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Menon U, Gentry-Maharaj A, Burnell M, Ryan A, Kalsi JK, Singh N, Dawnay A, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Parmar M, Jacobs IJ. Mortality impact, risks, and benefits of general population screening for ovarian cancer: the UKCTOCS randomised controlled trial. Health Technol Assess 2023:1-81. [PMID: 37183782 PMCID: PMC10542866 DOI: 10.3310/bhbr5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Background Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage. Trial design Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland. Methods Postmenopausal average-risk women, aged 50-74, with intact ovaries and no previous ovarian or current non-ovarian cancer. Interventions One of two annual screening strategies: (1) multimodal screening (MMS) using a longitudinal CA125 algorithm with repeat CA125 testing and transvaginal scan (TVS) as second line test (2) ultrasound screening (USS) using TVS alone with repeat scan to confirm any abnormality. The control (C) group had no screening. Follow-up was through linkage to national registries, postal follow-up questionnaires and direct communication with trial centres and participants. Objective To assess comprehensively risks and benefits of ovarian cancer screening in the general population. Outcome Primary outcome was death due to ovarian or tubal cancer as assigned by an independent outcomes review committee. Secondary outcomes included incidence and stage at diagnosis of ovarian and tubal cancer, compliance, performance characteristics, harms and cost-effectiveness of the two screening strategies and a bioresource for future research. Randomisation The trial management system confirmed eligibility and randomly allocated participants using computer-generated random numbers to MMS, USS and C groups in a 1:1:2 ratio. Blinding Investigators and participants were unblinded and outcomes review committee was masked to randomisation group. Analyses Primary analyses were by intention to screen, comparing separately MMS and USS with C using the Versatile test. Results 1,243,282 women were invited and 205,090 attended for recruitment between April 2001 and September 2005. Randomised 202,638 women: 50,640 MMS, 50,639 USS and 101,359 C group. Numbers analysed for primary outcome 202,562 (>99.9%): 50,625 (>99.9%) MMS, 50,623 (>99.9%) USS, and 101,314 (>99.9%) C group. Outcome Women in MMS and USS groups underwent 345,570 and 327,775 annual screens between randomisation and 31 December 2011. At median follow-up of 16.3 (IQR 15.1-17.3) years, 2055 women developed ovarian or tubal cancer: 522 (1.0% of 50,625) MMS, 517 (1.0% of 50,623) USS, and 1016 (1.0% of 101314) in C group. Compared to the C group, in the MMS group, the incidence of Stage I/II disease was 39.2% (95% CI 16.1 to 66.9) higher and stage III/IV 10.2% (95% CI -21.3 to 2.4) lower. There was no difference in stage in the USS group. 1206 women died of the disease: 296 (0.6%) MMS, 291 (0.6%) USS, and 619 (0.6%) C group. There was no significant reduction in ovarian and tubal cancer deaths in either MMS (p = 0.580) or USS (p = 0.360) groups compared to the C group. Overall compliance with annual screening episode was 80.8% (345,570/420,047) in the MMS and 78.0% (327,775/420,047) in the USS group. For ovarian and tubal cancers diagnosed within one year of the last test in a screening episode, in the MMS group, the sensitivity, specificity and positive predictive values were 83.8% (95% CI 78.7 to 88.1), 99.8% (95% CI 99.8 to 99.9), and 28.8% (95% CI 25.5 to 32.2) and in the USS group, 72.2% (95% CI 65.9 to 78.0), 99.5% (95% CI 99.5 to 99.5), and 9.1% (95% CI 7.8 to 10.5) respectively. The final within-trial cost-effectiveness analysis was not undertaken as there was no mortality reduction. A bioresource (UKCTOCS Longitudinal Women's Cohort) of longitudinal outcome data and over 0.5 million serum samples including serial annual samples in women in the MMS group was established and to date has been used in many new studies, mainly focused on early detection of cancer. Harms Both screening tests (venepuncture and TVS) were associated with minor complications with low (8.6/100,000 screens MMS; 18.6/100,000 screens USS) complication rates. Screening itself did not cause anxiety unless more intense repeat testing was required following abnormal screens. In the MMS group, for each screen-detected ovarian or tubal cancer, an additional 2.3 (489 false positives; 212 cancers) women in the MMS group had unnecessary false-positive (benign adnexal pathology or normal adnexa) surgery. Overall, 14 (489/345,572 annual screens) underwent unnecessary surgery per 10,000 screens. In the USS group, for each screen-detected ovarian or tubal cancer, an additional 10 (1630 false positives; 164 cancers) underwent unnecessary false-positive surgery. Overall, 50 (1630/327,775 annual screens) women underwent unnecessary surgery per 10,000 screens. Conclusions Population screening for ovarian and tubal cancer for average-risk women using these strategies should not be undertaken. Decreased incidence of Stage III/IV cancers during multimodal screening did not translate to mortality reduction. Researchers should be cautious about using early stage as a surrogate outcome in screening trials. Meanwhile the bioresource provides a unique opportunity to evaluate early cancer detection tests. Funding Long-term follow-up UKCTOCS (2015-2020) - National Institute for Health and Care Research (NIHR HTA grant 16/46/01), Cancer Research UK, and The Eve Appeal. UKCTOCS (2001-2014) - Medical Research Council (MRC) (G9901012/G0801228), Cancer Research UK (C1479/A2884), and the UK Department of Health, with additional support from The Eve Appeal. Researchers at UCL were supported by the NIHR UCL Hospitals Biomedical Research Centre and by MRC Clinical Trials Unit at UCL core funding (MR_UU_12023).
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Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Service Trust, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | | | | | - Steven J Skates
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian J Jacobs
- Department of Women's Health, University of New South Wales, Sydney, NSW, Australia
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Wang T, Bin Y, Zhao L, Li Q. Positive Rate of Malignant Cells in Endometrial Cytology Samples of Ovarian Cancer, Fallopian Tube Cancer, and Primary Peritoneal Cancer Patients: A Systematic Review and Meta-Analysis. J Cytol 2023; 40:51-57. [PMID: 37388400 PMCID: PMC10305903 DOI: 10.4103/joc.joc_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 03/30/2023] [Indexed: 07/01/2023] Open
Abstract
To estimate the feasibility of diagnosing ovarian cancer, fallopian tube cancer, and primary peritoneal cancer through endometrial cytology, we performed a systematic review and meta-analysis to calculate the pooled positive rate of malignant cells in endometrial cytology samples. We queried PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trails from inception to November 12, 2020 for studies estimating positive rates of malignant cells in endometrial cytology samples from patients with ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The positive rates of the included studies were calculated as pooled positive rate through meta-analyses of proportion. Subgroup analysis based on different sampling methods was conducted. Seven retrospective studies involving 975 patients were included. Pooled positive rate of malignant cells in endometrial cytology specimens of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer patients was 23% (95% CI: 16% - 34%). Statistical heterogeneity between the included studies was considerable (I2 = 89%, P < 0.01). The pooled positive rates of the group of brushes and the group of aspiration smears were 13% (95% CI: 10% - 17%, I2 = 0, P = 0.45) and 33% (95% CI: 25% - 42%, I2 = 80%, P < 0.01), respectively. Although endometrial cytology is not an ideal diagnostic tool for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer, it is a convenient, painless, and easy-to-implement adjunct to other tools. Sampling method is one of the factors that affect the detection rate.
