title: Diagnostic performance of urgent referrals for suspected gynaecological malignancies.
abstract: OBJECTIVE
  The objective of this study was to investigate the outcome of the urgent referrals with suspected gynaecological malignancy.
  
  
  METHODS
  Retrospective analysis of the data of the urgent referrals for suspected gynaecological cancers over a 12-month period at a gynaecological oncology cancer centre in the UK.
  
  
  RESULTS
  A total of 233 patients (70.61%) were referred with suspected endometrial pathology, 59 patients (17.88%) with suspected ovarian, 25 patients (7.58%) with suspected cervical and 13 patients (3.94%) with suspected vulval malignancy. The positive predictive value of referrals for diagnosing endometrial, ovarian, cervical and vulval malignancy was 11.6, 23.7, 12.0 and 15.4%, respectively. Amongst the indications for referral for suspected endometrial cancer, presence of postmenopausal vaginal bleeding had the higher odds for cancer (odds = 0.13; 95% CI 0.08-0.21). The odds for cancer for women referred with a pelvic mass was 0.17 (95% CI, 0.07-0.42) and for women referred with abdominal bloating was 0.66 (95% CI, 0.18-2.36). All the cases of malignancy were diagnosed in women referred with suspicious appearance of the cervix on clinical examination. The odds for cancer was 0.50 if the indication for referral was vulval itching. The majority of cases of gynaecological cancers during the study period were diagnosed following routine referrals.
  
  
  CONCLUSIONS
  The overall predictive value of two-week wait referrals for suspected gynaecological malignancies is low. Refinement of the current referral guidelines is required with particular emphasis in the premenopausal women where the diagnostic performance of the urgent referrals is significantly poorer.
authors.affiliation: Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK. nikolaos.burbos@nnuh.nhs.uk
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Burbos
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.forename: Barnaby
authors.initials: B
authors.lastname: Rufford
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom; D014850:Waiting Lists