Demir Richard H, Marchand Greg J
Arizona Regional Medical Center, Mesa, AZ, USA.
JSLS. 2012 Jan-Mar;16(1):71-84. doi: 10.4293/108680812X13291597716069.
Guidelines for referring women with pelvic masses suspicious for ovarian cancer to gynecologic oncologists have been developed by the American College of Obstetrician Gynecologists (ACOG). We set out to evaluate the negative predictive value of these guidelines and to assess a modified algorithm involving minimally invasive surgery in the treatment of women with masses suspected to be benign.
257 consecutive patients with adnexal masses of 8cm to 13cm on preoperative ultrasound examination meeting Triage Criteria set forth in ACOG Committee Opinion 280. Patients meeting the selection criteria were scheduled for operative laparoscopy, washings, adnexectomy, bagging, and colpotomy. A total of 240 patients successfully completed intended treatment (93.38%), and 234 of these did not require admission (97.5%). There was a low incidence of significant complications: 97.50% of women were successfully treated as outpatients, 97.92% of surgeries lasted <136 minutes, and <97.08% had blood loss <200mL. The negative predictive value of ACOG Committee Opinion 280 Triage Criteria as a deselector for having invasive ovarian malignancy in our population was 95.57% for premenopausal and 90.91% for postmenopausal women.
Laparoscopic adnexectomy, bagging, and colpotomy is a desirable goal for patients with ovarian masses in the 8cm to 13cm range meeting selection criteria affording a minimally invasive approach with attendant benefits including outpatient treatment (97.5%), few complications, low likelihood of iatrogenic rupture of the ovarian capsule (1.25%), and low necessity for reoperation after final pathology is evaluated (6.03%). Negative predictive value of ACOG Committee Opinion 280 is confirmed in a community gynecology practice and is recommended to form the basis of a new treatment algorithm for women with adnexal masses.
美国妇产科医师学会(ACOG)已制定了将疑似卵巢癌的盆腔肿块女性转诊至妇科肿瘤学家的指南。我们旨在评估这些指南的阴性预测值,并评估一种改良算法,该算法涉及在治疗疑似良性肿块的女性时采用微创手术。
257例连续患者术前超声检查发现附件肿块大小为8cm至13cm,符合ACOG委员会意见280中规定的分诊标准。符合选择标准的患者安排进行手术腹腔镜检查、冲洗、附件切除术、装袋和阴道切开术。共有240例患者成功完成预期治疗(93.38%),其中234例无需住院(97.5%)。严重并发症发生率较低:97.50%的女性作为门诊患者成功治疗,97.92%的手术持续时间<136分钟,<97.08%的患者失血<200mL。在我们的人群中,ACOG委员会意见280分诊标准作为排除侵袭性卵巢恶性肿瘤的阴性预测值,绝经前女性为95.57%,绝经后女性为90.91%。
对于符合选择标准的8cm至13cm范围内的卵巢肿块患者,腹腔镜附件切除术、装袋和阴道切开术是一个理想的目标,提供了一种微创方法,具有包括门诊治疗(97.5%)、并发症少、卵巢包膜医源性破裂可能性低(1.25%)以及最终病理评估后再次手术必要性低(6.03%)等伴随益处。ACOG委员会意见280的阴性预测值在社区妇科实践中得到证实,并建议作为附件肿块女性新治疗算法的基础。