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Affiliation(s)
- Tiantian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Yadi Bin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Lanbo Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
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Laios A, Otify M, Papadopoulou A, Gallos ID, Ind T. Outcomes of ovarian transposition in cervical cancer; an updated meta-analysis. BMC Womens Health 2022; 22:305. [PMID: 35869476 PMCID: PMC9308360 DOI: 10.1186/s12905-022-01887-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice. Methods A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy. Results There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83–100), 89% (95% CI 80–99) of women who did not develop ovarian cysts, and 99% (95% CI 1–5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76–113), 84% (95% CI 69–103) of women who did not develop ovarian cysts, and 99% (95% CI 82–120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55–69), and 95% (95% CI 85–107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group. Conclusions In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
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Menon U, Gentry-Maharaj A, Burnell M, Singh N, Ryan A, Karpinskyj C, Carlino G, Taylor J, Massingham SK, Raikou M, Kalsi JK, Woolas R, Manchanda R, Arora R, Casey L, Dawnay A, Dobbs S, Leeson S, Mould T, Seif MW, Sharma A, Williamson K, Liu Y, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Jacobs IJ, Parmar M. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 2021; 397:2182-2193. [PMID: 33991479 PMCID: PMC8192829 DOI: 10.1016/s0140-6736(21)00731-5] [Citation(s) in RCA: 291] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ovarian cancer continues to have a poor prognosis with the majority of women diagnosed with advanced disease. Therefore, we undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up in UKCTOCS. METHODS In this randomised controlled trial, postmenopausal women aged 50-74 years were recruited from 13 centres in National Health Service trusts in England, Wales, and Northern Ireland. Exclusion criteria were bilateral oophorectomy, previous ovarian or active non-ovarian malignancy, or increased familial ovarian cancer risk. The trial management system confirmed eligibility and randomly allocated participants in blocks of 32 using computer generated random numbers to annual multimodal screening (MMS), annual transvaginal ultrasound screening (USS), or no screening, in a 1:1:2 ratio. Follow-up was through national registries. The primary outcome was death due to ovarian or tubal cancer (WHO 2014 criteria) by June 30, 2020. Analyses were by intention to screen, comparing MMS and USS separately with no screening using the versatile test. Investigators and participants were aware of screening type, whereas the outcomes review committee were masked to randomisation group. This study is registered with ISRCTN, 22488978, and ClinicalTrials.gov, NCT00058032. FINDINGS Between April 17, 2001, and Sept 29, 2005, of 1 243 282 women invited, 202 638 were recruited and randomly assigned, and 202 562 were included in the analysis: 50 625 (25·0%) in the MMS group, 50 623 (25·0%) in the USS group, and 101 314 (50·0%) in the no screening group. At a median follow-up of 16·3 years (IQR 15·1-17·3), 2055 women were diagnosed with tubal or ovarian cancer: 522 (1·0%) of 50 625 in the MMS group, 517 (1·0%) of 50 623 in the USS group, and 1016 (1·0%) of 101 314 in the no screening group. Compared with no screening, there was a 47·2% (95% CI 19·7 to 81·1) increase in stage I and 24·5% (-41·8 to -2·0) decrease in stage IV disease incidence in the MMS group. Overall the incidence of stage I or II disease was 39·2% (95% CI 16·1 to 66·9) higher in the MMS group than in the no screening group, whereas the incidence of stage III or IV disease was 10·2% (-21·3 to 2·4) lower. 1206 women died of the disease: 296 (0·6%) of 50 625 in the MMS group, 291 (0·6%) of 50 623 in the USS group, and 619 (0·6%) of 101 314 in the no screening group. No significant reduction in ovarian and tubal cancer deaths was observed in the MMS (p=0·58) or USS (p=0·36) groups compared with the no screening group. INTERPRETATION The reduction in stage III or IV disease incidence in the MMS group was not sufficient to translate into lives saved, illustrating the importance of specifying cancer mortality as the primary outcome in screening trials. Given that screening did not significantly reduce ovarian and tubal cancer deaths, general population screening cannot be recommended. FUNDING National Institute for Health Research, Cancer Research UK, and The Eve Appeal.
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Affiliation(s)
- Usha Menon
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Burnell
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Andy Ryan
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Chloe Karpinskyj
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Giulia Carlino
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Julie Taylor
- Clinical Epidemiology, Institute of Health Informatics, University College London, London, UK
| | - Susan K Massingham
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Maria Raikou
- Department of Health Policy, London School of Economics and Political Science, London, UK; Department of Economics, University of Piraeus, Athens, Greece
| | - Jatinderpal K Kalsi
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Robert Woolas
- Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK
| | - Ranjit Manchanda
- Department of Gynaecological Oncology, Barts Health NHS Trust, London, UK; Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London Hospitals NHS Trust, London, UK
| | - Laura Casey
- Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Anne Dawnay
- Department of Clinical Biochemistry, Barts Health NHS Trust, London, UK
| | - Stephen Dobbs
- Department of Gynaecological Oncology, Belfast City Hospital, Belfast, UK
| | - Simon Leeson
- Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Bangor, UK
| | - Tim Mould
- Department of Gynaecological Oncology, University College London Hospitals NHS Trust, London, UK
| | - Mourad W Seif
- Division of Gynaecology and Cancer Sciences, St Mary's Hospital, Manchester, UK
| | - Aarti Sharma
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Karin Williamson
- Department of Gynaecological Oncology, Nottingham City Hospital, Nottingham, UK
| | - Yiling Liu
- MGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, SHORE-C, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair J McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Steven J Skates
- MGH Biostatistics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ian J Jacobs
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK; Department of Women's Health, University of New South Wales, Sydney, NSW, Australia
| | - Mahesh Parmar
- MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
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Giants in Obstetrics and Gynecology Series: a profile of Stuart Campbell, DSc, FRCPEd, FRCOG, FACOG. Am J Obstet Gynecol 2020; 223:152-166. [PMID: 32731955 PMCID: PMC9933493 DOI: 10.1016/j.ajog.2020.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022]
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Bäumler M, Gallant D, Druckmann R, Kuhn W. Ultrasound screening of ovarian cancer. Horm Mol Biol Clin Investig 2019; 41:hmbci-2019-0022. [PMID: 31661436 DOI: 10.1515/hmbci-2019-0022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/20/2019] [Indexed: 12/12/2022]
Abstract
Ovarian cancer has a high mortality rate. The most common serous type spreads rapidly throughout the peritoneal cavity when 5-year survival is 10%. If diagnosed in earlier stages where the cancer is still confined to the ovary, this survival rate is about 90%. This is the reason to be interested in screening at earlier stages in the average-risk general population. Thus, annual transvaginal ultrasound (TVS) alone or as a multimodal screening test following serum carbohydrate antigen 125 (CA125) has been investigated. Ultrasound lacks sensitivity and specificity; new contrast-enhanced approaches might improve these. When the serum marker is combined with ultrasound and interpreted by a rise in the level rather than by a fixed cut-off, improved sensitivity and specificity and a late but not significant reduction in mortality are observed. Further investigations could highlight the interest of a shorter than annual screening, of a long-term follow-up and new contrast-enhanced ultrasound techniques.
