Wednesday, January 20, 2016

'Simple Rules' boost ovarian cancer determination

Cancer Research UK / Wikimedia
CANCER DIGEST – Jan. 20, 2016 – New method of evaluating ovarian lesions shown on ultrasound could dramatically improve the ability of doctors to accurately determine whether they are cysts or cancerous tumors.

In a study published online today in the American Journal of Obstetrics and Gynecology, a group of European researchers led by Professor Dirk Timmerman, MD, PhD, of the Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium, showed the new method to be accurate nearly 90 to 100 percent of the time, which could speed treatment for those women diagnosed with ovarian cancer.

The study was conducted by 22 centers in 10 countries over 13 years (1999 to 2012) and involved approximately 5,000 patients with ovarian masses.The researchers examined patients before surgery, using a standardized examination technique and standardized terms and definitions to describe ultrasound findings. The predictions based on ultrasounds were subsequently compared with the findings after the tumor was examined under a microscope by pathologists.  

The study authors then applied a set of rules, they called Simple Rules for evaluating ultrasound masses based on certain variables, such as the diameters of the lesion, the diameters of the largest solid component, and the type of tumor. The authors also included the age and type of center patients were seen in to calculate the overall risk estimation. 

They found that the malignancy rate was 34 percent overall, 43 percent in oncology centers and 17 percent in other centers. Results also revealed the median age of patients with a benign tumor was 42 years old, while the median age for patients with a malignant tumor was 57. Taken all together the method identified between 89%-99% of patients with ovarian cancer using the results of the ultrasound examination.

"We conclude that individual risk estimates can be derived from the five ultrasound features in the Simple Rules with performance similar to the best previously published algorithms," stated Dr. Timmerman. "A simple classification based on these risk estimates may form the basis of a clinical management approach. This will hopefully facilitate choosing optimal treatment for all patients presenting with adnexal masses."

In an accompanying editorial in the same issue, Beryl Benacerraf, MD, president of the American Institute of Ultrasound in Medicine (AIUM) hailed the new system as a significant improvement that can help all doctors.

"Although an earlier systematic review indicated that magnetic resonance imaging (MRI) gives better results than ultrasound, Dr Timmerman and his colleagues have shown that the IOTA Simple Rules provide better results than ever before and support the notion that ultrasound is at least as accurate and likely better than MRI in distinguishing benign from malignant masses," he said in a press release.

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