Direct access from general practice to transvaginal ultrasound for early detection of ovarian cancer: a feasibility study
Creators: name: Baun, Marie-Louise Ladegaard
name: Dueholm, Margit
name: Heje, Hanne Nørgaard
name: Hamilton, William
name: Petersen, Lone Kjeld
name: Vedsted, Peter
Publisher: name: Taylor & Francis
Year: 2021
Subjects: subject: Medicine
subject: Cell Biology
subject: Genetics
subject: FOS: Biological sciences
subject: Physiology
subject: Biotechnology
subject: 59999 Environmental Sciences not elsewhere classified
subject: FOS: Earth and related environmental sciences
subject: Cancer
subject: Science Policy
subject: 110309 Infectious Diseases
subject: FOS: Health sciences

description: To investigate the feasibility of providing general practitioners (GPs) direct and fast referral access to transvaginal ultrasound (TVUS). A prospective cohort study. A total of 232 Danish general practices in parts of the Central Denmark Region. Women aged ≥40 years who consulted their GP for vague and non-specific symptoms (<i>n</i> = 479). The feasibility assessment included the GPs’ referral rate, indications for referral, management of test results, and findings from TVUS. A total of 479 women were referred to TVUS. The examinations revealed abnormalities in 104 (21.7%) women. Additional investigations were needed in 68 (14.2%) women of whom seven (1.5%) underwent major surgery. No case of ovarian cancer was diagnosed during the study period or the 6-month follow-up. However, three (0.6%) women with an abnormal transvaginal ultrasound were diagnosed with urogynecological cancer; this yielded a PPV of 4.4% (95% confidence interval: 1.5–12.2) and an NPV of 100.0% (95% confidence interval: 96.7–100.0) for urogynecological cancer. Providing GPs with direct access to transvaginal ultrasound was feasible; 80% of the investigated women were referred back to the GP, 14% were further investigated, 0.6% were diagnosed with urogynecological cancer, and 1.5% had major procedures performed without complications. Direct access to TVUS could be an important pathway to ensure fast evaluation of women presenting with vague non-specific symptoms of potential ovarian cancer. Future studies should explore the patient experience, cancer outcomes, and health economics issues.KEY POINTS <b>Current awareness</b> • GPs have no fast referral option for women presenting with vague non-specific symptoms that could indicate underlying ovarian cancer. <b>Key findings</b> • We offered GPs direct and fast referral access to TVUS; 51.7% of practices used the opportunity. • The GPs referred 479 women to TVUS; 104 had an abnormal TVUS and 68 needed additional investigations. • Seven women underwent major surgery, leading to three cases of urogynecological cancer. No woman had a false negative TVUS result. <b>Current awareness</b> • GPs have no fast referral option for women presenting with vague non-specific symptoms that could indicate underlying ovarian cancer. <b>Key findings</b> • We offered GPs direct and fast referral access to TVUS; 51.7% of practices used the opportunity. • The GPs referred 479 women to TVUS; 104 had an abnormal TVUS and 68 needed additional investigations. • Seven women underwent major surgery, leading to three cases of urogynecological cancer. No woman had a false negative TVUS result.