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Affiliation(s)
| | - Delphine Gallant
- Universitair Ziekenhuis Gent, Gynecology and Obstetrics, Edegem, Belgium
| | - René Druckmann
- Société européenne de langues française et allemande de Gynécologie Obstétrique (SELFAGO), Nice, France
| | - Walther Kuhn
- Donauisar Klinikum Deggendorf-Dingolfing-Landau, Gynäkologie und Geburtshilfe, Deggendorf, Germany
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Ovarian function after ovarian transposition and additional pelvic radiotherapy: A systematic review. Eur J Surg Oncol 2019; 45:1328-1340. [DOI: 10.1016/j.ejso.2019.02.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/26/2019] [Accepted: 02/14/2019] [Indexed: 11/22/2022] Open
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Schincaglia P, Brondelli L, Cicognani A, Buzzi G, Orsini LF, Bovicelli L, Jasonni VM, Bucchi L. A Feasibility Study of Ovarian Cancer Screening: Does Fine-Needle Aspiration Improve Ultrasound Specificity? TUMORI JOURNAL 2018; 80:181-7. [PMID: 8053074 DOI: 10.1177/030089169408000304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The prognosis for ovarian cancer patients depends on the stage at diagnosis. As a prerequisite for any proposed procedure for ovarian cancer screening, high levels of specificity should be obtained using combinations of tests. Based on preliminary data from an ongoing feasibility study, this report is focused on the possible gain in specificity provided by fine-needle aspiration of occult ovarian masses detected by ultrasound. Methods Ultrasonography was used as a basic test, and fine-needle aspiration was obtained from selected patients. Those with (a) positive aspiration cytology or histology, (b) complex or solid masses showing volume increase, (c) complex or irregular masses and inadequate samples, and (d) recurrent cystic lesions were operated on. Results A total of 3541 asymptomatic patients 50-69 years of age underwent ultrasonography, and 98 were selected for fine-needle aspiration. Of these, 19 (positivity rate 19/3541 or 0.5%) were operated on. Two ovarian cancer cases (FIGO Stage II and III) were detected (detection rate 2/3541 or 0.6 × 1,000; positive predictive value 2/19 or 10.5%). Specificity was 3443/3539 or 97.3% for ultrasound alone and 3522/3539 or 99.5% for the procedure as a whole. Surgical exploration for relapses of benign cysts reduced by some 50% the potential gain in positive predictive value provided by aspiration cytology compared with ultrasound alone. Conclusions Although fine-needle aspiration has improved the performance of ultrasound, this 2-levei procedure does not appear to achieve acceptable levels of specificity.
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Granowska M, Mather SJ, Jobling T, Naeem M, Burchell J, Taylor-Papadimitriou J, Shepherd J, Britton KE. Radiolabelled Stripped Mucin, SM3, Monoclonal Antibody for Immunoscintigraphy of Ovarian Tumours. Int J Biol Markers 2018; 5:89-96. [PMID: 2283483 DOI: 10.1177/172460089000500208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A new monoclonal antibody, SM3, against stripped mucin core protein has been evaluated for the radioimmunoscintigraphy of ovarian cancer. It was radiolabelled with In-111, I-123 and Tc-99m and results showed a sensitivity of 95%, 100% and 100% and an accuracy of 73%, 86% and 100% for malignancy; respectively.
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Affiliation(s)
- M Granowska
- Department of Nuclear Medicine, St. Bartholomew's Hospital, London, England
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Artaş G, Pala Ş, Kuloğlu T, Atilgan R, Yavuzkir Ş, Akyol A. The effects of sclerotherapy with 5% trichloroacetic acid on the cyst diameter and ovarian tissue in the rat ovarian cyst model. J OBSTET GYNAECOL 2018; 38:686-692. [PMID: 29564948 DOI: 10.1080/01443615.2017.1399991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare the effects of only aspiration with aspiration and 5% trichloroacetic acid (TCA) application on ovarian cyst size and ovarian reserve. The ovarian cysts of 14 rats that were divided into two groups randomly were investigated after total salpingectomy procedure. G1 was the group of saline application after cyst aspiration, while in G2, after aspiration 5% TCA at half amount of aspiration volume was injected into the cyst and re-aspirated after five minutes. The abdomens of the rats were closed and re-explored after 1 month. The cyst diameters of the rats in each group were measured. Ovaries were removed for histopathological examination. There was no significant difference in cyst diameter in G1 before and after aspiration. In G2, there was a significant decrease in cyst size after TCA application. Ovarian follicle counts were not significantly different between the two groups. In conclusion, application of 5% TCA to the ovarian cysts for five minutes significantly reduces the cyst size. Impact Statement What is already known on this subject: Minimally invasive therapies come into prominence to avoid surgical complications and diminished fertility in the treatment of ovarian cysts. USG-guided aspiration and sclerosis has been reported as cost-efficient and effective treatment methods for localised benign cysts in other organs such as the thyroid, parathyroid, liver, kidney and spleen. It has been shown that sclerotherapy applied to infertile women with ovarian cysts reduces pelvic pain without affecting the number of follicles, term pregnancy and abortion rates, extracted oocytes, embryo quality or hormonal levels when compared to non-ovarian cystic infertile women. TCA is a chemical agent that is topically applied, not systemically absorptive, which causes denaturation of proteins and structural cell death, resulting in coagulation necrosis after chemical cauterisation. For this reason, we used 5% TCA to treat simple ovarian cysts on a rat model. What the results of this study add: In this experimental study, we showed that the application of 5% TCA into the cyst for five minutes - then aspirated - significantly reduced the size of the ovarian cysts. Five percent TCA application did not affect the ovarian reserve. What the implications are of these findings for clinical practice and/or further research: Our study is original because of the fact that to the best of our knowledge, this is the first study about the use of 5% TCA in treatment of ovarian cysts in the literature.
