The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer
Objective. The purpose of this study was to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer. Methods. Annual TVS screening was performed on 14,469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women ≥ 50 years of a...
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| Veröffentlicht in: | Gynecologic oncology 2000-06, Vol.77 (3), p.350-356 |
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| description | Objective. The purpose of this study was to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer.
Methods. Annual TVS screening was performed on 14,469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women ≥ 50 years of age and (2) women ≥ 25 years of age with a family history of ovarian cancer. Ovarian volume was calculated using the prolate ellipsoid (length × height × width × 0.523). An abnormal sonogram was defined by (1) an ovarian volume >10 cm3 in postmenopausal women or >20 cm3 in premenopausal women or (2) a papillary or complex tissue projection into a cystic ovarian tumor. All women with abnormal TVS had a repeat sonogram in 4–6 weeks. Patients with a persistently abnormal second screen had a serum CA-125 determination, tumor morphology indexing, and Doppler flow sonography, and were advised to have surgical tumor removal.
Results. One hundred eighty patients with persisting TVS abnormalities underwent exploratory laparoscopy or laparotomy. Seventeen ovarian cancers were detected: 11 Stage I, 3 Stage II, and 3 Stage III. Only three patients with Stage I cancers had a palpable ovarian mass on clinical examination. All patients with Stage I and II ovarian cancer are alive without recurrence 1.8–9.8 years (median, 4.5 years) after diagnosis. Two of the three Stage III patients have died of disease: one at 4.3 years and one at 7.7 years after detection. Four patients developed ovarian cancer within 12 months of a negative scan (FN): 2 Stage II, 2 Stage III. Three of these patients are alive with no evidence of disease 0.4, 1.9, and 5.5 years after diagnosis, and 1 patient has died of disease 0.7 years after diagnosis. Four patients developed ovarian cancer more than 12 months following a normal screen. All 4 presented clinically with Stage III disease. Two of these patients have died of disease and two patients are alive 1.5 and 2.1 years after diagnosis. TVS screening was associated with the following statistical variables: sensitivity, 81%; specificity, 98.9%; positive predictive value (PPV), 9.4%; and negative predictive value (NPV), 99.97%. After 46,113 screening years, there have been 3 ovarian cancer deaths in the annually screened population and 2 ovarian cancer deaths in women receiving less than annual screening. The survival of ovarian cancer patients in the annually screened population was 95.0 ± 4.9% at 2 years and 88.2 ± 8.0% at 5 years. Excluding all cases o |
| doi_str_mv | 10.1006/gyno.2000.5816 |
| format | Article |
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Methods. Annual TVS screening was performed on 14,469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women ≥ 50 years of age and (2) women ≥ 25 years of age with a family history of ovarian cancer. Ovarian volume was calculated using the prolate ellipsoid (length × height × width × 0.523). An abnormal sonogram was defined by (1) an ovarian volume >10 cm3 in postmenopausal women or >20 cm3 in premenopausal women or (2) a papillary or complex tissue projection into a cystic ovarian tumor. All women with abnormal TVS had a repeat sonogram in 4–6 weeks. Patients with a persistently abnormal second screen had a serum CA-125 determination, tumor morphology indexing, and Doppler flow sonography, and were advised to have surgical tumor removal.
