Abstract
Sunday, March 10, 2013
Are too many imaging tests being performed in women with an adnexal mass?
Abstract
Objective:
To evaluate the patterns of radiologic imaging requested by family physicians and gynaecologists in the work-up of women found to have an adnexal mass on pelvic ultrasound, and to evaluate whether advanced imaging tests are associated with more appropriate referral of women with a high-risk adnexal mass to gynaecologic oncologists.
Methods:
Centralized provincial databases of health care usage were used to identify women aged 45 and older who had a pelvic ultrasound examination between 2006 and 2008. Subsequent imaging tests ordered were identified according to physician specialty. For women who proceeded to laparotomy, logistic regression was performed to determine which imaging tests enabled primary physicians to make appropriate referrals of women with high risk adnexal tumours to a gynaecologic oncologist.
Results:
We identified 193 261 women aged 45 and older who had a pelvic ultrasound. Of these, 19 949 (10.3%) had a subsequent laparotomy; 2223 women were categorized as having a benign adnexal mass, 627 were categorized as having a malignant adnexal mass, and the remainder had another diagnosis such as uterine fibroid. Up to 12% of women had a pelvic MRI, and 58% of women had a CT scan after a pelvic ultrasound. Family physicians referred 95% of women with a high-risk ovarian mass to a gynaecologic surgeon rather than to a gynaecologic oncologist, and gynaecologists referred 47% of such women to a gynaecologic oncologist after imaging. Gynaecologic oncologists operated on 55% of women with a malignant adnexal mass. On multivariate analysis, a preoperative CT scan (OR 3.58; P < 0.001) and a CT scan and MRI (OR 7.78; P < 0.001) were associated with surgery performed by a gynaecologic oncologist, but a preoperative MRI alone was not significantly associated (OR 1.86; P = 0.09). After ultrasound alone the mean time to surgery was 100 days; this increased significantly when further imaging tests were performed (with additional CT to 131 days, with MRI to 170 days, and with CT and MRI to 179 days; P = 0.002).
Conclusion:
Performing a pelvic MRI after a pelvic ultrasound does not increase the rate of referral of women with a high-risk adnexal mass to a gynaecologic oncologist. A consensus on appropriate imaging and triage is needed when an adnexal mass is identified on ultrasound.
To evaluate the patterns of radiologic imaging requested by family physicians and gynaecologists in the work-up of women found to have an adnexal mass on pelvic ultrasound, and to evaluate whether advanced imaging tests are associated with more appropriate referral of women with a high-risk adnexal mass to gynaecologic oncologists.
Methods:
Centralized provincial databases of health care usage were used to identify women aged 45 and older who had a pelvic ultrasound examination between 2006 and 2008. Subsequent imaging tests ordered were identified according to physician specialty. For women who proceeded to laparotomy, logistic regression was performed to determine which imaging tests enabled primary physicians to make appropriate referrals of women with high risk adnexal tumours to a gynaecologic oncologist.
Results:
We identified 193 261 women aged 45 and older who had a pelvic ultrasound. Of these, 19 949 (10.3%) had a subsequent laparotomy; 2223 women were categorized as having a benign adnexal mass, 627 were categorized as having a malignant adnexal mass, and the remainder had another diagnosis such as uterine fibroid. Up to 12% of women had a pelvic MRI, and 58% of women had a CT scan after a pelvic ultrasound. Family physicians referred 95% of women with a high-risk ovarian mass to a gynaecologic surgeon rather than to a gynaecologic oncologist, and gynaecologists referred 47% of such women to a gynaecologic oncologist after imaging. Gynaecologic oncologists operated on 55% of women with a malignant adnexal mass. On multivariate analysis, a preoperative CT scan (OR 3.58; P < 0.001) and a CT scan and MRI (OR 7.78; P < 0.001) were associated with surgery performed by a gynaecologic oncologist, but a preoperative MRI alone was not significantly associated (OR 1.86; P = 0.09). After ultrasound alone the mean time to surgery was 100 days; this increased significantly when further imaging tests were performed (with additional CT to 131 days, with MRI to 170 days, and with CT and MRI to 179 days; P = 0.002).
Conclusion:
Performing a pelvic MRI after a pelvic ultrasound does not increase the rate of referral of women with a high-risk adnexal mass to a gynaecologic oncologist. A consensus on appropriate imaging and triage is needed when an adnexal mass is identified on ultrasound.
Preoperative clinical and radiological features of metastatic ovarian tumors
Abstract
PURPOSE:
To investigate the clinical characteristics and pre-operative imaging features of non-genital metastatic ovarian tumors.