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Affiliation(s)
- Gökhan Artaş
- a Department of Pathology , Firat University School of Medicine , Elazig , Turkey
| | - Şehmus Pala
- b Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Tuncay Kuloğlu
- c Department of Histology and Embriology , Firat University School of Medicine , Elazig , Turkey
| | - Remzi Atilgan
- b Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Şeyda Yavuzkir
- b Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
| | - Alparslan Akyol
- b Department of Obstetrics and Gynecology , Firat University School of Medicine , Elazig , Turkey
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Campbell S, Gentry-Maharaj A. The role of transvaginal ultrasound in screening for ovarian cancer. Climacteric 2018; 21:221-226. [PMID: 29490504 DOI: 10.1080/13697137.2018.1433656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Ovarian cancer is a low-prevalence postmenopausal cancer with a high mortality rate and is the fifth most lethal cancer in women. The most common serous subtype with TP53 mutations spreads rapidly throughout the peritoneal cavity (stage III/IV) when 5-year survival is 10%. If diagnosed while confined to the ovary (stage I), the survival rate exceeds 90%. This is the rationale for screening. Annual transvaginal ultrasound (TVU) scans used as a primary screening modality or as a second-line test following primary screening with serum CA125 (multimodal) have been investigated in several trials. Only two large randomized controlled trials have provided mortality data. The US Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial studied over 78 000 women (randomized to screening with either TVU or CA125, or control) over 6 years with 14 years follow-up and found no mortality benefit from screening and increased morbidity in the screened arm. The UK Collaborative Trial of Ovarian Cancer Screening studied over 202 000 women randomized to TVU, multimodal or control in a 1 : 1 : 2 ratio over 7-11 years with 11 years follow-up. CA125 was interpreted by the Risk of Ovarian Cancer algorithm which identifies a rise in the level rather than a fixed cut-off. There was a late reduction in mortality after 7 years in the screened arm (23% in the multimodal arm and 21% in the TVU arm), but the overall reduction was not significant. Further follow-up may reveal whether TVU has a primary or secondary role in ovarian cancer screening.
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Affiliation(s)
| | - A Gentry-Maharaj
- b Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health , University College London , London , UK
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Yang WL, Lu Z, Bast RC. The role of biomarkers in the management of epithelial ovarian cancer. Expert Rev Mol Diagn 2017; 17:577-591. [PMID: 28468520 DOI: 10.1080/14737159.2017.1326820] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite advances in surgery and chemotherapy for ovarian cancer, 70% of women still succumb to the disease. Biomarkers have contributed to the management of ovarian cancer by monitoring response to treatment, detecting recurrence, distinguishing benign from malignant pelvic masses and attempting to detect disease at an earlier stage. Areas covered: This review focuses on recent advances in biomarkers and imaging for management of ovarian cancer with particular emphasis on early detection. Relevant literature has been reviewed and analyzed. Expert commentary: Rising or persistent CA125 blood levels provide a highly specific biomarker for epithelial ovarian cancer, but not an optimally sensitive biomarker. Addition of HE4, CA 72.4, anti-TP53 autoantibodies and other biomarkers can increase sensitivity for detecting early stage or recurrent disease. Detecting disease recurrence will become more important as more effective therapy is developed. Early detection will require the development not only of biomarker panels, but also of more sensitive and specific imaging strategies. Effective biomarker strategies are already available for distinguishing benign from malignant pelvic masses, but their use in identifying and referring patients with probable ovarian cancer to gynecologic oncologists for cytoreductive operations must be encouraged.
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Affiliation(s)
- Wei-Lei Yang
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Odyssey Program , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Zhen Lu
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Robert C Bast
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Yang WL, Lu Z, Bast RC. The role of biomarkers in the management of epithelial ovarian cancer. Expert Rev Mol Diagn 2017. [PMID: 28468520 DOI: 10.1080/14737159.2017.1326820] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Despite advances in surgery and chemotherapy for ovarian cancer, 70% of women still succumb to the disease. Biomarkers have contributed to the management of ovarian cancer by monitoring response to treatment, detecting recurrence, distinguishing benign from malignant pelvic masses and attempting to detect disease at an earlier stage. Areas covered: This review focuses on recent advances in biomarkers and imaging for management of ovarian cancer with particular emphasis on early detection. Relevant literature has been reviewed and analyzed. Expert commentary: Rising or persistent CA125 blood levels provide a highly specific biomarker for epithelial ovarian cancer, but not an optimally sensitive biomarker. Addition of HE4, CA 72.4, anti-TP53 autoantibodies and other biomarkers can increase sensitivity for detecting early stage or recurrent disease. Detecting disease recurrence will become more important as more effective therapy is developed. Early detection will require the development not only of biomarker panels, but also of more sensitive and specific imaging strategies. Effective biomarker strategies are already available for distinguishing benign from malignant pelvic masses, but their use in identifying and referring patients with probable ovarian cancer to gynecologic oncologists for cytoreductive operations must be encouraged.
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Affiliation(s)
- Wei-Lei Yang
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Odyssey Program , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Zhen Lu
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Robert C Bast
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Yang WL, Lu Z, Bast RC. The role of biomarkers in the management of epithelial ovarian cancer. Expert Rev Mol Diagn 2017. [PMID: 28468520 DOI: 10.1080/14737159.2017.1326820]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
INTRODUCTION Despite advances in surgery and chemotherapy for ovarian cancer, 70% of women still succumb to the disease. Biomarkers have contributed to the management of ovarian cancer by monitoring response to treatment, detecting recurrence, distinguishing benign from malignant pelvic masses and attempting to detect disease at an earlier stage. Areas covered: This review focuses on recent advances in biomarkers and imaging for management of ovarian cancer with particular emphasis on early detection. Relevant literature has been reviewed and analyzed. Expert commentary: Rising or persistent CA125 blood levels provide a highly specific biomarker for epithelial ovarian cancer, but not an optimally sensitive biomarker. Addition of HE4, CA 72.4, anti-TP53 autoantibodies and other biomarkers can increase sensitivity for detecting early stage or recurrent disease. Detecting disease recurrence will become more important as more effective therapy is developed. Early detection will require the development not only of biomarker panels, but also of more sensitive and specific imaging strategies. Effective biomarker strategies are already available for distinguishing benign from malignant pelvic masses, but their use in identifying and referring patients with probable ovarian cancer to gynecologic oncologists for cytoreductive operations must be encouraged.
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Affiliation(s)
- Wei-Lei Yang
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,b Odyssey Program , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Zhen Lu
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Robert C Bast
- a Department of Experimental Therapeutics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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García-Tejedor A, Castellarnau M, Burdio F, Fernández E, Martí D, Pla MJ, Ponce J. Ultrasound-guided aspiration of adnexal cysts with a low risk of malignancy: is it a recommendable option? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:985-991. [PMID: 26014317 DOI: 10.7863/ultra.34.6.985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to establish the viability of ultrasound (US)-guided adnexal cyst aspiration and identify a target group in which this procedure would be advisable. METHODS A prospective cohort of 96 women with a low risk of malignant adnexal cysts was studied between 2002 and 2009, using recurrence after the procedure as the primary outcome measure. All procedures were performed on an outpatient basis without anesthesia. Patients were followed by US imaging at 6, 12, 24, 48, and 72 months. Potential risk factors for recurrence (menopausal status, previous hysterectomy, symptoms, US pattern, cyst diameter, and aspirated fluid volume and color) were analyzed by multivariate logistic regression. The association between recurrence and cyst size was calculated by Kaplan-Meier curves. RESULTS The median diameter of the cysts was 61 (range, 30-150) mm. Multivariate logistic regression analysis showed that an increased risk of recurrence was associated with a cyst diameter of greater than 70 mm (odds ratio, 4.2; 95% confidence interval, 1.2-14.1) and the presence of symptoms (odds ratio, 5.03; 95% confidence interval, 1.02-24.6). The median follow-up time was 24 (range, 2-78) months. Surgery was avoided in 64 patients (73.6%). Full cyst recurrence was observed in 34 patients (39.0%). CONCLUSIONS Ultrasound-guided aspiration is a viable alternative to surgery for treatment of adnexal cysts with a low risk of malignancy, especially when the cyst diameter is less than 70 mm.
