly with involvement of an experienced ultrasonographer.
Specialists in gynecologic ultrasound provided a likely histologic diagnosis in 99% of 150 cases compared with 52% for less experienced ultrasonographers, Joseph Yazbek, M.D., of Guy's and St. Thomas' Hospital, and colleagues reported in the February issue of the Lancet Oncology.
Better imaging studies led to 40% fewer major staging procedures. High-quality ultrasonography had a sensitivity for cancer diagnosis that was double that of less experienced ultrasonographers.
"The effect of expert scanning might be even greater if used in the primary assessment of ovarian pathology," the authors said. "Increased confidence in the diagnosis of benign ovarian lesions is likely to decrease the need for additional diagnostic tests ... and also decrease the number of referrals to regional cancer centers."
Ultrasonography reliably detects adnexal abnormalities and is used routinely in the assessment of patients with gynecologic complaints. However, the imaging modality's ability to establish the nature of an adnexal tumor varies and depends primarily on the experience and skill of the operator, the authors said.
Routine (level II) ultrasonography is usually performed by less experienced operators, probably leading to lower overall accuracy, the authors continued. Theoretically, higher-quality ultrasonography could have a major impact on the evaluation of adnexal masses because of the different approaches to management of ovarian cancer versus benign tumors.
Dr. Yazbek and colleagues sought to determine whether level III (experienced) ultrasonography has a measurable impact on management of adnexal masses compared with level II ultrasonography. They randomized 150 patients with suspected ovarian cancer to evaluation by level II or level III ultrasonographers. The primary endpoint was the number of major surgical staging procedures in each study group.
The results showed that 27 of 73 (37%) patients in the level II group underwent major surgical staging procedures (including laparotomy and at least an oophorectomy and omental biopsy) versus 17 of 77 (22%) in the level III group (P=0.049). The total number of surgical procedures was similar in the two groups (35 of 73 versus 33 of 77).
Among patients who had surgical procedures, the median hospital stay was six days in the level II group and five days in the level III group (P=0.01).
Level III ultrasonography provided a likely histologic diagnosis to physicians in 76 of 77 cases compared with 38 of 73 with level II ultrasonography. Eighteen of the 150 patients had final diagnoses of ovarian malignancy. Level II ultrasonography had a sensitivity of 40% and specificity of 100%, compared with 88% sensitivity and 96% specificity for level III ultrasonography.
The authors declared no conflicts of interest.
Primary source: The Lancet OncologySource reference:Yazbek J, et al "Effect of quality of gynecological ultrasonography on management of patients with suspected ovarian cancer: a randomized controlled trial" Lancet Oncol 2008; DOI: 10.1016/S1470-2045(08)70005-6.