Ultrasound follow up of an adnexal mass has the potential to save lives

Ormsby, Eleanor L.; Pavlik, Edward J.; Nagell, J.R. van

doi:10.1016/j.ajog.2015.06.041

Cited by 12 publications

(11 citation statements)

References 27 publications

(25 reference statements)

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“…3 18 19 Target doses and diagnostic reference levels are often set locally, on the assumption that dose variation is driven by differences in equipment or patients. 20 21 However, without understanding precise factors behind variation in reported doses, it is unknown whether the setting of target levels locally is needed. For example, if dose variations between localities reflect differences in how CT machines are used rather than differences in underlying patient populations or machine manufacturer or specific models, setting standards and targets locally needlessly complicates optimization activities.…”

Section: Introductionmentioning

confidence: 99%

International variation in radiation dose for computed tomography examinations: prospective cohort study

Smith‐Bindman

Wang

Chu

et al. 2019

BMJ

128

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ObjectiveTo determine patient, institution, and machine characteristics that contribute to variation in radiation doses used for computed tomography (CT).DesignProspective cohort study.SettingData were assembled and analyzed from the University of California San Francisco CT International Dose Registry.ParticipantsStandardized data from over 2.0 million CT examinations of adults who underwent CT between November 2015 and August 2017 from 151 institutions, across seven countries (Switzerland, Netherlands, Germany, United Kingdom, United States, Israel, and Japan).Main outcome measuresMean effective doses and proportions of high dose examinations for abdomen, chest, combined chest and abdomen, and head CT were determined by patient characteristics (sex, age, and size), type of institution (trauma center, care provision 24 hours per day and seven days per week, academic, private), institutional practice volume, machine factors (manufacturer, model), country, and how scanners were used, before and after adjustment for patient characteristics, using hierarchical linear and logistic regression. High dose examinations were defined as CT scans with doses above the 75th percentile defined during a baseline period.ResultsThe mean effective dose and proportion of high dose examinations varied substantially across institutions. The doses varied modestly (10-30%) by type of institution and machine characteristics after adjusting for patient characteristics. By contrast, even after adjusting for patient characteristics, wide variations in radiation doses across countries persisted, with a fourfold range in mean effective dose for abdomen CT examinations (7.0-25.7 mSv) and a 17-fold range in proportion of high dose examinations (4-69%). Similar variation across countries was observed for chest (mean effective dose 1.7-6.4 mSv, proportion of high dose examinations 1-26%) and combined chest and abdomen CT (10.0-37.9 mSv, 2-78%). Doses for head CT varied less (1.4-1.9 mSv, 8-27%). In multivariable models, the dose variation across countries was primarily attributable to institutional decisions regarding technical parameters (that is, how the scanners were used).ConclusionsCT protocols and radiation doses vary greatly across countries and are primarily attributable to local choices regarding technical parameters, rather than patient, institution, or machine characteristics. These findings suggest that the optimization of doses to a consistent standard should be possible.Study registrationClinicaltrials.gov NCT03000751.

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Section: Introductionmentioning

confidence: 99%

International variation in radiation dose for computed tomography examinations: prospective cohort study

Smith‐Bindman

Wang

Chu

et al. 2019

BMJ

128

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“…Ultrasound has been widely studied in the United States and Europe as a screening tool and as a diagnostic adjunct. We are beginning to discover that ovarian ultrasound screening alone, or in combination with CA125, may have the potential to save lives [14,15]. Findings from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) recently reported preliminary results of a shift to early stage disease and a reduction in cancer deaths on follow up to 14 years with multimodal ovarian cancer screening with serum CA125 interpreted using the Risk of Ovarian Cancer Algorithm (ROCA), transvaginal ultrasound, and clinical assessment.…”

Section: Presentmentioning

confidence: 99%

A Perspective on Ovarian Cancer Biomarkers: Past, Present and Yet-To-Come

Ueland

2017

Diagnostics

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The history of biomarkers and ultrasonography dates back over more than 50 years. The present status of biomarkers used in the context of ovarian cancer is addressed. Attention is given to new interpretations of the etiology of ovarian cancer. Cancer antigen 125 (CA125) and multivariate index assays (Ova1, Risk of Ovarian Malignancy Algorithm, Overa) are biomarker-driven considerations that are presented. Integration of biomarkers into ovarian cancer diagnostics and screening are presented in conjunction with ultrasound. Consideration is given to the serial application of both biomarkers and ultrasound, as well as morphology-based indices. Attempts are made to foresee how individualized molecular signatures may be able to both provide an alert of the potential for ovarian cancer and to provide molecular treatments tailored to a personalized genetic signature. In the future, an annual pelvic ultrasound and a comprehensive serum biomarker screening/diagnostic panel may replace the much maligned bimanual examination as part of the annual gynecologic examination. Taken together, it is likely that a new medical specialty for screening and early diagnostics will emerge for physicians and epidemiologists, a field of study that is independent of patient gender, organ, or the subspecialties of today.

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“…To address this question, work that focused on the ultrasound discovery of adnexal masses was reviewed [13]. Malignancy has been found in stable masses, which enlarged and increased in morphologic complexity in up to three years after initial detection in the UKCTOCS [12].…”

Section: Subjectivitymentioning

confidence: 99%

“…Even allowing the 0.001% ARL to be relaxed 10 fold would still lead to the expectation of a considerable number of extra malignancies within three years of the first scan. If prematurely stopping surveillance caused 50% or more of these malignancies to be diagnosed at an advanced stage, likely destined to be fatal, then extra deaths due to curtailing surveillance can be expected to be high and emphasizes the peril of limiting ultrasound surveillance [13]. …”

Section: Subjectivitymentioning

confidence: 99%

“…The question of how best to manage these masses has been the subject of much interest and debate among clinicians including obstetric gynecologists, primary care physicians, radiologists and gynecology oncologists. Several reports have asserted that resected ovarian cysts do not contain malignancy [9,10,11], but that if left unmonitored, ovarian cysts can progress to ovarian cancers [12,13]. Therefore, all ovarian cysts may present some source of concern.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials

2017

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Women that are positive for an ovarian abnormality in a clinical setting can have either a malignancy or a benign tumor with probability favoring the benign alternative. Accelerating the abnormality to surgery will result in a high number of unnecessary procedures that will place cost burdens on the individual and the health delivery system. Surveillance using serial ultrasonography is a reasonable alternative that can be used to discover if changes in the ovarian abnormality will occur that favor either a malignant or benign interpretation. Several ovarian cancer screening trials have had extensive experiences with changes in subclinical ovarian abnormalities in normal women that can define growth, stability or resolution and give some idea of the time frame over which changes occur. The present report examines these experiences and relates them to the current understanding of ovarian cancer ontology, presenting arguments related to the benefits of surveillance.

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Ultrasound follow up of an adnexal mass has the potential to save lives

Cited by 12 publications

References 27 publications

International variation in radiation dose for computed tomography examinations: prospective cohort study

International variation in radiation dose for computed tomography examinations: prospective cohort study

A Perspective on Ovarian Cancer Biomarkers: Past, Present and Yet-To-Come

Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials

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