The expertise of the technician performing a gynecologic ultrasound not only affects the accuracy of the test results but also initial management of patients with suspected ovarian cancer. These results were recently published in The Lancet Oncology.
Ovarian cancer is the most deadly gynecologic cancer. This is largely due to the fact that the cancer is typically diagnosed once it is in advanced stages. There are currently no standard screening measures for ovarian cancer in the general population. Screening for ovarian cancer is only performed if a woman complains of symptoms associated with ovarian cancer (such as bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, or urgent or frequent urination).
If ovarian cancer is suspected, a gynecologic ultrasound can be used to help detect the disease. The ultrasound provides visualization of the ovaries and surrounding structures to look for a mass on the ovary or elsewhere in the pelvis. If such a mass is found, ultrasound results may be able to determine if the mass is benign (non-cancerous) or possibly cancerous. If results indicate that the mass may be cancerous, a biopsy is performed. These results may also indicate whether the biopsy will involve extensive surgery to remove as much of the cancer as possible or just a sample of the cells through a needle.
Results from previous studies have determined that an ultrasound performed by a technician with greater expertise in the procedure more accurately distinguishes between a benign condition and ovarian cancer. However, it has not been established whether these findings will lead to changes in initial management of patients with symptoms of ovarian cancer.
Researchers from England recently conducted a clinical study including 150 patients who were referred to a gynecological cancer center between 2004 and 2006. These patients were suspected to have an ovarian tumor. One group of patients underwent routine gynecologic ultrasonography (level II), while the other group underwent an expert-level gynecologic ultrasonography (level III).
- Surgery for suspected ovarian cancer was performed on 37% of patients who underwent level II ultrasonography compared with 22% who underwent level III ultrasonography.
- The number of days spent in the hospital for surgery was six days for those who underwent level II and five days for those who underwent level III ultrasonography.
- Sensitivity and specificity (the ability to accurately detect and provide a diagnosis of cancer versus non-cancerous conditions) was only 40% in patients who underwent level II ultrasonography compared with 100% for those who underwent level III ultrasonography.
The researchers concluded: “Improved quality of ultrasonography has a measurable effect on the management of patients with suspected ovarian cancer in a [specialty] [gynecological] cancer centre, and results in a significant decrease in the number of major [diagnostic] procedures and a shorter inpatient hospital stay.”
Patients who are to undergo a gynecologic ultrasound due to a suspected ovarian tumor may wish to discuss the qualifications of the ultrasound technician with their physician.
Reference: Yazbek J, Raji S, Ben-Nagi J, et al. Effect of quality of gynaecological ultrasonography on managemetn of patients with suspected ovarian cancer: a randomised controlled trial. The Lancet Oncology. 2008; 2008; 9:124-131.