Results. One hundred eighty patients with persisting TVS abnormalities underwent exploratory laparoscopy or laparotomy. Seventeen ovarian cancers were detected: 11 Stage I, 3 Stage II, and 3 Stage III. Only three patients with Stage I cancers had a palpable ovarian mass on clinical examination. All patients with Stage I and II ovarian cancer are alive without recurrence 1.8–9.8 years (median, 4.5 years) after diagnosis. Two of the three Stage III patients have died of disease: one at 4.3 years and one at 7.7 years after detection. Four patients developed ovarian cancer within 12 months of a negative scan (FN): 2 Stage II, 2 Stage III. Three of these patients are alive with no evidence of disease 0.4, 1.9, and 5.5 years after diagnosis, and 1 patient has died of disease 0.7 years after diagnosis. Four patients developed ovarian cancer more than 12 months following a normal screen. All 4 presented clinically with Stage III disease. Two of these patients have died of disease and two patients are alive 1.5 and 2.1 years after diagnosis. TVS screening was associated with the following statistical variables: sensitivity, 81%; specificity, 98.9%; positive predictive value (PPV), 9.4%; and negative predictive value (NPV), 99.97%. After 46,113 screening years, there have been 3 ovarian cancer deaths in the annually screened population and 2 ovarian cancer deaths in women receiving less than annual screening. The survival of ovarian cancer patients in the annually screened population was 95.0 ± 4.9% at 2 years and 88.2 ± 8.0% at 5 years. Excluding all cases of nonepithelial or borderline epithelial malignancies, the survival of patients with ovarian cancer in the annually screened population was 92.9 ± 6.9% at 2 years and 83.6 ± 10.8% at 5 years.
Conclusions. (1) TVS screening, when performed annually, is associated with a decrease in stage at detection and a decrease in case-specific ovarian cancer mortality. (2) TVS screening does not appear to be effective in detecting ovarian cancer in which ovarian volume is normal.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1006/gyno.2000.5816</identifier><identifier>PMID: 10831341</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Carcinoma - diagnosis ; Carcinoma - diagnostic imaging ; Carcinoma - pathology ; Female ; Humans ; Mass Screening ; Middle Aged ; Ovarian Neoplasms - diagnosis ; Ovarian Neoplasms - diagnostic imaging ; Ovarian Neoplasms - pathology ; Predictive Value of Tests ; Prognosis ; Risk Factors ; Sensitivity and Specificity ; Ultrasonography - methods ; Ultrasonography - standards</subject><ispartof>Gynecologic oncology, 2000-06, Vol.77 (3), p.350-356</ispartof><rights>2000 Academic Press</rights><rights>Copyright 2000 Academic Press.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-9873f05bfea36e015f08aa812aaa61f67de2b3190b07a635bde5e69583f9863</citedby><cites>FETCH-LOGICAL-c435t-9873f05bfea36e015f08aa812aaa61f67de2b3190b07a635bde5e69583f9863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1006/gyno.2000.5816$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10831341$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Nagell, J.R.</creatorcontrib><creatorcontrib>DePriest, P.D.</creatorcontrib><creatorcontrib>Reedy, M.B.</creatorcontrib><creatorcontrib>Gallion, H.H.</creatorcontrib><creatorcontrib>Ueland, F.R.</creatorcontrib><creatorcontrib>Pavlik, E.J.</creatorcontrib><creatorcontrib>Kryscio, R.J.</creatorcontrib><title>The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>Objective. The purpose of this study was to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer.
Methods. Annual TVS screening was performed on 14,469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women ≥ 50 years of age and (2) women ≥ 25 years of age with a family history of ovarian cancer. Ovarian volume was calculated using the prolate ellipsoid (length × height × width × 0.523). An abnormal sonogram was defined by (1) an ovarian volume >10 cm3 in postmenopausal women or >20 cm3 in premenopausal women or (2) a papillary or complex tissue projection into a cystic ovarian tumor. All women with abnormal TVS had a repeat sonogram in 4–6 weeks. Patients with a persistently abnormal second screen had a serum CA-125 determination, tumor morphology indexing, and Doppler flow sonography, and were advised to have surgical tumor removal.
