The majority of these adnexal cysts and masses are managed by general gynaecologists, which may lead to inadequate staging of ovarian cancer during the primary operation [2, 3].
Incomplete or inadequate staging often leads to an imprecise understanding of the clinical conditions of the patient and hence to inappropriate or incomplete therapeutic planning.
Although large and complicated processes were optimized by the multiagent system, there were several cases where the HEN simplification had stopped at the insufficient and inadequate stages.
Surgery is often required in this situation owing to inadequate staging.
Omitting lymphadenectomy carries a risk of inadequate staging, leading to secondary lymphadenectomy or systematic adjuvant radiotherapy.
Exclusion criteria included inadequate assessment of histological grade, inadequate staging, synchronous breast primary tumours, surgeon or patient refusal, or previous malignancies.
Axillary treatment was considered inadequate if further treatment (surgery or radiotherapy) was omitted after an inadequate staging procedure, or a positive axillary sample.
The peak could be related to inadequate staging evaluation, because at the time of the study no bone scan, liver ultrasound or computed tomography scan staging was done.
In December 2001, however, the National Confidential Enquiry on Perioperative Deaths (NCEPOD) reported wide variation in hospital caseloads and experience, inadequate staging by clinicians, insufficient reporting of stage by pathologists and poor compliance with treatment guidelines for cancer patients operated as recently as 1999 2000 (NCEPOD, 2001).
In addition, many previous studies suffered limitations of design or methodology (e.g. low accrual, inadequate disease stage selection, inadequate surgical treatment) that may have obscured a treatment effect.
