Sonographer experience translates into fewer unnecessary ovarian tumor surgeries

Unnecessary surgeries for suspected, but ultimately benign, ovarian tumors could be reduced if ultrasonography is improved, according to a recent report in The Lancet Oncology. The study showed that the number of surgeries for suspected cancers was significantly higher after routine ultrasounds compared with ultrasounds performed by sonographers who have more than 10 years of experience.

Ultrasound is commonly used for preoperative assessment, but diagnostic accuracy varies with operator experience and skill. Dr. Joseph Yazbek and colleagues at Guy's and St Thomas' Hospital NHS Foundation Trust in London conducted a randomized study to determine whether this operator variation led to differences in management of 165 patients with ovarian abnormalities.

Seventy-seven women at London's regional South-East Gynaecological Cancer Centre received ultrasounds performed by examiners who had more than 10 years of experience in gynecological ultrasonography and were certified teachers of the technique (level III). The remaining 73 patients received ultrasounds performed by technologists trained in gynecological ultrasonography who were certified at level II.

Of the women who received scans by the level II technologists, 37% underwent major surgical staging procedures, compared with 22% of those who received ultrasounds by level III examiners.

The results surprised Yazbek.

"We expected a greater reduction in the number of major operative procedures and more minimally invasive procedures in the level III arm of the study," he said. Other studies have shown that level III ultrasonographers can identify cancerous tumors with 95% accuracy."

In this trial, all cancerous tumors among the women were identified, and level III examiners correctly diagnosed the nature of the abnormalities in all but one of the patients. Level II examiners did so in only 52% of the cases.

"Clinicians still do not have a great belief in the ability of ultrasound to accurately predict the nature of ovarian tumors," Yazbek said. "This will happen with time, by training more specialists in gynecological ultrasound and further improving the diagnostic ability of ultrasound scanning to differentiate benign from malignant ovarian tumors."

Few ultrasonographers specialize in gynecology in the U.K. Training more specialists would help improve the accuracy of diagnoses for patients, according to Dr. Yazbek.

The problem is likely not confined to the U.K.

"In general, ultrasound operator-dependence is well known," said Dr. Leslie Scoutt, chief of the radiology department's ultrasound section at Yale University. Scoutt was not associated with the study.

experience with gynecological ultrasound were more accurate when

characterizing ovarian masses than less experienced technologists.

(Provided by J. Yazbek)

For more information from the Diagnostic Imaging archives:

High-quality ultrasound demonstrates measurable effect in ovarian cancer management

Report from SNM: PET/CT excels in management of recurring ovarian cancer

MSCT assists ovarian mass identification