An international team led by Imperial College London and KU Leuven (UK and Belgium, respectively) have developed a new test, named ADNEX, which may aid in the diagnosis of ovarian tumors and in the selection of the most effective treatment. The results were published recently in the British Medical Journal.
In ovarian cancer, identification of tumor type can be very difficult, which can result in a reduced efficacy of treatment. Women may not be sent to the correct specialist surgeon, or those with benign cysts may undergo more serious surgery than is necessary. Furthermore, studies have reported that ovarian cancer patients have an increased chance of survival if referred to a specialized gynecological unity; currently, however, this option is not often presented to patients in the USA and Europe.
Although prediction models that differentiate between benign and malignant tumors already exist, the ADNEX test is more advanced. This is because it can discriminate between benign and malignant tumors, as well as accurately identifying different types of malignant tumor; including borderline, stage I invasive, stage II-IV invasive and secondary metastatic tumors.
Tom Bourne (Department of Surgery and Cancer, Imperial College London) emphasized the value of tests like these: “It’s very important to get the preoperative diagnosis right. If it isn’t right, the patient might have a more extensive operation than they need, for example having an ovary removed unnecessarily.
“If a tumor is benign, a woman might not need any treatment at all. If it is malignant, you need to know what type of tumor it is to choose the best treatment and that treatment needs to be carried out by specialist gynecological cancer surgeon.
“At the moment, the way we assess women with ovarian cysts for the presence of cancer and select treatment lacks accuracy. This new approach to classifying ovarian tumors can help doctors make the right management decisions, which will improve the outcome for women with cancer. It will also reduce the likelihood of women with all types of cysts having excessive or unnecessary treatment that may impact on their fertility.”
Development of the test involved data taken from 3506 patients across ten European countries between 1999 and 2007. The team investigated which of these preoperative data accurately predicted diagnosis. Finally, the researchers tested their model on a further 2403 patients between 2009 and 2012.
ADNEX uses patients’ clinical information, features identified from an ultrasound scan and a straightforward tumor marker blood test. The test not only identifies the tumor type, but also provides the confidence in the diagnosis as a percentage.
Moreover, the test is convenient for use by doctors. Doctors can either enter the necessary information into a clinical database or into a smartphone application. The team report that ADNEX is ready for use now.