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Re: gynecologic oncologists From: Efrain Ramirez MD (eramirez@icepr.com) Wed Mar 31 05:18:06 1999 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Scotia Phillips, RT, RDMS: "Re: Office Mammography" Previous message: Jay Kulkin: "Re: gynecologic oncologists" In reply to: Jay Kulkin: "Re: gynecologic oncologists" Next in thread: Braun, R. Daniel: "Re: gynecologic oncologists" The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals Solveig Tingulstad, MD,a Bjørn Hagen, MD, PhD,a Finn Egil Skjeldestad, MD, PhD,a,c Tore Halvorsen, MD, PhD,b Kjell Nustad, MD, PhD,d and Mathias Onsrud, MD, PhDa 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.) What Geff was talking about...bottom line is ..if you have a high degree of suspicion that it could malignant call you onco friend... At Wed, 31 Mar 1999, Jay Kulkin wrote: > >The concept sounds good but clinically this case would suggest that >gyn-oncologists would remove a lot of 10cm endometriomas. Obviously, they don't have the time or inclination to do this but in my experience they make themselves available even on an emergency basis when unexpected findings >arise. I think the entire clinical picture is significant and many would >ask for gyn-onc assist in the majority of suspicious cases. One must also >consider other variables as LFT's etc. A sensitive and important issue >which should be on the minds of all clinicians. > >Jay > > At 01:28 AM 3/31/99 -0600, you wrote: >>I realize that I am not "supposed" to be posting here. I would >>apologize except that this is too important an issue to worry about >>rules. Women's lives are at stake. >> >>I was merely quoting an excerpt from the NIH's Consensus Statement on >>ovarian cancer. We are not discussing a skin condition or a cold or >>flu. We are talking about a disease that kills over 14,000 women in >>this country every year. It is very difficult to diagnose and usually >>isn't caught until it is advanced. It has been proven that women who >>are optimally debulked and properly staged have a better chance for >>long-term survival. Now, do you really expect me to believe that a >>doctor who does maybe a few of these surgeries a year has as much >>expertise as a doctor who does a hundred? Obviously, the NIH doesn't >>believe that. >> >>Can you honestly say that if it were your mother, sister or daughter who >>was suspected of having ovarian cancer, that you would not choose >>someone with that kind of experience and expertise (a gyn/onc) to do her >>surgery? I think not. This is a question of ethics. I was very >>fortunate. My ob/gyn referred me immediately to a gyn/onc after finding >>a complex ovarian mass and a CA125 of 400. This is professionalism at >>its best. >> >>You will be hearing a lot about this in the future. Organizations like >>the National Ovarian Cancer Coalition and Ovarian Cancer National >>Alliance will be working hard to inform all women about this specialty >>and their options when faced with a possible ovarian cancer diagnosis. I >>would hope that ob/gyns all over this country will show support for >>their patients by referring them when indicated. >> >>This will be my last post. Thank you for allowing me the opportunity to >>express myself here. >> >>You >> >-- >Jay M. Kulkin, MD MBA >Medical Director BCBS of Georgia >office 770-386-0640 ext. 17 >office e mail-jkulkin@bcbs-ga.com > -- Efrain Ramirez MD FACOG "The things you learn after you know everything are the important ones" Next message: Scotia Phillips, RT, RDMS: "Re: Office Mammography" Previous message: Jay Kulkin: "Re: gynecologic oncologists" In reply to: Jay Kulkin: "Re: gynecologic oncologists" Next in thread: Braun, R. Daniel: "Re: gynecologic oncologists"

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