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Affiliation(s)
- Amparo García-Tejedor
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.).
| | - Marta Castellarnau
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
| | - Fernando Burdio
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
| | - Eulalia Fernández
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
| | - Dolores Martí
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
| | - Maria J Pla
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
| | - Jordi Ponce
- Department of Gynecology, Bellvitge University Hospital, Barcelona, Spain (A.G.-T., J.P., E.F., D.M., M.J.P.); Departments of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Hospital General de l'Hospitalet, Barcelona, Spain (M.C.); and Department of Surgery. Hospital del Mar, Barcelona, Spain (F.B.)
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Wan YL, Crosbie EJ. Commentary on ‘Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening’. BJOG 2014; 121 Suppl 7:40-7. [DOI: 10.1111/1471-0528.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- YL Wan
- Institute of Cancer Sciences; University of Manchester; St Mary's Hospital; Manchester UK
| | - EJ Crosbie
- Institute of Cancer Sciences; University of Manchester; St Mary's Hospital; Manchester UK
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Management of epithelial ovarian cancer from diagnosis to restaging: an overview of the role of imaging techniques with particular regard to the contribution of 18F-FDG PET/CT. Nucl Med Commun 2014; 35:588-97. [PMID: 24535383 DOI: 10.1097/mnm.0000000000000091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Epithelial ovarian carcinoma is a major form of cancer affecting women in the western world. The silent nature of this disease results in late presentation at an advanced stage in many patients. It is therefore important to assess the role of imaging techniques in the management of these patients. This article presents a review of the literature on the role of (18)F-FDG-PET/CT in the different stages of management of epithelial ovarian cancer. Moreover, a comparison with other imaging techniques has been made and the relationship between (18)F-PET/CT and the assay of serum CA-125 levels has been discussed.
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Cohen JG, White M, Cruz A, Farias-Eisner R. In 2014, can we do better than CA125 in the early detection of ovarian cancer? World J Biol Chem 2014; 5:286-300. [PMID: 25225597 PMCID: PMC4160523 DOI: 10.4331/wjbc.v5.i3.286] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/12/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is a lethal gynecologic malignancy with greater than 70% of women presenting with advanced stage disease. Despite new treatments, long term outcomes have not significantly changed in the past 30 years with the five-year overall survival remaining between 20% and 40% for stage III and IV disease. In contrast patients with stage I disease have a greater than 90% five-year overall survival. Detection of ovarian cancer at an early stage would likely have significant impact on mortality rate. Screening biomarkers discovered at the bench have not translated to success in clinical trials. Existing screening modalities have not demonstrated survival benefit in completed prospective trials. Advances in high throughput screening are making it possible to evaluate the development of ovarian cancer in ways never before imagined. Data in the form of human “-omes” including the proteome, genome, metabolome, and transcriptome are now available in various packaged forms. With the correct pooling of resources including prospective collection of patient specimens, integration of high throughput screening, and use of molecular heterogeneity in biomarker discovery, we are poised to make progress in ovarian cancer screening. This review will summarize current biomarkers, imaging, and multimodality screening strategies in the context of emerging technologies.
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Nikolaou M, Adonakis G, Zyli P, Androutsopoulos G, Saltamavros A, Psachoulia C, Tsapanos V, Decavalas G. Transvaginal ultrasound-guided aspiration of benign ovarian cysts. J OBSTET GYNAECOL 2014; 34:332-5. [DOI: 10.3109/01443615.2013.874406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Atilgan R, Ozkan ZS, Kuloglu T, Kocaman N, Baspinar M, Can B, Şimşek M, Sapmaz E. Impact of intracystic ethanol instillation on ovarian cyst diameter and adjacent ovarian tissue. Eur J Obstet Gynecol Reprod Biol 2013; 174:133-6. [PMID: 24411950 DOI: 10.1016/j.ejogrb.2013.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/04/2013] [Accepted: 12/12/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the regression level of simple ovarian cyst size after local ethanol application and the damage level of adjacent ovarian reserve in rats. STUDY DESIGN This study was conducted at Firat University Animal Laboratory with 18 mature (12-14 weeks old) female Wistar albino rats weighing 200-220g, with regular cycles. Ovarian cyst induction was performed with unilateral salpingectomy. Fourteen rats with ovarian cysts after a second laparotomy were divided into two groups as follows: Group 1 (n=7): cyst aspiration group, and Group 2 (n=7): intracystic 95% ethanol application group. One month after the cyst aspiration procedure a third laparotomy was performed. The cyst number and size were recorded for each rat. Right ovariectomy was performed and formalin-fixed/paraffin-embedded tissues were sectioned at 5μm thickness. Under light microscopy, ovarian total follicle reserve and fibrosis were evaluated with Masson trichrome staining and apoptosis was evaluated with TUNEL staining. The groups were compared with the Mann-Whitney U test and Wilcoxon Rank test. p<0.05 was considered significant. RESULTS Ovarian cyst formation was observed in 85% (15/18) of rats. The mean diameter of ovarian cysts in Groups 1 and 2 were, respectively, 10.3mm and 10.1mm. After aspiration, there was no significant reduction in the cyst diameter (10.3mm vs 8.1mm), but after ethanol application the diameter significantly reduced (10.1mm vs 3.4mm, p<0.05). Mean ovarian follicle count in Group 2 was significantly lower than in Group 1 (25 vs 42, p<0.05), and mean fibrosis and apoptosis scores in Group 2 were significantly higher than in Group 1 (2.5 vs 0.9, p<0.05). CONCLUSION Local ethanol application reduces cyst diameter but concomitantly decreases ovarian reserve due to increased fibrosis in rats. In humans, intracystic ethanol application should be performed cautiously.
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Affiliation(s)
- Remzi Atilgan
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey
| | - Zehra Sema Ozkan
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey.
