High-quality ultrasound demonstrates measureable effect in ovarian cancer management

Ultrasound exams conducted by expert sonographers make a measurable difference over routine exams in the treatment of suspected ovarian cancer, decreasing the number of major staging procedures and reducing in-patient hospital stays.

Previous studies showed that ultrasound operator expertise is proportional to accuracy when differentiating between benign and malignant adnexal masses. But no studies examined how much accuracy affected patients.

Dr. Joseph Yazbek and colleagues in the department of obstetrics and gynecology at King's College Hospital NHS Foundation Trust and the Southeast Gynecological Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, both in London, published their study in The Lancet Oncology, which made it available online Jan. 18.

They enrolled 150 women with suspected adnexal tumors, all referred to the regional gynecological cancer center at Guy's and St Thomas'. One group of 73 women received routine ultrasound exams at Guy's and St Thomas' clinics, and the other 77 received expert-level ultrasound exams at King's College Hospital.

All patients were then followed through treatment to better understand how the quality of the ultrasound exam affected clinical practice. The researchers found 27 of the 73 women in the routine ultrasound group, or 37% of patients, underwent major surgical staging procedures, while only 17 of the 77 women in the expert ultrasound group, or 22%, had the same procedures, a difference of 15%.

Both groups had roughly the same number of surgical procedures in total, with 35 in the routine group and 33 in the expert group. The mean hospital stay for patients in the expert group, however, was one day less than for those in the routine group, at five versus six days.

In addition, 76 of the 77 women in the expert group were given a likely histological diagnosis after their ultrasound exam, while only 38 of 73 in the routine group received such a diagnosis after their ultrasound.

Finally, 18 of the 150 patients were diagnosed with malignant ovarian cancer. In this study, routine ultrasound had a sensitivity of 40% (two of five) and a specificity of 100% (10 of 10). Expert-level ultrasound had a sensitivity of 88% (seven of eight) and a specificity of 96% (27 of 28).

The researchers concluded that ultrasound exam quality has a measurable effect on the management of suspected ovarian cancer, most prominently seen in the number of staging surgeries and length of hospital stays.