Gynecologic oncology referral rates of adnexal masses suspicious for ovarian cancer in an academic health system: A cohort study.

Abstract

5544 Background: Ovarian-Adnexal Reporting Data System (O-RADS) is an international lexicon and risk stratification tool. O-RADS 4 or 5 lesions are complex adnexal masses that a 10-90% risk of malignancy, and national guidelines recommend gynecologic oncology referral. Our objective was to examine patient, clinician, and imaging factors associated with referral to gynecologic oncology for complex adnexal masses. Methods: This retrospective cohort study was exempt from IRB review. We identified all patients with O-RADS 4 or 5 lesions on ultrasound (US) or MRI from July 1, 2020 to December 31, 2023. Our primary outcome was referral to gynecologic oncology. We gathered patient demographic data and ordering clinician characteristics from electronic health records. We performed descriptive statistics and multivariate logistic regression of patient demographics and ordering clinician characteristics associated with gynecologic oncology referral. Results: Our cohort included 373 patients with O-RADS 4 or 5 lesions and no prior gynecologic oncology care. The referral rate to gynecologic oncology was 68%, and referral within 30 days of abnormal imaging was 43%. Time from abnormal imaging to referral ranged from 0 to 407 days (mean 15.3, median 4 days). In multivariate analyses, the likelihood of referral to gynecologic oncology was higher among patients with repeat abnormal imaging compared to those with single instance of abnormal imaging (aOR 20.61, 95%CI 2.63-161.6), O-RADS 5 lesions compared to O-RADS 4 lesions (aOR 9.15, 95%CI 3.47-24.85) and detection on MRI compared to US (aOR 7.79, 95%CI 1.57-38.65). The likelihood of referral to gynecologic oncology was lower among non-white patients (aOR 0.24, 95%CI 0.08-0.76). There were no differences by Hispanic ethnicity, rurality, insurance, or language. Referral was higher among patients whose imaging was ordered by an internal medicine clinician (aOR 3.89, 95%CI 1.48-10.20) compared to ob/gyn. Conclusions: One-third of patients with complex adnexal masses were not referred to gynecologic oncology. Disparities in referral to gynecologic oncology for complex adnexal masses rates based on patient race and ordering clinician specialty highlight the need for system-based approaches including clinician education or automated referrals. Gynecologic oncology referral after O-RADS 4/5. Multivariate OR (95%CI) Postmenopausal (≥55 years) 1.89 (0.95-3.74) Race - White Reference - Black 0.57 (0.27-1.21) - Asian 1.03 (0.30-3.58) - Some other race 0.24 (0.08-0.76) Ordering specialty - Obstetrics/Gynecology Reference - Emergency Medicine 0.93 (0.33-2.62) - Internal Medicine 3.89 (1.48-10.20) - Family Medicine 1.62 (0.66-3.98) - Other specialty 0.87 (0.27-2.76) Has PCP 1.66 (0.81-3.42) O-RADS - 4 Reference - 5 9.15 (3.27-24.85) Imaging - MRI 7.79 (1.57-38.65) - US Reference Repeat abnormal imaging 20.61 (2.63-161.79)