| | - Tuncay Kuloglu
- Firat University School of Medicine, Department of Histology and Embryology, 23119 Elazig, Turkey
| | - Nevin Kocaman
- Firat University School of Medicine, Department of Histology and Embryology, 23119 Elazig, Turkey
| | - Melike Baspinar
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey
| | - Behzat Can
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey
| | - Mehmet Şimşek
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey
| | - Ekrem Sapmaz
- Firat University School of Medicine, Department of Obstetrics and Gynecology, 23119 Elazig, Turkey
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Lawrie TA, Rabbie R, Thoma C, Morrison J. Pegylated liposomal doxorubicin for first-line treatment of epithelial ovarian cancer. Cochrane Database Syst Rev 2013; 2013:CD010482. [PMID: 24142521 PMCID: PMC6457824 DOI: 10.1002/14651858.cd010482.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Epithelial ovarian cancer (EOC) is often diagnosed at an advanced stage, requiring primary cytoreductive surgery and combination chemotherapy for its first-line management. Currently, the recommended standard first-line chemotherapy is platinum-based, usually consisting of carboplatin and paclitaxel (PAC/carbo). Pegylated liposomal doxorubicin (PLD) is an improved formulation of doxorubicin that is associated with fewer and less severe side effects than are seen with non-modified doxorubicin. In combination with carboplatin, PLD has recently been shown to improve progression-free survival compared with PAC/carbo in women with relapsed, platinum-sensitive EOC. It is therefore important to know whether any survival benefit can be attributed to PLD when it is used in the first-line setting. OBJECTIVES To evaluate the role of PLD, alone or in combination, in first-line chemotherapy for women with EOC. SEARCH METHODS We searched The Cochrane Gynaecological Cancer Group's Trial Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE from January 1990 to February 2013. In addition, we searched online trial registries for ongoing trials and abstracts of studies presented at relevant scientific meetings from 2000 onwards. SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared PLD alone or in combination with other agent/s (e.g. carboplatin) versus other agent/s for first-line chemotherapy in women with EOC who may or may not have undergone primary cytoreductive surgery. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed the risk of bias for each included trial. We obtained updated trial data when possible. MAIN RESULTS We included two large trials. One trial compared three-weekly PLD and carboplatin (PLD/carbo) with PAC/carbo. The other trial included four experimental arms, one of which was PLD plus PAC/carbo, that were compared with the standard PAC/carbo regimen. We did not combine results of these two trials in the meta-analysis. We considered the two studies to be at low risk of bias.For the comparison PLD/carbo versus PAC/carbo (820 women; stages Ic to IV), no statistically significant differences in progression-free survival (PFS) (hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.85 to 1.19) or overall survival (OS) (HR 0.94, 95% CI 0.78 to 1.13) were noted between study arms. Severe anaemia (risk ratio [RR] 2.74, 95% CI 1.54 to 4.88) and thrombocytopenia (RR 8.09, 95% CI 3.93 to 16.67) were significantly more common with PLD/carbo, whereas alopecia (RR 0.09, 95% CI 0.06 to 0.14) and severe neurotoxicity (RR 0.09, 95% CI 0.01 to 0.66) were significantly more common with PAC/carbo. Quality of life scores were not significantly different.For the comparison PLD/PAC/carbo versus PAC/carbo (1726 women; stage III/IV), it is important to note that PLD was given for alternate cycles only (i.e. every 6 weeks). No statistically significant difference in PFS (HR 0.98, 95% CI 0.88 to 1.09) or OS (HR 0.95, 95% CI 0.84 to 1.08) between these two treatment arms was reported. However, women in the triplet arm experienced significantly more severe haematological adverse events (anaemia, thrombocytopenia, neutropenia and febrile neutropenia) compared with those given standard treatment.No RCTs evaluated single-agent PLD for first-line treatment of EOC. AUTHORS' CONCLUSIONS PLD/carbo is a reasonable alternative to PAC/carbo for the first-line treatment of EOC. Although three-weekly PLD/carbo may be associated with increased dose delays and discontinuations compared with the standard PAC/carbo regimen, it might be more acceptable to women who wish to avoid alopecia or those at high risk of neurotoxicity. No survival benefits appear to be associated with the alternating triplet regimen, and the additional toxicity associated with adding PLD to PAC/carbo limits further investigation. Further studies are needed to establish the safest, most effective PLD/carbo regimen for newly diagnosed disease.
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Affiliation(s)
- Theresa A Lawrie
- The Evidence‐Based Medicine Consultancy Ltd3rd Floor Northgate HouseUpper Borough WallsBathUKBA1 1RG
| | - Roy Rabbie
- Epsom and St Helier University Hospitals NHS TrustDepartment of Respiratory MedicineWrythe LaneCarshaltonLondonUKSM5 1AA
| | | | - Jo Morrison
- Musgrove Park HospitalDepartment of Gynaecological OncologyTaunton and Somerset NHS Foundation TrustTauntonSomersetUKTA1 5DA
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Pegylated liposomal doxorubicin for first-line treatment of epithelial ovarian cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pavlik EJ, van Nagell JR. Early Detection of Ovarian Tumors Using Ultrasound. WOMENS HEALTH 2013; 9:39-55; quiz 56-7. [DOI: 10.2217/whe.12.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ovarian cancer can be treated with a very good prognosis if detected in the early stages, but not after it has advanced. Transvaginal ultrasound is capable of identifying changes in ovarian size and structure, and thereby detects early ovarian malignancies. This view has generated four major trials on transvaginal ultrasound detection: the Kentucky, PLCO, UKCTOCS, and SCSOCS trials. Each is sufficiently different to warrant examination. The Kentucky, UKCTOCS and SCSOCS trials report a shift to early stage detection. The Kentucky trial reports a survival benefit, while follow-up survival analysis is pending in the UKCTOCS and SCSOCS trials. Details of these trials are presented including definitions, inclusions/exclusions, analytic structure (intention-to-treat vs per protocol), performance (sensitivity, specificity, positive predictive value and negative predictive value), extent of screening-related treatment, time from screening to treatment, length of follow-up and survival versus mortality analysis. Questions are answered here about effectiveness, application, prevalence, cost and the potential for harm.
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Affiliation(s)
- Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0293, USA
| | - John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0293, USA
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Campbell S. A short history of sonography in obstetrics and gynaecology. Facts Views Vis Obgyn 2013; 5:213-29. [PMID: 24753947 PMCID: PMC3987368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The history of sonography in Obstetrics and Gynaecology dates from the classic 1958 Lancet paper of Ian Donald and his team from Glasgow. Fifty years on it is impossible to conceive of practising Obstetrics and Gynaecology without one of the many forms of ultrasound available today. Technological developments such as solid state circuitry, real time imaging, colour and power Doppler, transvaginal sonography and 3/4D imaging have been seized by clinical researchers to enhance the investigation and management of patients in areas as diverse as assessment of fetal growth and wellbeing, screening for fetal anomalies, prediction of pre-eclampsia and preterm birth, detection of ectopic gestation, evaluation of pelvic masses, screening for ovarian cancer and fertility management. Ultrasound guided procedures are now essential components of fetal therapy and IVF treatment. This concise history is written by someone who has witnessed each of these advances throughout the ultrasound era and is able to give perspective to these momentous happenings.
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Affiliation(s)
- S Campbell
- Create Health Clinic, London, United Kingdom
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Campbell S. Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:245-254. [PMID: 22911634 DOI: 10.1002/uog.12281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
Mutations in BRCA1 and BRCA2 genes account for the majority of hereditary breast and ovarian cancers. Approximately 10% of cases of ovarian cancer are due to germline mutations in BRCA1 and BRCA2. Ovarian cancer associated with BRCA1 and BRCA2 mutations has a distinct histological phenotype. This type of cancer is predominantly of serous or endometrioid histology and is high grade. Patients with BRCA1 or BRCA2 mutations should be offered risk-reducing salpingo-oophorectomy by age 40 years, or when childbearing is complete. Nowadays there are no differences between the treatments provided for sporadic and hereditary ovarian cancer, although there are indications that targeted therapy is effective in women with BRCA1/BRCA2-associated tumors. Retrospective studies reveal a high level of sensitivity to platinum agents in BRCA-associated tumors and initial trials show good efficacy and tolerability for polyADP-ribose polymerase inhibitors in mutation carriers with advanced ovarian cancers. These agents might also potentially be used in chemoprevention. Authors review the current management of hereditary ovarian cancer. Orv. Hetil., 2011, 152, 1596–1608.
