Even when ob/gyns use guidelines from the ACOG/Society of Gynecologic Oncology to refer patients with pelvic pain to a gynecologic oncologist, many early-stage ovarian cancers are still missed. Among postmenopausal women, following the official recommendations yielded a sensitivity of 98.3% and a specificity of 59.9% among women who had late-stage primary ovarian cancer or peritoneal cancer. The positive predictive value for the group was 56.8%. But for women with early-stage tumors, the results were somewhat disappointing: Sensitivity 79.6%, positive predictive value (PPV) 24.3%. Among premenopausal women, the guidelines proved even less sensitive in detecting early cancer: 55.6% (vs. 92.3% for late-stage cancers) and only 14.75 for PPV (vs. 29.3% for late disease.) The ACOG/SGO guidelines take into account menopausal status, CA125 level, imaging data, physical findings, and family history. 

Dearking AC, Aletti GD, Sommerfield MK, et al. How relevant are the American College of Obstetricians and Gynecologists/Society of Gynecologic Oncology guidelines for referral of adnexal mass? 