Nonepithelial ovarian cancer - the current clinical practice in the Nordic countries. Survey from the surgical subcommittee of the Nordic society of gynecological oncology (NSGO).

BACKGROUND: Nonepithelial ovarian cancer (NEOC) represents a wide variety of rare tumors. They are often diagnosed at an early stage and have a good prognosis compared to epithelial ovarian cancer. In the Nordic countries, the total annual number of patients diagnosed with ovarian cancer, Fallopian tube cancer or primary peritoneal carcinoma (hereafter ovarian cancer) was 2281 in 2014-2018, of which 3-10% were NEOC. International guidelines for diagnosis, treatment and follow-up have been developed. We present the results of a survey, aiming at clarifying current clinical practice in the Nordic countries. MATERIAL AND METHODS: Between 09.2020 and 02.2021 a 33-question electronic survey was distributed to 22 hospitals in Finland, Sweden, Norway, Iceland and Denmark via the Nordic Society of Gynecological Oncology (NSGO) National Representatives. Data were collected in a secure web-based software platform. The questionnaire focused on demographics, diagnosis, treatment and follow-up programs. RESULTS: Twenty-one (95,4%) centers completed the survey. A total of 155 annual new NEOC cases treated in the Nordic countries were reported, corresponding to approximately 7% of all ovarian cancer cases. Most centers measured some or all of the recommended biomarkers routinely. Vaginal ultrasound and computed tomography (CT) were the preferred imaging modalities. The majority of centers conducted multidisciplinary team (MDT) meetings. The primary reported treatment was surgery. In 65% of centers, lymph node dissection was only performed in cases with suspicious lymph nodes. Surveillance was usually offered > four years. DISCUSSION: Despite, the presence of clinical European guidelines, variation in the current clinical practice amongst participating centers adhering to national guidelines was observed. Prospective clinical national research programs are sparse, and an enhanced cooperation in the Nordic countries toward development of a Nordic guideline and database is highly warranted and a prerequisite for future research, preferably in cooperation with the larger international groups.

[Intra- and interobserver variation in capsule endoscopy reviews]. / Intra- og interobservatøroverensstemmelse ved gennemsyn af kapselendoskopifilm.

INTRODUCTION: It is unclear which professional groups can and should perform reviews of capsule endoscopy (CE) exams of the GI tract. We investigate whether a junior doctor or an endoscopy nurse can review CE films with the same diagnostic results as a specialist. MATERIAL AND METHODS: An endoscopy nurse and a junior doctor, both with no CE experience, reviewed 30 CE films twice and noted their findings. A distinction was made between clinically important and non-important findings. An endoscopy specialist and the Given Imaging Review Service reviewed the films once each, and their findings were used as the study's gold standard. Time consumption, intra- and interobserver agreement, sensitivity and specificity were assessed. RESULTS: The junior doctor improved in speed from 1st to 2nd review, but the nurse did not. Both performed poorly compared with Given Imaging Review Service regarding diagnostic accuracy. The junior doctor improved in diagnostic accuracy from 1st to 2nd review, while the nurse did not. The nurse showed a decrease in sensitivity from 1st to 2nd review from 89% to 62%, whereas the junior doctor's sensitivity increased from 48% to 62%. Both missed many pathological findings and their results were not reproducible. CONCLUSION: The nurse and junior doctor did not obtain the same diagnostic results as the gold standard. The results raise questions of whether nurses or junior doctors should perform capsule endoscopy reviews.