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Review

Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools

1
The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
2
University of Exeter Medical School, University of Exeter, Exeter EX1 1TX, UK
3
Gynaecological Oncology Research Group, Division of Cancer Sciences, University of Manchester, Manchester M13 9WL, UK
4
Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester M13 9WL, UK
5
Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC 3000, Australia
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(12), 3686; https://doi.org/10.3390/cancers12123686
Received: 12 November 2020 / Revised: 2 December 2020 / Accepted: 4 December 2020 / Published: 8 December 2020
Most women with ovarian cancer are diagnosed after they develop symptoms—identifying symptomatic women earlier has the potential to improve outcomes. Tools, ranging from simple symptom checklists to diagnostic prediction models that incorporate tests and risk factors, have been developed to help identify women at increased risk of undiagnosed ovarian cancer. In this review, we systematically identified studies evaluating these tools and then compared the reported diagnostic performance of tools. All included studies had some quality concerns and most tools had only been evaluated in a single study. However, four tools were evaluated in multiple studies and showed moderate diagnostic performance, with relatively little difference in performance between tools. While encouraging, further large and well-conducted studies are needed to ensure these tools are acceptable to patients and clinicians, are cost-effective and facilitate the early diagnosis of ovarian cancer.
In the absence of effective ovarian cancer screening programs, most women are diagnosed following the onset of symptoms. Symptom-based tools, including symptom checklists and risk prediction models, have been developed to aid detection. The aim of this systematic review was to identify and compare the diagnostic performance of these tools. We searched MEDLINE, EMBASE and Cochrane CENTRAL, without language restriction, for relevant studies published between 1 January 2000 and 3 March 2020. We identified 1625 unique records and included 16 studies, evaluating 21 distinct tools in a range of settings. Fourteen tools included only symptoms; seven also included risk factors or blood tests. Four tools were externally validated—the Goff Symptom Index (sensitivity: 56.9–83.3%; specificity: 48.3–98.9%), a modified Goff Symptom Index (sensitivity: 71.6%; specificity: 88.5%), the Society of Gynaecologic Oncologists consensus criteria (sensitivity: 65.3–71.5%; specificity: 82.9–93.9%) and the QCancer Ovarian model (10% risk threshold—sensitivity: 64.1%; specificity: 90.1%). Study heterogeneity precluded meta-analysis. Given the moderate accuracy of several tools on external validation, they could be of use in helping to select women for ovarian cancer investigations. However, further research is needed to assess the impact of these tools on the timely detection of ovarian cancer and on patient survival. View Full-Text
Keywords: ovarian cancer; symptoms; early detection; risk assessment; diagnostic prediction model; triage tool; ovarian cancer symptoms ovarian cancer; symptoms; early detection; risk assessment; diagnostic prediction model; triage tool; ovarian cancer symptoms
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MDPI and ACS Style

Funston, G.; Hardy, V.; Abel, G.; Crosbie, E.J.; Emery, J.; Hamilton, W.; Walter, F.M. Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools. Cancers 2020, 12, 3686. https://doi.org/10.3390/cancers12123686

AMA Style

Funston G, Hardy V, Abel G, Crosbie EJ, Emery J, Hamilton W, Walter FM. Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools. Cancers. 2020; 12(12):3686. https://doi.org/10.3390/cancers12123686

Chicago/Turabian Style

Funston, Garth, Victoria Hardy, Gary Abel, Emma J. Crosbie, Jon Emery, Willie Hamilton, and Fiona M. Walter 2020. "Identifying Ovarian Cancer in Symptomatic Women: A Systematic Review of Clinical Tools" Cancers 12, no. 12: 3686. https://doi.org/10.3390/cancers12123686

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