METHODS:
A retrospective case series study that compared 18 patients with histologically confirmed non-genital metastatic ovarian tumors (the study group) with 25 patients who were diagnosed with a primary ovarian cancer (control group).CONCLUSION:
Pre-operative sonography findings, CA-125 levels and RMI 2 scores can be highly accurate in differentiating between primary and metastatic ovarian tumoropen access: Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases
WJSO
Conclusions
Our findings suggest that the major independent prognostic factors in patients with
advanced ovarian cancer needing colorectal resections are completeness of cytoreduction
and depth of bowel wall invasion. Surgical management and pathological assessment
should be aware of and deal with dual locoregional and mesenteric lymphatic spread.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
The Foundation for Women’s Cancer Announces 2013 Recipient of the Claudia Cohen Research Foundation Prize for Outstanding Gynecologic Cancer Researcher
press release
Los Angeles, CA (PRWEB) March 09, 2013
Saturday, March 09, 2013
Recording of family history is associated with colorectal cancer stage
Recording of family history is associated with colorectal cancer stage.:
| Related Articles |
CONCLUSION: A FH of CRC and other Lynch-related cancers was not recorded in ∼40% of young CRC patients and recording improved only slightly over the years. As a first step in the identification of Lynch-related cancer families, physicians should be trained to record a detailed FH in the work-up of all newly diagnosed CRC patients.
PMID: 23470269 [PubMed - in process]
LPA Stimulates the Phosphorylation of p130Cas via Gαi2 in Ovarian Cancer Cells
Blogger's Note: LPA has been investigated in ovarian cancer as an early detection test (failed) for over a decade+; this is continuing research
LPA Stimulates the Phosphorylation of p130Cas via Gαi2 in Ovarian Cancer Cells
Farletuzumab (a monoclonal antibody against folate receptor alpha) in relapsed platinum-sensitive ovarian cancer (MORAb-003)
ScienceDirect.com - Gynecologic Oncology - Farletuzumab (a monoclonal antibody against folate receptor alpha) in relapsed platinum-sensitive ovarian cancer
Highlights
►
Complete or partial ORR was 75% with combination therapy.
► Response rate among subjects with first progression-free interval < 12 months (75%) was comparable to subjects with progression-free interval ≥ 12 (84%).
► In 21% of evaluable subjects, second progression-free interval was longer than first progression-free interval.
► Response rate among subjects with first progression-free interval < 12 months (75%) was comparable to subjects with progression-free interval ≥ 12 (84%).
► In 21% of evaluable subjects, second progression-free interval was longer than first progression-free interval.
A clinical experience of single agent Bevacizumab in relapsing ovarian cancer
ScienceDirect.com - Gynecologic Oncology - A clinical experience of single agent Bevacizumab in relapsing ovarian cancer
Highlights
►
The median time to progression in women with heavily treated recurrent
ovarian carcinoma treated with bevacizumab was 4 months.
► The most frequent adverse effect was arterial hypertension (62% of patients) and no intestinal perforation was reported.
► The PFS was marginally improved in patients who experienced severe arterial hypertension during the first month of therapy.
► The most frequent adverse effect was arterial hypertension (62% of patients) and no intestinal perforation was reported.
► The PFS was marginally improved in patients who experienced severe arterial hypertension during the first month of therapy.
open access: Longitudinal health-related quality of life assessment: implications for prognosis in ovarian cancer
Journal of Ovarian Research | Abstract | Longitudinal health-related quality of life assessment: implications for prognosis in ovarian cancer
Abstract:
Background
There is no information in the literature on the impact of changes in quality of life
(QoL) scores on prognosis in ovarian cancer. We investigated whether changes in QoL
during treatment could predict survival in ovarian cancer patients.....
open access - full pdf version
open access - full pdf version
Oophorectomy for Benign Causes: No Survival Benefit
Oophorectomy for Benign Causes: No Survival Benefit
"....The researchers conclude that oophorectomy was not associated with increased survival at any age. However, they note, "At the time of hysterectomy, women with known high-penetrance susceptibility genes for ovarian and breast cancer (BRCA, Lynch) should strongly consider oophorectomy because the lifetime risk of ovarian cancer is high. In contrast, approximately 300,000 U.S. women without these mutations, and many more worldwide, have bilateral oophorectomy at the time of hysterectomy for benign disease every year," they add. "Consequently, the association of oophorectomy with increased mortality in the overall population has substantial public health implications." "
Caring for your skin, nails and hair during and after cancer treatment | Oncolink
Caring for your skin, nails and hair during and after cancer treatment | Oncolink
Part I: Panel Discussion
Part II: Make-Up Application and Wig Tips
Diagnostic accuracy of Risk of Malignancy Index in predicting complete tumor removal at primary debulking surgery for ovarian cancer patients
Diagnostic accuracy of Risk of Malignancy Index in predicting complete tumor removal at primary debulking surgery for ovarian cancer patients - Fagö-Olsen - Acta Obstetricia et Gynecologica Scandinavica - Wiley Online Library
Abstract
Ovarian cancer patients, in whom
complete tumor removal is impossible with primary debulking surgery
(PDS) may benefit from neoadjuvant chemotherapy and interval debulking
surgery. However, the task of performing a pre-operative evaluation
about the feasibility of PDS is difficult. We aimed to investigate if
risk of malignancy index (RMI) was a useful marker for this evaluation.
RMI and surgical outcome were investigated in 164 patients, of whom 49
had no residual tumor after PDS. Receiver operating characteristic
showed an area under the curve of 0.72 (confidence interval: 0.64–0.80).
