scholarly journals One-stop clinic for patients with suspected ovarian cancer: results from a retrospective outcome study of the referral pathway

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ayisha A. Ashmore ◽  
Chellappah Gnanachandran ◽  
Iqra Luqman ◽  
Kathryn Horrocks
Keyword(s):  
Ovarian Cancer ◽  
Primary Care ◽  
Waiting Times ◽  
Pelvic Mass ◽  
Premenopausal Women ◽  
Initial Assessment ◽  
Ca 125 ◽  
Outcome Study ◽  
Ovarian Malignancy ◽  
One Stop

Abstract Background Women with abdominal pain and bloating frequently have their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. Methods This was a retrospective observational outcome study. Data were collected from electronic documents of patients’ referrals, assessments, and clinical correspondences over 48 months. The study was conducted in a secondary gynaecology cancer centre with direct referrals from primary care. The pelvic mass clinic was set up to include a consultation and an ultrasound scan with support available for patients if required. All patients included were referred directly from primary care for suspected ovarian cancer with Ca-125 result over a period of 2 years. Results 286 were referred from primary care according to the NICE guidelines of ‘2-week wait for ovarian cancer’. Only 223 patients who had a Ca-125 result reported at the time of their referral were included in the analysis. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. 18 patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. The malignancy rate in women under 50 years of age was 22% (4/18) and 78% (14/18) in women aged 50 or above. Conclusion One-stop focused gynaecology ultrasound clinics where clinicians may assess patients and perform ultrasound scans for suspected cancer, may be better for managing this patient population due to improved efficiencies in waiting times, same day diagnosis and a reduction in waiting times to first appointment. Secondly, the majority of the patients with Ca-125 of more than 35 U/mL, who were referred through this pathway, did not have cancer. This review queries the future value of using Ca-125 as the basis for referrals from primary care for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for premenopausal women.

scholarly journals One-Stop Clinic for Patients with Suspected Ovarian Cancer Pathway from a Retrospective Outcome Study

2020 ◽  
Author(s):  
Ayisha Adeeba Ashmore ◽  
C. Gnanachandran ◽  
I. Luqman ◽  
K. Horrocks
Keyword(s):  
Ovarian Cancer ◽  
Primary Care ◽  
Pelvic Mass ◽  
Initial Assessment ◽  
Ca 125 ◽  
Outcome Study ◽  
Ovarian Malignancy ◽  
Cancer Symptoms ◽  
Nice Guideline ◽  
One Stop

Abstract Background:Recent encouragement in early detection of cancer nationally has significantly increased the number of referrals made through the two-week wait suspected cancer pathway. In particular women with abdominal pain and bloating are frequently having their Ca-125 levels investigated for suspected ovarian cancer and this has led to a significant increase in referrals to the ovarian cancer service. We have conducted this study to help improve the efficiency in which these patients are investigated and to improve future pathways within the referral service. Methods:A retrospective observational outcome study. Data were collected from electronic documents of patients’ referrals, assessments, and clinical correspondences.The study was conducted in a tertiary gynaecology cancer centre with primary care direct referrals. The pelvic mass clinic was the clinic setup with consultation, scan and patient support was available. All patients referred by direct primary care for suspected ovarian cancer over two years with Ca-125 result. Data were collected and analysed from the pelvic mass clinic over 48 months, which was available through electronic documentation. Data included information on their consultation, ultrasound scan findings, any further intervention, surgery, and histological outcome of all patient who underwent biopsies or surgery.Results: Two hundred and eighty-six patients were referred from primary care where the NICE guideline, ‘two-week wait for ovarian cancer’, was applied. Two hundred and twenty-three patients were included in this analysis, who had a Ca-125 result reported at the time of their referral. Out of the 223 patients, 126 patients were discharged with or without a repeat Ca-125 after the initial assessment. Seventeen patients were diagnosed with cancer following the referral, but only 12 of them had a primary ovarian malignancy. Conclusion:Majority of the patients with Ca-125 of more than 35U/mL, who were referred through this pathway, did not have cancer. This message can be disseminated by primary care practitioners who may be able to reassure patients prior to their initial consultation with a gynaecologist. This review queries the future value of using Ca-125 as the basis for referrals from primary care referrals for suspected ovarian malignancy. Further studies are required to assess whether a higher Ca-125 cut off may be used as the basis of referrals for postmenopausal women. One-stop focused gynaecology ultrasound clinic (OSFGUC) where clinicians may assess patients with suspected ovarian cancer symptoms and perform ultrasound scans may be better for managing this patient population.