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Affiliation(s)
- József Gábor Joó
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Szülészeti és Nőgyógyászati Klinika Budapest Baross u. 27. 1088
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Tinelli A, Vergara D, Martignago R, Leo G, Malvasi A, Tinelli R, Marsigliante S, Maffia M, Lorusso V. Ovarian cancer biomarkers: a focus on genomic and proteomic findings. Curr Genomics 2011; 8:335-42. [PMID: 19384429 PMCID: PMC2652404 DOI: 10.2174/138920207782446142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 09/20/2007] [Accepted: 09/26/2007] [Indexed: 12/19/2022] Open
Abstract
Among the gynaecological malignancies, ovarian cancer is one of the neoplastic forms with the poorest prognosis and with the bad overall and disease-free survival rates than other gynaecological cancers; several studies, analyzing clinical data and pathological features on ovarian cancers, have focused on the identification of both diagnostic and prognostic markers for applications in clinical practice. High-throughput technologies have accelerated the process of biomarker discovery, but their validity should be still demonstrated by extensive researches on sensibility and sensitivity of ovarian cancer novel biomarkers, determining whether gene profiling and proteomics could help differentiate between patients with metastatic ovarian cancer and primary ovarian carcinomas, and their potential impact on management. Therefore, considerable interest lies in identifying molecular prognostic biomarkers and protein indicators to guide treatment decisions and clinical follow up; the current state of knowledge about the potential clinical value of gene expression profiling in ovarian cancer is discussed, focusing on three main areas: distinguishing normal ovarian tissue from ovarian tumors, identifying different subtypes of ovarian cancer and identifying cancer likely to be responsive to therapy. In this elaborate we discuss the use of novel molecules, discovered by proteomics and genomics approaches, as potential protein biomarkers in the management of ovarian cancer, to improve the anticancer therapy for malignant ovarian tumors and to monitor the clinical follow up.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, "Vito Fazzi" Hospital, Lecce, Italy
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Abstract
The majority of women with ovarian cancer have advanced stage disease at the time of diagnosis and a poor 5 year survival rate. Hence, screening has been investigated in the hopes of improving survival by diagnosing ovarian cancer at an earlier stage. Most screening methods thus far have included ultrasound and/or serum tumor markers. However, low prevalence of the disease, high false positive rate of current screening methods, and the probable rapid growth of most ovarian carcinomas from no defined precursor lesion, all contribute to difficulty in screening for ovarian cancer. While screening may be able to detect ovarian cancer at an earlier stage, adequate data is presently lacking on whether screening improves survival. The results of ongoing large clinical trials will be available in a few years and should provide critical information regarding the usefulness of screening. Pending results of those large clinical trials, screening is not currently recommended for women at average risk for ovarian cancer. Screening is most likely to be performed in women with an increased familial risk of ovarian cancer, but patients should be aware that even with this risk factor, there is currently insufficient evidence to know if screening is effective. New screening methods, including new or multiple serum markers and proteomics, are also being investigated.
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Koutlaki N, Nikas I, Dimitraki M, Grapsas X, Psillaki A, Mandratzi J, Liberis A, Liberis V. Transvaginal aspiration of ovarian cysts: Our experience over 121 cases. MINIM INVASIV THER 2010; 20:155-9. [DOI: 10.3109/13645706.2010.532220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ultrasound and doppler in gynecological cancers. J Obstet Gynaecol India 2010. [DOI: 10.1007/s13224-010-0004-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pavlik EJ, Saunders BA, Doran S, McHugh KW, Ueland FR, DeSimone CP, DePriest PD, Ware RA, Kryscio RJ, van Nagell JR. The search for meaning-Symptoms and transvaginal sonography screening for ovarian cancer. Cancer 2009; 115:3689-98. [DOI: 10.1002/cncr.24407] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Daniel L Clarke-Pearson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC 27599, USA.
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Zerem E, Imamović G, Omerović S. Percutaneous Drainage without Sclerotherapy for Benign Ovarian Cysts. J Vasc Interv Radiol 2009; 20:921-5. [DOI: 10.1016/j.jvir.2009.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 04/08/2009] [Accepted: 04/14/2009] [Indexed: 01/23/2023] Open
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Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, Lewis S, Davies S, Philpott S, Lopes A, Godfrey K, Oram D, Herod J, Williamson K, Seif MW, Scott I, Mould T, Woolas R, Murdoch J, Dobbs S, Amso NN, Leeson S, Cruickshank D, Mcguire A, Campbell S, Fallowfield L, Singh N, Dawnay A, Skates SJ, Parmar M, Jacobs I. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10:327-40. [DOI: 10.1016/s1470-2045(09)70026-9] [Citation(s) in RCA: 463] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Our limited understanding of the natural biology of ovarian cancer, along with its low prevalence in the general population make early detection especially challenging. To be successful at the population level, an ovarian cancer screening test must prove its beneficial effect on ovarian cancer-specific mortality while achieving near-perfect specificity in order to minimize the harms resulting from false-positive results. No current screening tests for ovarian cancer fulfill these expectations. We review the current status and the challenges of ovarian cancer screening in the context of evidence-based principles that define a valuable cancer screening program.
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Affiliation(s)
- Christine S Walsh
- Department of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 160W, Los Angeles, CA 90048, USA.
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Ovarian Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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van Nagell JR, DePriest PD, Ueland FR, DeSimone CP, Cooper AL, McDonald JM, Pavlik EJ, Kryscio RJ. Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened. Cancer 2007; 109:1887-96. [PMID: 17373668 DOI: 10.1002/cncr.22594] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and most women present with advanced-stage disease. The current investigation was performed to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer. METHODS Annual TVS screening was performed on 25,327 women from 1987 to 2005. Asymptomatic women aged>or=50 years and women aged>or=25 years who had a family history of ovarian cancer were eligible for participation in this trial. RESULTS Among 364 patients (1.4%) with a persisting ovarian tumor on TVS who underwent exploratory laparoscopy or laparotomy with tumor removal, 35 primary invasive ovarian cancers, 9 serous ovarian tumors of low malignant potential, and 7 cancers metastatic to the ovary were detected. Stage distribution was as follows: 28 patients had stage I disease, 8 patients had stage II disease, and 8 patients had stage III disease. Four patients died of disease, 2 patients died of other causes, and 38 patients were alive and well from 0.5 years to 15.8 years after diagnosis (mean, 5.3 years). Nine women developed ovarian cancer within 12 months of a negative screen (false-negative results), and 3 of these patients died of disease. TVS screening had a sensitivity of 85.0%, specificity of 98.7%, positive predictive value of 14.01%, and negative predictive value of 99.9%. After 107,276 screening years, there have been 7 ovarian cancer deaths in the annually screened population and 3 ovarian cancer deaths among women who were noncompliant. Excluding patients with nonepithelial or borderline ovarian malignancies, the survival of patients with ovarian cancer in the annually screened population was 89.9%+/-10.1% at 2 years and 77.2%+/-22.8% at 5 years. CONCLUSIONS TVS screening, when it was performed annually, was associated with a decrease in disease stage at detection and with case-specific ovarian cancer mortality, but it was not effective in detecting ovarian cancers in women who had normal ovarian volume.
