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Improving the quality of pre-operative ultrasound can reduce the number of unnecessary staging procedures performed to confirm ovarian cancer and can also shorten the hospital stay, according to a report. Improving the quality of pre-operative ultrasound can reduce the number of unnecessary staging procedures performed to confirm ovarian cancer and can also shorten the hospital stay, according to a report in the January 21st online issue of The Lancet Oncology.

Previous research has shown that ultrasound performed by expert operators, also known as level III ultrasonography, is better in differentiating between benign and malignant ovarian disease than is routine, or level II, ultrasonography, which is typically performed by less experienced operators. Whether this difference translates into improved cancer management, however, was unknown.

In the current study, Dr. Joseph Yazbek, from King's College Hospital NHS Foundation Trust in London, and colleagues assessed the number of staging procedures and other outcomes in 150 women with suspected adnexal tumors who were randomized to undergo routine or expert ultrasound.

Thirty-seven per cent of routine ultrasound patients underwent a major staging operation for suspected ovarian cancer compared with 22 per cent of expert ultrasound patients (relative risk = 1.68, p = 0.049). By contrast, the percentage of patients in each group undergoing any surgical procedure was not significantly different, hovering around 45 per cent. This was due to an increased number of minimally invasive procedures in the expert ultrasound group.

Expert ultrasound was associated with a one-day reduction in the median hospital stay for operative patients: five vs. six days with routine ultrasound (p = 0.01).

Expert ultrasound was able to provide a likely histologic diagnosis in 99 per cent of the patients, whereas routine ultrasound only provided such information in 52 per cent of patients, the report indicates.

Ultimately, 18 of the 150 (12 per cent) patients were diagnosed with ovarian cancer. Expert ultrasound was 88 per cent sensitive and 96 per cent specific in detecting the malignancy, while routine ultrasound was 40 per cent sensitive and 100 per cent specific.

"This study shows that the quality of gynecologic ultrasonography has a significant effect on the choices made by gynecologic oncologists in the management of patients with suspected ovarian cancer," the researchers conclude.