The possibility of complete tumor removal decreased with increasing RMI
and there was a tendency towards higher RMI in patients with residual
tumor after PDS, but no single cut-off value of RMI produced useful
clinical predictive values. In conclusion, RMI alone is not an optimal
method to determine if complete tumor removal is possible with PDS.
Carestream MyVue Patient Portal Now Available as a Cloud Service (Italy)
Carestream MyVue Patient Portal Now Available as a Cloud Service
"Carestream's MyVue patient portal will be available as a cloud service in March 2013. MyVue empowers patients to securely access, manage and share their medical images and radiology reports with healthcare providers.
Deploying the portal as a Vue Cloud Service offers the flexibility of a monthly fee and can accommodate more users without additional network expansions. Carestream manages remote access, networking requirements and security procedures for users of its cloud services, while also addressing regulatory compliance and service uptime.....
(interactive map) Overall Ranking, 2009 - State Health System Ranking - The Commonwealth Fund
Overall Ranking, 2009 - State Health System Ranking - Health Systems Data Center - The Commonwealth Fund
".... Search by zip code or location name, or browse the tablet-accessible U.S. maps, to see regional pages with detailed performance and ranking data on measures of access to care, prevention and treatment, avoidable hospital use and costs, and measures associated with living a healthy life. Or compare the performance of states and communities and export custom bar charts and tables.....
Friday, March 08, 2013
2013 Cochrane Review: Laparoscopy versus laparotomy for FIGO stage I ovarian cancer including plain language summary
Laparoscopy versus laparotomy for FIGO stage I ovarian cancer - The Cochrane Library
Abstract (repost)
BACKGROUND:
This is an updated version of the original review that was first published in the Cochrane Database of Systematic Reviews 2008, Issue 4. Laparoscopy has become an increasingly common approach to surgical staging of apparent early-stage ovarian tumours. This review was undertaken to assess the available evidence on the benefits and risks of laparoscopy compared with laparotomy for the management of International Federation of Gynaecology and Obstetrics (FIGO) stage I ovarian cancer.OBJECTIVES:
To evaluate the benefits and risks of laparoscopy compared with laparotomy for the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic).SEARCH METHODS:
For the original review, we searched the Cochrane Gynaecological Cancer Group Trials (CGCRG) Register, Cochrane Central Register of Controlled Trials (CENTRAL 2007, Issue 2), MEDLINE, EMBASE, LILACS, Biological Abstracts and CancerLit from 1 January 1990 to 30 November 2007. We also handsearched relevant journals, reference lists of identified studies and conference abstracts. For this updated review, we extended the CGCRG Specialised Register, CENTRAL, MEDLINE, EMBASE and LILACS searches to 6 December 2011.SELECTION CRITERIA:
Randomised controlled trials (RCTs), quasi-RCTs and prospective case-control studies comparing laparoscopic staging with open surgery (laparotomy) in women with stage I ovarian cancer according to FIGO.DATA COLLECTION AND ANALYSIS:
There were no studies to include, therefore we tabulated data from non-randomised studies (NRS) for discussion.MAIN RESULTS:
We performed no meta-analyses.AUTHORS' CONCLUSIONS:
This review has found no good-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice.Wednesday, March 06, 2013
Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: A meta-analysis
Abstract
Abstract
Background
The
impact of intraoperative rupture on prognosis is controversial in
early-stage epithelial ovarian cancer (EOC). Thus, we performed a
meta-analysis to determine its impact and to evaluate factors to
increase its risk.
Methods
We
searched PubMed, Embase, and the Cochrane Library till May 2011, and 9
eligible studies including 2382 patients were evaluated. All patients
were classified into three groups: no rupture; intraoperative rupture;
preoperative involvement.
Results
Preoperative
involvement decreased progression-free survival when compared with
intraoperative rupture (PFS; HR, 1.47; 95% CI, 1.01–2.14), which also
showed poorer PFS than no rupture (HR, 2.41; 95% CI, 1.74–3.33).
Although preoperative involvement reduced PFS when compared with
intraoperative rupture (HR, 2.63; 95% CI, 1.11–6.20), there was no
difference in it between intraoperative rupture and no rupture in
patients who underwent complete surgical staging operation and adjuvant
platinum-based chemotherapy if needed (HR, 1.49; 95% CI, 0.45–4.95).
Furthermore, adhesion to adjacent tissues, grade 2 or 3 disease were
more common (ORs, 2.01 and 2.47; 95% CIs, 1.20–3.37 and 1.12–5.46),
whereas mucinous tumor was less frequent (OR, 0.51; 95% CI, 0.37–0.72)
in intraoperative rupture than in no rupture.
Conclusions
Intraoperative
rupture may not decrease PFS when compared with no rupture in patients
with early-stage EOC who underwent complete surgical staging operation
and adjuvant platinum-based chemotherapy. Furthermore, more adhesion to
adjacent tissues and grade 2 or 3 disease, and less mucinous tumor are
expected to increase the risk of intraoperative rupture.
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