Jan 15th: New Symptom Indices Offer No Gain in Ovarian Ca - in Oncology/Hematology, Ovarian Cancer from MedPage Today

Action Points  

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• Explain that two new ovarian cancer symptom indices offered little advantage over the current Goff Index.



• Point out that for all three indices, sensitivity was lower for data obtained from the general practitioner's notes and highest for those interviewed over the telephone, ant that the specificity was largely unchanged

"The small differences between the three indices indicate that there is little to gain from deriving new symptom indices," the authors concluded.


"This sobering news follows hard on the heels of a large U.S. randomized trial finding no benefit, and indeed some harm, to women who were screened annually with a transvaginal ultrasound exam and a CA-125 blood test compared with a usual care control group," they wrote, referring to the NIH-sponsored Prostate, Lung, Colon, and Ovary (PLCO) screening program (JAMA 2011; 305:2295-2303).

They said one question the ovarian cancer community needs to answer is where it should focus its efforts: On the time between when a tumor is large enough to cause mild symptoms and when it is large enough to cause symptoms that prompt women to call a physician, or on a better understanding of disease etiology, leading to better prevention and therapy.

"These other research directions remain critical as the search continues for better ways to find ovarian cancer early," they said.

Primary source: Journal of the National Cancer Institute Source reference: Lim AWW, et al. "Predictive value of symptoms for ovarian cancer: Comparison of symptoms reported by questionnaire, interview, and general practitioner notes" J Natl Cancer Inst 2012; 104: 1-11. Additional source: Journal of the National Cancer Institute Source reference: Hartge P, Speyer JL. "Finding Ovarian Cancer" J Natl Cancer Inst 2012; DOI: 10.1093/jnci/drj518.

Related Article(s): ESGO: Ultrasound Allows Early Ovarian Cancer Diagnosis ESGO: Anti-CA125 Fails to Slow Ovarian Cancer SGO: Change in Antigen Predicts Ovarian Cancer Outcomes

Microbubble-enhanced US in Body Imaging: What Role? (abstract)

Note: CE US = contrast enhanced ultrasound

Abstract
Contrast agents for ultrasonography (US) comprise microscopic bubbles of gas in an encapsulating shell. They are unique in that they interact with the imaging process, oscillating in response to a low-intensity ultrasound field and disrupting in response to a high-intensity field. New contrast-specific imaging modes allow US to show exquisite vascularity and tissue perfusion in real time and with excellent spatial resolution. In Europe, Asia, and Canada, to name only the most obvious, characterization of focal liver masses is the first and best established use of contrast-enhanced (CE) US, allowing for the noninvasive diagnosis of commonly encountered liver masses with comparable accuracy to that of computed tomography and magnetic resonance studies. CE US is a preferred modality for the difficult task of diagnosis of liver nodules detected on surveillance scans in those at risk for hepatocellular carcinoma. Newer body applications include the guidance of ablative intervention, monitoring activity of bowel inflammation in Crohn disease, characterization of kidney masses, especially cystic renal cell carcinoma, diagnosis of prostate cancer, and monitoring the response of tumors to antivascular drug therapies. Microbubble contrast agents are easy to use and robust; their use poses no risk of nephrotoxicity and requires no ionizing radiation. CE US plays a vital and expanding role that improves management and patient care.