Impact of a multivariate index assay on referral patterns for surgical management of an adnexal mass

Abstract

OBJECTIVE:To determine the impact on referral patterns of using a Multivariate Index Assay, CA125, modified-American College of Obstetricians and Gynecologists referral guidelines, and clinical assessment among patients undergoing surgery for an adnexal mass after initial evaluation by nongynecologic oncologists.STUDY DESIGN: Overall, 770 patients were enrolled by nongynecologic oncologists from 2 related, multiinstitutional, prospective trials and analyzed retrospectively. All patients had preoperative imaging and biomarker analysis. The subset of patients enrolled by nongynecologic oncologists was analyzed to determine the projected referral patterns and sensitivity for malignancy based on multivariate index assay (MIA), CA125, modified-American College of Obstetricians and Gynecologists (ACOG) guidelines, and clinical assessment compared with actual practice. RESULTS:The prevalence of malignancy was 21.3% (n ¼ 164 MIA demonstrated statistically significant higher sensitivity (P < .0001) and lower specificity (P < .0001) for detecting malignancy compared with clinical assessment, CA125, and modified-ACOG guidelines. CONCLUSION:In this study population, use of MIA as a risk stratification test was associated with referral patterns by nongynecologic oncologists comparable to actual clinical practice and higher sensitivity for malignancy than other adnexal mass triage algorithms.

Applicability of the modified ACOG/SGO referral criteria for adnexal mass within a limited‐resource setting

“…As compared with findings from Bristow et al 11 and Im et al, 9 the ACOG/SGO guidelines yielded a higher PPV among the present study population, which would be expected given the higher prevalence of malignancy at JHS Hospital. These findings highlight the challenge of developing a standardized algorithm that is fully generalizable and applicable to all patient populations given the inherently different a priori risks of malignancy in various hospital settings.…”

“…As compared with findings from Bristow et al . and Im et al., the ACOG/SGO guidelines yielded a higher PPV among the present study population, which would be expected given the higher prevalence of malignancy at JHS Hospital.…”

Adherence of Primary Care Physicians to Evidence-Based Recommendations to Reduce Ovarian Cancer Mortality

“…In a trial of almost 500 patients set to undergo surgery for an adnexal mass, OVA1 demonstrated higher sensitivity and a negative predictive value for ovarian malignancy compared to clinical impression and other blood marker (CA-125) measurements in a population of nongynecologic oncology practices. 8 OVA1 generates a numeric result and categorizes patient risk of malignancy (high vs. low) stratified by menopausal status (pre vs. post). OVA1 has been approved for use in clinical practice since 2009 and has been validated for use by nongynecologic oncologists in several studies.…”

“…OVA1 has been approved for use in clinical practice since 2009 and has been validated for use by nongynecologic oncologists in several studies. 8 However, the extent to which it is used by physicians to evaluate whether a patient needs to be referred to a gynecologic oncologist before surgery has not been measured.…”

Current trends in urogynecological surgeries in Poland

“…In Poland, 15.4% of the entire population is > 65 years old, and, as of 2017, life expectancy for women at birth is 81.8 years [ 1 ]. The demand for care of pelvic floor disorders has been projected to increase by 35% between 2010 and 2030 [ 2 ]. There are many surgical options for POP treatment–both native tissue and synthetic mesh operations.…”