Evaluation in the predictive value of serum human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both in detecting ovarian malignancy

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Beng Hock Teh ◽  
Soon Leong Yong ◽  
Wee Wee Sim ◽  
Kim Bee Lau ◽  
Haris Njoo Suharjono
Keyword(s):  
Predictive Value ◽  
Area Under The Curve ◽  
Pelvic Mass ◽  
Premenopausal Women ◽  
Ca 125 ◽  
Diagnostic Study ◽  
Ovarian Malignancy ◽  
Cancer Antigen 125 ◽  
Cancer Antigen ◽  
Sensitivity Specificity

Abstract Background This study was conducted to evaluate the performance of human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both via the Risk of Ovarian Malignancy Algorithm (ROMA) in detecting ovarian malignancy. Methods This was a diagnostic study enrolling 129 patients with pelvic mass(es) suspected of originating in the ovary who had been scheduled for surgery or radiological-guided biopsy. Serum HE4 and CA 125 levels were measured. HE4, CA 125 and ROMA were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The receiver operating characteristic (ROC) plots were graphed and area under the curve (AUC) values were calculated to investigate the accuracy of each marker for predicting ovarian malignancy. Results Overall, CA 125 remained significantly more sensitive (88.9% vs. 51.9%, p = 0.006) but less specific (56.9% vs. 95.1%, p < 0.001) than HE4. HE4 was superior to CA 125 in specificity (97.7% vs. 54.5%, p < 0.001) for premenopausal women. ROMA was non-significantly more sensitive (100.0% vs. 92.3%, p = 1.000) than CA 125 but both were equally specific (71.4%) for the postmenopausal group. In the premenopausal group, the AUC of serum HE4 was higher than serum CA 125 (0.851 vs. 0.817) but was equivalent to ROMA (0.851 vs. 0.859). In the postmenopausal group, ROMA exhibited an excellent AUC value as compared to CA 125 and HE4 (AUC of 0.907 vs. 0.874 vs. 0.863, respectively). Conclusion HE4 is useful in ruling out ovarian malignancy among premenopausal women. For postmenopausal women, ROMA appears to be an all-rounder with overall good sensitivity and specificity.

scholarly journals Benign Ovarian Cysts with Raised CA-125 Levels: Do We Need to Evaluate the Fallopian Tubes?

2020 ◽  
Vol 12 (04) ◽  
pp. 276-280
Author(s):  
Devesh Sharma ◽  
Anjali Vinocha
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Cyst ◽  
Transvaginal Ultrasound ◽  
Premenopausal Women ◽  
Carbohydrate Antigen ◽  
Ca 125 ◽  
Ovarian Cysts ◽  
Fallopian Tubes ◽  
Case Record ◽  
Carbohydrate Antigen 125

Abstract Objectives It is not clearly known whether some benign (simple) ovarian cysts can convert into cancerous cysts. Size of cyst and wall abnormalities do predict the potentiality of malignancy. Not many studies have been done to explore the malignant potential of large-sized (> 5 cm) unilocular ovarian cysts without wall abnormalities. This study evaluated the correlation between ultrasonographic size of benign ovarian cysts and carbohydrate antigen 125 (CA-125) levels. Methodology Sixty (60) premenopausal women were recruited for the study preoperatively, based on transvaginal ultrasound (TVUS) findings present in the case record sheet received along with the CA-125 sample in the biochemistry laboratories. Those cases with elevated CA-125 levels were selected, where patients had unilocular ovarian cysts without wall abnormalities. CA-125 was done using ECLIA methodology (Cobas e411, Germany). Statistical correlation was calculated between the ovarian cyst size and CA-125 levels using Spearman’s Rho coefficient. Results Mean age group of subjects were 29.7 ± 7.3 years and mean value of CA-125 (normal < 35 IU/mL) was found to be increased: 118.0 ± 147.1 IU/mL so was the mean diameter of cysts (cut off ≤ 5 cm): 48.6 ± 59.8 cm. No correlation was found between CA-125 levels and volume of ovarian cyst (r = 0.005, p = 0.680) for all subjects. Conclusions The lack of correlation between size of ovarian cysts and CA-125 levels provides a hint that the ovarian cyst epithelium does not directly express CA-125 and it may come from sites like the fallopian tube. Thus, raised level of CA-125 in benign ovarian cyst should be followed-up more closely, demanding assessment of fallopian tubes for early diagnosis of ovarian cancer. Also, algorithms can be explored to include size of ovarian cyst and CA 125 levels to predict ovarian cancer.

