Blogger's Note: this abstract provides little comprehensive information (as per most abstracts) noting that the journal of Gynecologic Oncology is a subscriber-based journal ($$$); 'nail in the coffin' for ovarian cancer/pre-surgical assessment ??
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abstract: Preoperative Identification of a Suspicious Adnexal Mass: A Systematic Review and Meta-analysis [Gynecol Oncol. 2012] - PubMed - NCBI
Abstract
OBJECTIVE:
To
systematically review the existing literature in order to determine the
optimal strategy for
preoperative identification of the adnexal mass
suspicious for ovarian
cancer.
METHODS:
A
review of all systematic reviews and guidelines published between 1999
and 2009 was conducted as a first step. After the identification of a
2004 AHRQ systematic review on the topic, searches of MEDLINE for
studies published since 2004 was also conducted to update and supplement
the evidentiary base. A bivariate, random-effects meta-regression model
was used to produce summary estimates of sensitivity and specificity
and to plot summary ROC curves with 95% confidence regions.
RESULTS:
Four
meta-analyses and 53 primary studies were included in this review. The
diagnostic performance of each technology was compared and contrasted
based on the summary data on sensitivity and specificity obtained from
the meta-analysis. Results suggest that 3D ultrasonography has both a
higher sensitivity and specificity when compared to 2D ultrasound.
Established morphological scoring systems also performed with
respectable sensitivity and specificity, each with equivalent diagnostic
competence. Explicit scoring systems did not perform as well as other
diagnostic testing methods.
Assessment of an adnexal mass by colour
Doppler technology was neither as sensitive nor as specific as simple
ultrasonography. Of the three imaging modalities considered, MRI
appeared to perform the best, although results were not statistically
different from CT. PET did not perform as well as either MRI or CT. The
measurement of the CA-125 tumour marker appears to be less reliable than
do other available assessment methods.
CONCLUSION:
The
best available evidence was collected and included in this rigorous
systematic review and meta-analysis. The abundant evidentiary base
provided the
context and direction for the diagnosis of
early-staged
ovarian cancer.
