SAN DIEGO—A chart review of 1,035 women who underwent surgery for a pelvic mass found that 94% of postmenopausal patients with ovarian or other gynecologic cancers would have been appropriately referred to a gynecologic oncologist for specialized treatment when referral guidelines were used—the ones published in 2002 by the Society of Gynecologic Oncologists (SGO) and the American College of Obstetricians and Gynecologists (ACOG) for patients diagnosed with ovarian cancer.
The authors of the study concluded that these referral guidelines appear to predict benign masses accurately in most cases, as shown by a high overall negative predictive value.
The retrospective study also found that a family history of ovarian and breast cancer is less useful in predicting ovarian cancer than the other four criteria in the guidelines—postmenopausal state, abnormal preoperative CA-125 level, presence of ascites, and evidence of abdominal or distant metastases by exam and imaging studies.
“For premenopausal women referred to gynecologic oncologists under the SGO and ACOG guidelines, the positive predictive value for elevated CA-125, ascites, or evidence for metastasis ranged from 58% to 70%,” said Samuel Im, MD, a gynecologic oncology fellow at the University of California, Irvine, who reported the data here at the SGO annual meeting.
“But the positive predictive value of family history of breast or ovarian cancer was only 18.8%.”
Among postmenopausal women, the positive predictive value for the guidelines was 59.5%, and the negative predictive value was 91.1%.
Patients under age 50 were considered premenopausal (777 women in this study), and those 50 or older were classified as postmenopausal (241).
“Based on guidelines, 70% of the premenopausal primary cancer patients would have been referred to gynecologic oncologists, versus 94% in the postmenopausal group,” Dr. Im said.
The positive predictive value of the referral guidelines as a group was low, he said, especially for premenopausal women, primarily because of the large number of women with benign masses who had a positive family history for breast or ovarian cancer. This made family history a relatively poor indicator of malignancy in women with pelvic masses.
But the negative predictive value was high for both premenopausal and postmenopausal women, Dr. Im said.