Table 1

Typical situations and use of text to describe the diagnostic process for patients with ovarian cancer and number of free texts and patients with text (referring to the ovary) according to our classification scheme

ScenarioExampleClassificationTextsPatientsNo (%)
Suggestive clinical feature but no mention of ovarian malignancy in text (before coded date)Seen by GP. Suspected ovarian cyst or ovarian mass—for example, ‘lump? ovary’ but no mention of cancerBlank151*105 (31)
Specific statement that clinical feature is benignText states that cyst or lump is benign or that there is no evidence (yet) of malignancy—for example, ‘multiple fibroids’, ‘thought to have ovarian ca but histology so far has shown benign cyst’, ‘the curettings were benign’Benign77 (2)
Referred for investigation of possible ovarian cancerSeen by GP. Symptoms and signs suspicious of possible ovarian cancer, so referred for urgent scan/blood tests or gynaecology outpatients appointmentSuspected11685 (25)
Diagnostic test indicates suspicion of ovarian cancerHas had scan/blood tests and report (or GP entry relating to report) is suspicious of ovarian cancer
Specialist's communication states that ovarian cancer very likelyHas been seen at gynaecology outpatient clinic, and consultant letter (or GP entry relating to letter) may state ovarian cancer diagnosis very likely
Specialist communication after surgery indicates presumptive ovarian cancer, but histology/cytology awaitedHas had surgery for probable ovarian cancer. Surgeon's report (or GP entry relating to report) may describe, for example, appearance of ovaries, presence of peritoneal spread, ascites. The surgeon may be confident of a diagnosis, but is still awaiting a histological (or cytological) confirmation
A malignancy is suspected or confirmed, but site/origin not yet establishedCancer is suspected, or has been confirmed but the site of the cancer has not yet been establishedAmbiguous5036 (10)
Metastatic cancer (non-ovarian origin)Cancer is from another site—for example, ‘metastic lobular carcinoma of the breast’Secondary51 (0)
Histologically or cytologically confirmed ovarian cancerHistological or cytological confirmation of ovarian cancer has been made—for example, from surgery such as laparotomy, or cytology from ascitic fluid drainageDefinite374220 (64)
Text provides additional confirmatory evidence of ovarian cancer (eg, grade, spread)The Read code for ovarian cancer is supplemented by extra information in the text such as ‘grade III’, ‘sig metastsatic spread’, ‘chemotherapy’
No further information available in free text on basis of the coded ovarian cancer diagnosisSometimes the information relating to how the doctor has arrived at the diagnosis is not there—for example, simply, ‘ovarian cancer’
Text on date of diagnosis excludes ovarian cancer as a diagnosis (eg, emendations indicating error, or discussion about cancer rather than diagnosis)For example, ‘this consultation has been changed as wrong diagnosis entered’, ‘Pt very concerned about possible cancer of ovary. … healthy eating and exercise discussed’Negation33 (1)
  • * ‘Blank’ text that was recorded on the date of diagnosis was not included in this category.

  • The misspellings and abbreviations included in the GP notes have been retained in the table.