Predicting ovarian malignancy

Following the Calman-Hine report in 1995, the United Kingdom decided to establish a centralised healthcare system for the management of all gynaecological and other malignancies.1 This movement introduced tertiary centres in an attempt to improve the survival outcomes of patients with ovarian cancer by providing the best available treatment from specialist oncology surgeons and nurses in a secure multidisciplinary environment. Although no randomised trial has compared the results of this new scheme, many population cohort and retrospective studies have shown that the management of women by such a team, compared with management by general gynaecologists or surgeons, results in better survival outcomes.2 3

However, for such a costly system to work efficiently, referrals of patients from general practitioners and secondary care to the tertiary centres need to be well designed. The key concept in this setting is accuracy. Patients need to be referred as accurately as possible to avoid benign tumours being operated on by specialist surgeons and patients with ovarian cancer being operated on locally.

This is exactly the point where a prediction model …