High-quality, pre-op ultrasound improves adnexal masses evaluation

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For suspected ovarian cancer, high-quality ultrasonography can double the sensitivity of accurate diagnoses, help reduce major staging procedures and shorten hospital stays, according to a study published in the February 2008 issue of Lancet Oncology.

According to Joseph Yazbek, MD, of Guy's and St. Thomas' Hospital in London, and colleagues, specialists in gynecologic ultrasound provided a likely histologic diagnosis in 99 percent of 150 cases compared with 52 percent for less experienced ultrasonographers. High-quality ultrasonography had a sensitivity for cancer diagnosis that was double that of less experienced ultrasonographers, said Yazbek.

"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."

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.

According to the results, 27 of 73 (37 percent) 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 percent) in the level III group. 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.

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 percent and specificity of 100 percent, compared with 88 percent sensitivity and 96 percent specificity for level III ultrasonography.