HE4, CA125 and risk of ovarian malignancy algorithm (ROMA) as diagnostic tools for ovarian cancer in patients with a pelvic mass: An Italian multicenter study

2016 ◽  
Vol 141 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Cesare Romagnolo ◽  
Antonette E. Leon ◽  
Aline S.C. Fabricio ◽  
Martina Taborelli ◽  
Jerry Polesel ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Multicenter Study ◽  
Pelvic Mass ◽  
Diagnostic Tools ◽  
Ovarian Malignancy

scholarly journals Diagnostic performance of CA 125, HE4, and risk of Ovarian Malignancy Algorithm for ovarian cancer

2018 ◽  
Vol 33 (1) ◽  
pp. e22624 ◽  
Author(s):  
Boyeon Kim ◽  
Yongjung Park ◽  
Banseok Kim ◽  
Hyo Jun Ahn ◽  
Kyung-A Lee ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Diagnostic Performance ◽  
Ca 125 ◽  
Ovarian Malignancy

scholarly journals Preoperative detection of ovarian cancer by color doppler ultrasonography and CA 125

1970 ◽  
Vol 36 (2) ◽  
pp. 68-73 ◽  
Author(s):  
Fawzia Hossain ◽  
Md Nazmul Karim ◽  
Shah Md Mahfuzur Rahman ◽  
Nazreen Khan ◽  
Maruf Siddiqui ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Early Detection ◽  
Predictive Value ◽  
Ovarian Tumor ◽  
Pulsatility Index ◽  
Color Doppler ◽  
Resistance Index ◽  
Ca 125 ◽  
Ovarian Malignancy ◽  
Age Group

Purpose: Early detection of ovarian malignancy is of great clinical importance. The high mortality rate is due to the difficulties with the early detection of ovarian cancer. Current research attempted to assess the accuracy of Color Doppler Sonography and serum CA-125 level as diagnostic tool of ovarian tumor.Materials and Methods: In this cross-sectional study, 60 consecutive patients with ovarian tumor attending the Department of Obstetrics and Gynecology of BSMMU were recruited. Of the study participants 23.3% belong to 16-25 year age group, 20% belong to 26-35 years age group and 23.30% each were of 46-55 years and > 55 years age group. All the patients recruited were from in-patient department and had undergone surgery. Following excision, routine histopathology revealed 43.30% malignant (n=26) and 56.7% (n=34) benign ovarian lesion. Data were collected from the clinical history form and bimanual pelvic examination, serum CA 125 levels, estimation of Resistance index (RI), Pulsatility Index (PI), Novel Index by CDS and post-operative histo-pathological findings were then recorded. Sensitivity, specificity, accuracy, positive and negative predictive value of the diagnosis made by CDS, CA125, in the discrimination of the benign and malignant ovarian tumors was calculated. Using Receiver operative characteristics analysis the accuracy of RI, PI, CA 125 and Novel Index in the diagnosis of ovarian tumor (benign or malignant) were assessed.Results: With the Cut-off of <.5, Resistance Index is found to be capable of detecting 92% of malignant cases (sensitivity 91.7), and could detect 89% (specificity 88.9) of benign cases correctly which translates in to 90% accuracy in the diagnosis of ovarian tumor. Predictive values for positive (84.6) and negative (94.1) tests were also found to be quite high. Pulsatility index was found to be moderate accuracy (63.3%) with cutoff <1 for malignancy, however low predictive value for a positive test (38.5) questions its use. Both CA-125 and Novel Index showed similar level of sensitivity and specificity. Although Novel Index is derivative of CA125, Novel Index demonstrated better diagnostic accuracy and negative predictive value. The cutoff for CA 125 was mandated as 83.58. With the value the sensitivity is 76.9% and the specificity is 94.1%. RI is found to be more sensitive in detection of positive cases (Malignant) and CA125 is found to be more accurate in detection of negative cases (Benign). However a combination could be tried to make a better detection.Conclusion: Color Doppler ultra-sonography and CA125 excels in different tasks, the study concludes in favor of concurrent use of the methods for improving efficacy and thus early detection of ovarian malignancy. DOI: 10.3329/bmrcb.v36i2.6991Bangladesh Med Res Counc Bull 2010; 36: 68-73

scholarly journals DIAGNOSTIC VALUE OF CA-125 IN PATIENTS WITH EPITHELIAL OVARIAN CANCER AT THE DR. SOETOMO GENERAL HOSPITAL SURABAYA IN 2016