Results. One hundred eighty patients with persisting TVS abnormalities underwent exploratory laparoscopy or laparotomy. Seventeen ovarian cancers were detected: 11 Stage I, 3 Stage II, and 3 Stage III. Only three patients with Stage I cancers had a palpable ovarian mass on clinical examination. All patients with Stage I and II ovarian cancer are alive without recurrence 1.8–9.8 years (median, 4.5 years) after diagnosis. Two of the three Stage III patients have died of disease: one at 4.3 years and one at 7.7 years after detection. Four patients developed ovarian cancer within 12 months of a negative scan (FN): 2 Stage II, 2 Stage III. Three of these patients are alive with no evidence of disease 0.4, 1.9, and 5.5 years after diagnosis, and 1 patient has died of disease 0.7 years after diagnosis. Four patients developed ovarian cancer more than 12 months following a normal screen. All 4 presented clinically with Stage III disease. Two of these patients have died of disease and two patients are alive 1.5 and 2.1 years after diagnosis. TVS screening was associated with the following statistical variables: sensitivity, 81%; specificity, 98.9%; positive predictive value (PPV), 9.4%; and negative predictive value (NPV), 99.97%. After 46,113 screening years, there have been 3 ovarian cancer deaths in the annually screened population and 2 ovarian cancer deaths in women receiving less than annual screening. The survival of ovarian cancer patients in the annually screened population was 95.0 ± 4.9% at 2 years and 88.2 ± 8.0% at 5 years. Excluding all cases of nonepithelial or borderline epithelial malignancies, the survival of patients with ovarian cancer in the annually screened population was 92.9 ± 6.9% at 2 years and 83.6 ± 10.8% at 5 years.
Conclusions. (1) TVS screening, when performed annually, is associated with a decrease in stage at detection and a decrease in case-specific ovarian cancer mortality. (2) TVS screening does not appear to be effective in detecting ovarian cancer in which ovarian volume is normal.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma - diagnosis</subject><subject>Carcinoma - diagnostic imaging</subject><subject>Carcinoma - pathology</subject><subject>Female</subject><subject>Humans</subject><subject>Mass Screening</subject><subject>Middle Aged</subject><subject>Ovarian Neoplasms - diagnosis</subject><subject>Ovarian Neoplasms - diagnostic imaging</subject><subject>Ovarian Neoplasms - pathology</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Ultrasonography - methods</subject><subject>Ultrasonography - standards</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kEFPGzEQha2qqATaa4_Ip942jNfY6z2iCCgSEhKJ1KM16x0Ht1k72JtI-fdsFA69cJrDfO9J72Psp4C5ANDX60NM8xoA5soI_YXNBLSq0ka1X9kMoIXK1Mqcs4tS_k6UBFF_Y-cCjBTyRsyYW70Sv_M-OHQHnjxfZYxlj-sQccOXKaZ1xu1rcHzpMlEMcc1D5LflMGzHNOA4ff6kgSLHkb-E8o_7lPnzHnPAyBcYHeXv7MzjptCPj3vJlvd3q8Xv6un54XFx-1S5G6nGqjWN9KA6Tyg1gVAeDKIRNSJq4XXTU91J0UIHDWqpup4U6VYZ6Vuj5SX7dWrd5vS2ozLaIRRHmw1GSrtiGyFUrRozgfMT6HIqJZO32xwGzAcrwB6l2qNUe5Rqj1KnwNVH864bqP8PP1mcAHMCaFq3D5RtcYGm6X3I5Ebbp_BZ9zt7Y4aZ</recordid><startdate>20000601</startdate><enddate>20000601</enddate><creator>van Nagell, J.R.</creator><creator>DePriest, P.D.</creator><creator>Reedy, M.B.</creator><creator>Gallion, H.H.</creator><creator>Ueland, F.R.</creator><creator>Pavlik, E.J.</creator><creator>Kryscio, R.J.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20000601</creationdate><title>The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer</title><author>van Nagell, J.R. ; DePriest, P.D. ; Reedy, M.B. ; Gallion, H.H. ; Ueland, F.R. ; Pavlik, E.J. ; Kryscio, R.J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-9873f05bfea36e015f08aa812aaa61f67de2b3190b07a635bde5e69583f9863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma - diagnosis</topic><topic>Carcinoma - diagnostic imaging</topic><topic>Carcinoma - pathology</topic><topic>Female</topic><topic>Humans</topic><topic>Mass Screening</topic><topic>Middle Aged</topic><topic>Ovarian Neoplasms - diagnosis</topic><topic>Ovarian Neoplasms - diagnostic imaging</topic><topic>Ovarian Neoplasms - pathology</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Ultrasonography - methods</topic><topic>Ultrasonography - standards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Nagell, J.R.</creatorcontrib><creatorcontrib>DePriest, P.D.</creatorcontrib><creatorcontrib>Reedy, M.B.</creatorcontrib><creatorcontrib>Gallion, H.H.</creatorcontrib><creatorcontrib>Ueland, F.R.</creatorcontrib><creatorcontrib>Pavlik, E.J.</creatorcontrib><creatorcontrib>Kryscio, R.J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Nagell, J.R.</au><au>DePriest, P.D.</au><au>Reedy, M.B.</au><au>Gallion, H.H.</au><au>Ueland, F.R.</au><au>Pavlik, E.J.</au><au>Kryscio, R.J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2000-06-01</date><risdate>2000</risdate><volume>77</volume><issue>3</issue><spage>350</spage><epage>356</epage><pages>350-356</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>Objective. The purpose of this study was to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer.
