US Performed by Gyn-Onc More Reliable Than Tumor Marker
Interesting Study. I have not heard of any Gyn-Oncs actually performing an US, but maybe they should, when indicated as repeat US. Ultimately though, surgery and pathology is still required for confirmation.
Using sonography, we classified the adnexal masses of 292 patients into 4 patterns. Pattern A was benign cystic tumors; B was benign mixed tumors (cysts with a smooth solid component); C was malignant mixed tumors (cysts with an irregular solid component or thickened septum), and D was solid tumors. We diagnosed tumors showing patterns A and B as benign, while patterns C and D represented tumors with low malignant potential or actual malignancy. The sensitivity and specificity of sonography was 82.2 and 82.1%, respectively, and these values were superior to those for tumor markers (CA125, CA19-9, CA72-4). Both the sensitivity and specificity of intraoperative frozen sections were the highest, showing that this is the most reliable examination. However, 15 of 191 patients undergoing frozen section were upgraded by the final pathological diagnosis. If sonography is performed by an experienced gynecologic oncologist, this examination is more reliable than tumor markers. However, intraoperative frozen section should still be performed during surgery for patients with ovarian tumors.
I had US (presume that means ultra sound?), CT scan, chest X-ray and of course CA125 plus endoscopy of bladder prior to surgery as I had a lot of ascites. Then had six chemo before surgery
and four after.
I believe that most of us had transvaginal ultrasounds and CT Scans plus CA125's. But still there is no way to diagnosis OvCa without a biopsy and as stated in the article above, 15 of 191 patients were upgraded by the final pathological diagnosis.
I thought it was interesting that if US is done by gyn-onc, they can better predict tumor type prior to surgery. Therefore if a mass is found in upon initial US, maybe GO should always do follow-up US, since they will then learn to correlate US images with actual findings and possibly prevent women from waiting longer (since most Ob/GYn's take the wait and see approach). In any case, when there is a mass and symptoms, a aptient should always be referred to GO (but many Ob/Gyn fail to do so).
Most gyn-oncs are prepared for the worst in any case and perform full cytoreductive surgery if frozen path is at all suspicious.
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