Re: gynecologic oncologists
From: Geffrey H. Klein, MD (gklein@icsi.net)
Tue Mar 30 21:19:45 1999
At 7:20 PM -0600 on 3/30/99, Robin wrote:
> The following is an excerpt from the NIH Consensus Development
> Conference Statement, April 5-7, 1994:
>
> "Women with ovarian masses who have been identified preoperatively as
> having a significant risk of ovarian cancer should be given the option
> of having their surgery performed by a gynecologic oncologist"
Since you are preaching to us, you must be familiar with this month's Green
Journal article regarding this issue..
--
_________
The risk-of-malignancy index to evaluate potential ovarian cancers in local
hospitals
Solveig Tingulstad, MD, Bjørn Hagen, MD, PhD, Finn Egil Skjeldestad, MD,
PhD, Tore Halvorsen, MD, PhD, Kjell Nustad, MD, PhD, and Mathias Onsrud,
MD, PhD
Objective: To assess the risk-of-malignancy index (a scoring system based
on menopausal status, ultrasound features, and serum CA 125) at district
hospitals for referral of women with suspected malignant pelvic masses for
primary surgery at a central gynecologic oncology unit.
Methods: All seven hospitals in Health Region IV, Norway, agreed to refer
women with pelvic masses and risk-of-malignancy indices of 200 or more for
centralized primary surgery. In total, 365 women 30 years of age or older,
admitted consecutively at the local hospitals, were enrolled in the study
from February 1, 1995, to January 31, 1997.
Results: Compliance with the study was satisfactory; 84% (65 of 77) of
women with risk-of-malignancy indices of at least 200 were referred for
centralized primary surgery. Sensitivity and specificity to malignancy were
71% and 92%, respectively, which is in agreement with previous validation
of the risk-of-malignancy index in teaching hospital settings. False
negatives were due mainly to stage Ia (18 of 24) ovarian cancer, whereas 27
of 28 stage II-IV ovarian cancer cases were identified correctly.
Conclusion: The risk-of-malignancy index identified women with malignant
pelvic masses efficiently. Our study showed the risk-of-malignancy index
strategy in a practical setting to be able to centralize primary surgery
for advanced ovarian cancer from local hospitals to a subspecialty unit. We
recommend the risk-of-malignancy index for detection of patients with
advanced ovarian cancer for centralized primary surgery.
(Obstet Gynecol 1999;93:448-452. © 1999 by The American College of
Obstetricians and Gynecologists.)
Department of Obstetrics and Gynecology, University Hospital of Trondheim,
Trondheim, Norway
Department of Pathology, University Hospital of Trondheim, Trondheim, Norway
Section of Epidemiological Research, SINTEF, UNIMED, Trondheim, Norway
Central Laboratory, The Norwegian Radium Hospital, Oslo, Norway
Geffrey H. Klein, MD
geffrey.klein@obgyn.net
2200 Nasa Rd 1 #200
Houston, Texas 77058
(713) 741 2273 ext 2628
