Anne Dørum

Base rate of ovarian cancer on algorithms in patients with a pelvic mass

Algorithms have been developed to identify ovarian cancer in women with a pelvic mass. The aim of this study was to determine how the base rates of ovarian cancer influence the case finding abilities of recently developed algorithms applicable to pelvic tumors. We used three ovarian cancer algorithms and the principle of Bayes' theorem for risk estimation. First, we evaluated the case finding abilities of the Risk of Malignancy Algorithm, the Rajavithi-Ovarian Predictive Score, and the Copenhagen Index in a prospectively collected sample at Oslo University Hospital of 227 postmenopausal women with a 74% base rate of ovarian cancer. Second, we examined the case finding abilities of the Risk of Malignancy Algorithm in three published studies with different base rates of ovarian cancer. We applied Bayes' theorem in these examinations. In the Oslo sample, all three algorithms functioned poorly as case finders for ovarian cancer. When the base rate changed from 8.2% to 43.8% in the three studies using the Risk of Malignancy Algorithm, the proportion of false negative ovarian cancer diagnoses increased from 1.2% to 3.4%, and the number of false positive diagnosis increased from 4.6% to 14.2%. This study demonstrated that the base rate of ovarian cancer in the samples tested was important for the case finding abilities of algorithms.

Cold Atmospheric Pressure Plasma (CAP) as a New Tool for the Management of Vulva Cancer and Vulvar Premalignant Lesions in Gynaecological Oncology

Vulvar cancer (VC) is a specific form of malignancy accounting for 5–6% of all gynaecologic malignancies. Although VC occurs most commonly in women after 60 years of age, disease incidence has risen progressively in premenopausal women in recent decades. VC demonstrates particular features requiring well-adapted therapeutic approaches to avoid potential treatment-related complications. Significant improvements in disease-free survival and overall survival rates for patients diagnosed with post-stage I disease have been achieved by implementing a combination therapy consisting of radical surgical resection, systemic chemotherapy and/or radiotherapy. Achieving local control remains challenging. However, mostly due to specific anatomical conditions, the need for comprehensive surgical reconstruction and frequent post-operative healing complications. Novel therapeutic tools better adapted to VC particularities are essential for improving individual outcomes. To this end, cold atmospheric plasma (CAP) treatment is a promising option for VC, and is particularly appropriate for the local treatment of dysplastic lesions, early intraepithelial cancer, and invasive tumours. In addition, CAP also helps reduce inflammatory complications and improve wound healing. The application of CAP may realise either directly or indirectly utilising nanoparticle technologies. CAP has demonstrated remarkable treatment benefits for several malignant conditions, and has created new medical fields, such as “plasma medicine” and “plasma oncology”. This article highlights the benefits of CAP for the treatment of VC, VC pre-stages, and postsurgical wound complications. There has not yet been a published report of CAP on vulvar cancer cells, and so this review summarises the progress made in gynaecological oncology and in other cancers, and promotes an important, understudied area for future research. The paradigm shift from reactive to predictive, preventive and personalised medical approaches in overall VC management is also considered.