2019 ◽  
Vol 25 (2) ◽  
pp. 145
Author(s):  
Kintan Putri ◽  
Betty Agustina Tambunan ◽  
Willy Sandhika
Keyword(s):  
Ovarian Cancer ◽  
Positive Predictive Value ◽  
Epithelial Ovarian Cancer ◽  
Tumor Marker ◽  
General Hospital ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Ca 125 ◽  
Ovarian Malignancy

Ovarian cancer is the fourth cancer with most incidence in Indonesian female with 10.238 cases in 20141. Tumor marker CA-125 is assosciated with ovarian cancer, importantly epithelial ovarian cancer. This study aims to find out diagnostic value (sensitivity, specificity, positive predictive value, negative predictive value) of CA-125 among patients with epithelial ovarian cancer in Dr. Soetomo General Hospital Surabaya in 2016. This study used analytic cross sectional method and was performed by evaluating medical records of patients suspected for ovarian malignancy in Dr. Soetomo General Hospital Surabaya in 2016. There were total 97 patients found fit for criteria of inclusion in this study. Tissue histopathological examination confirmed 66 patients have epithelial ovarian malignancy and 31 patients do not. Samples distributed using 35 U/ml as CA-125 upper limit, TP: 54.64%, FP: 19.59%, FN: 13.40%, dan TN: 12.37%. Diagnostic value obtained as follows: sensitivity 80.30%, spesificity 38.71%, positive predictive value 73.61%, negative predictive value 48%, and accuracy 67.01%. Tumor marker associated with ovarian cancer CA-125 has found high in sensitivity but low in specificity among patients with epithelial ovarian cancer in Dr. Soetomo General Hospital Surabaya in 2016.

scholarly journals A Combinatorial Proteomic Biomarker Assay to Detect Ovarian Cancer in Women

2018 ◽  
Vol 10 ◽  
pp. 1179299X1875664 ◽  
Author(s):  
Meredith C Henderson ◽  
Michael Silver ◽  
Sherri Borman ◽  
Quynh Tran ◽  
Elias Letsios ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
General Population ◽  
Clinical Performance ◽  
Gynecological Cancer ◽  
Area Under The Curve ◽  
Ca 125 ◽  
Limiting Factor ◽  
Ovarian Malignancy ◽  
Better Than ◽  
Rule Out

Ovarian cancer is often fatal and incidence in the general population is low, underscoring the necessity (and the challenges) for advancements in screening and early detection. The goal of this study was to design a serum-based biomarker panel and corresponding multivariate algorithm that can be used to accurately detect ovarian cancer. A combinatorial protein biomarker assay (CPBA) that uses CA125, HE4, and 3 tumor-associated autoantibodies resulted in an area under the curve of 0.98. The CPBA Ov algorithm was trained using subjects who were suspected to have gynecological cancer and were scheduled for surgery. As a surgical rule-out test, the clinical performance achieves 100% sensitivity and 83.7% specificity. Although sample size (n = 60) is a limiting factor, the CPBA Ov algorithm performed better than either CA-125 alone or the Risk of Ovarian Malignancy Algorithm.

Non-Hodgkin's lymphoma presenting as advanced ovarian cancer—a case report and review of literature

2005 ◽  
Vol 15 (3) ◽  
pp. 554-557 ◽  
Author(s):  
S. Perlman ◽  
A. Ben-Arie ◽  
E. Feldberg ◽  
Z. Hagay
Keyword(s):  
Ovarian Cancer ◽  
Hodgkin’S Lymphoma ◽  
Advanced Ovarian Cancer ◽  
Pelvic Mass ◽  
Lymphoid Cells ◽  
Hodgkin's Lymphoma ◽  
Ca 125 ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Primary Neoplasm

Non-Hodgkin's lymphoma involving the ovaries is unusual and may cause confusion for the clinician since its presentation might resemble other, much more frequent tumors. Malignant lymphoid cells may occur in the ovary either as a primary neoplasm or as a secondary manifestation of a disseminated occult or known disease. The most common presenting signs or symptoms of malignant lymphomas involving the ovaries are abdominal or pelvic pain or mass. We present here a unique case of non-Hodgkin's lymphoma involving the ovaries presenting as advanced ovarian cancer with a pelvic mass, pleural effusion, and marked elevation of CA-125.

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