Methods. Annual TVS screening was performed on 14,469 asymptomatic women from 1987 to 1999. Eligibility criteria included (1) all women ≥ 50 years of age and (2) women ≥ 25 years of age with a family history of ovarian cancer. Ovarian volume was calculated using the prolate ellipsoid (length × height × width × 0.523). An abnormal sonogram was defined by (1) an ovarian volume >10 cm3 in postmenopausal women or >20 cm3 in premenopausal women or (2) a papillary or complex tissue projection into a cystic ovarian tumor. All women with abnormal TVS had a repeat sonogram in 4–6 weeks. Patients with a persistently abnormal second screen had a serum CA-125 determination, tumor morphology indexing, and Doppler flow sonography, and were advised to have surgical tumor removal.
Results. One hundred eighty patients with persisting TVS abnormalities underwent exploratory laparoscopy or laparotomy. Seventeen ovarian cancers were detected: 11 Stage I, 3 Stage II, and 3 Stage III. Only three patients with Stage I cancers had a palpable ovarian mass on clinical examination. All patients with Stage I and II ovarian cancer are alive without recurrence 1.8–9.8 years (median, 4.5 years) after diagnosis. Two of the three Stage III patients have died of disease: one at 4.3 years and one at 7.7 years after detection. Four patients developed ovarian cancer within 12 months of a negative scan (FN): 2 Stage II, 2 Stage III. Three of these patients are alive with no evidence of disease 0.4, 1.9, and 5.5 years after diagnosis, and 1 patient has died of disease 0.7 years after diagnosis. Four patients developed ovarian cancer more than 12 months following a normal screen. All 4 presented clinically with Stage III disease. Two of these patients have died of disease and two patients are alive 1.5 and 2.1 years after diagnosis. TVS screening was associated with the following statistical variables: sensitivity, 81%; specificity, 98.9%; positive predictive value (PPV), 9.4%; and negative predictive value (NPV), 99.97%. After 46,113 screening years, there have been 3 ovarian cancer deaths in the annually screened population and 2 ovarian cancer deaths in women receiving less than annual screening. The survival of ovarian cancer patients in the annually screened population was 95.0 ± 4.9% at 2 years and 88.2 ± 8.0% at 5 years. Excluding all cases of nonepithelial or borderline epithelial malignancies, the survival of patients with ovarian cancer in the annually screened population was 92.9 ± 6.9% at 2 years and 83.6 ± 10.8% at 5 years.
Conclusions. (1) TVS screening, when performed annually, is associated with a decrease in stage at detection and a decrease in case-specific ovarian cancer mortality. (2) TVS screening does not appear to be effective in detecting ovarian cancer in which ovarian volume is normal.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>10831341</pmid><doi>10.1006/gyno.2000.5816</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Carcinoma - diagnosis Carcinoma - diagnostic imaging Carcinoma - pathology Female Humans Mass Screening Middle Aged Ovarian Neoplasms - diagnosis Ovarian Neoplasms - diagnostic imaging Ovarian Neoplasms - pathology Predictive Value of Tests Prognosis Risk Factors Sensitivity and Specificity Ultrasonography - methods Ultrasonography - standards |
| title | The Efficacy of Transvaginal Sonographic Screening in Asymptomatic Women at Risk for Ovarian Cancer |
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