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Affiliation(s)
- John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, Kentucky 40536, USA.
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Aletti GD, Gallenberg MM, Cliby WA, Jatoi A, Hartmann LC. Current management strategies for ovarian cancer. Mayo Clin Proc 2007; 82:751-70. [PMID: 17550756 DOI: 10.4065/82.6.751] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Epithelial ovarian cancer originates in the layer of cells that covers the surface of the ovaries. The disease spreads readily throughout the peritoneal cavity and to the lymphatics, often before causing symptoms. Of the cancers unique to women, ovarian cancer has the highest mortality rate. Most women are diagnosed as having advanced stage disease, and efforts to develop new screening approaches for ovarian cancer are a high priority. Optimal treatment of ovarian cancer begins with optimal cytoreductive surgery followed by combination chemotherapy. Ovarian cancer, even in advanced stages, is sensitive to a variety of chemotherapeutics. Although improved chemotherapy has increased 5-year survival rates, overall survival gains have been limited because of our inability to eradicate all disease. Technologic advances that allow us to examine the molecular machinery that drives ovarian cancer cells have helped to identify numerous therapeutic targets within these cells. In this review, we provide an overview of ovarian cancer with particular emphasis on recent advances in operative management and systemic therapies.
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Affiliation(s)
- Giovanni D Aletti
- Division of Gynecologic Surgery, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Torres A, Torres K, Paszkowski T, Staśkiewicz GJ, Maciejewski R. Cytokine response in the postoperative period after surgical treatment of benign adnexal masses: comparison between laparoscopy and laparotomy. Surg Endosc 2007; 21:1841-8. [PMID: 17356933 DOI: 10.1007/s00464-007-9260-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 11/26/2006] [Accepted: 12/19/2006] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cytokines are the main mediators of the inflammation and the response to trauma. The purpose of the present study was the comparative assessment in sera of patients with benign adnexal masses treated by laparoscopy or laparotomy of the following proinflammatory and anti-inflammatory cytokines: interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and IL-10 in the early postoperative period. METHODS A total of 40 patients with benign adnexal masses were studied; 25 of whom underwent laparoscopy and 15, laparotomy. Blood serum concentration of IL-1beta, IL-6, IL-8, TNF-alpha, and IL-10 were measured by commercially available ELISA assays before and 4 h, 24 h, and 48 h after the operation. RESULTS Concentrations of IL-6 were significantly increased in both groups at 4 h, 24 h, and 48 h after the surgery; levels of IL-10 showed a significant increase 4 h and 24 h after the operation; an increase in IL-1beta levels was observed only after laparotomy; no significant variations were observed in serum levels of IL-8; the postoperative increase of IL-1beta, IL-6, and IL-10 levels was more pronounced in patients undergoing laparotomy than in those treated laparoscopically; length of the surgical procedure, amount of CO2 used, tumor diameter, age, and body mass index (BMI) of the patients did not influence the postoperative patterns of the studied cytokines. CONCLUSIONS Systemic cytokine response after operations for benign adnexal masses depends on the degree of the surgical trauma, and is less pronounced in patients undergoing laparoscopy.
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Affiliation(s)
- A Torres
- Human Anatomy Department, Medical University of Lublin, Jaczewskiego 4, 20-094, Lublin, Poland.
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Abstract
PURPOSE OF REVIEW Epithelial ovarian cancer is usually diagnosed in the advanced stage and carries a poor prognosis. When detected at an early stage, the 5-year survival rate is 90%. Despite the availability of various diagnostic tools for ovarian cancer screening, high levels of sensitivity and specificity are not achievable. There is therefore an ongoing need to identify new screening tests and strategies that should be readily available, relatively noninvasive, and achieve high sensitivity, specificity, and positive and negative predictive values. RECENT FINDINGS Our review focuses on various screening technologies including serum biomarkers, transvaginal ultrasonography as well as multimodality screening that can be used for early detection of ovarian cancer. The efficacy of different screening tools is discussed along with the efforts made to improve sensitivity, specificity and positive predictive value. The initial results of two large population-based screening studies are presented. SUMMARY An optimal screening test with high levels of sensitivity and specificity is indispensable for early detection of ovarian cancer. Serological screening with serum biomarkers (serum proteins and autoantibodies) can be used as a first-line screening test. In combination with TVS or color-flow Doppler imaging, this may prove very effective in early detection of ovarian cancer.
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Affiliation(s)
- Adnan Munkarah
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
Ovarian neoplasms are common in women of all ages. As many as 10% of women in the United States will undergo surgical removal of an adnexal mass sometime in their lifetime. Gynecologic surgeons have pioneered laparoscopic surgery, developing what was originally a diagnostic tool into a safe and effective approach to management of adnexal masses. Accumulating scientific data support the laparoscopic approach to the adnexal mass as the preferred treatment.
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Affiliation(s)
- Wesley S Hilger
- Division of Gynecologic Oncology, Mayo Clinic, Scottsdale, Arizona, USA
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de Oliveira Franzin CMM, Kraft ML, Faundes D, Zeferino LC, Alvarenga M, Marussi EF. Detection of ovarian Sertoli-Leydig cell tumors exclusively by color Doppler sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1327-30. [PMID: 16998106 DOI: 10.7863/jum.2006.25.10.1327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Duke D, Colville J, Keeling A, Broe D, Fotheringham T, Lee MJ. Transvaginal aspiration of ovarian cysts: long-term follow-up. Cardiovasc Intervent Radiol 2006; 29:401-5. [PMID: 16502175 DOI: 10.1007/s00270-005-0167-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy. METHODS Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness. RESULTS Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy. CONCLUSION Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.
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Affiliation(s)
- D Duke
- Department of Academic Radiology, Beaumont Hospital, Dublin, Ireland
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47
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Abstract
The efficacy of ovarian cancer screening remains to be proven. Advances in ultrasound and tumor marker technology, combined with complex statistical analysis have facilitated 2 large ongoing randomized controlled trials of screening which are powered to determine the impact on mortality. Serum proteomics seems to be a promising area for biomarker discovery, but requires more rigorous validation before it can be used in clinical trials. Current screening tests, clinical trials in the general and high-risk populations, screening acceptability and costs are reviewed in this article.
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Affiliation(s)
- Adam N Rosenthal
- Institute for Women's Health, University College London, Elizabeth Garrett Anderson Hospital, London, UK.
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Elmasry K. Screening for ovarian cancer: progress and challenges. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2006; 32:173-5. [PMID: 16857072 DOI: 10.1783/147118906777888440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Karim Elmasry
- Translational Research Laboratories, Department of Gynaecological Oncology, Windeyer Institute, London, UK.
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Abstract
Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States. Although there has been a statistically significant improvement in 5-year survival, in 2005 more than 16,000 women were expected to die of this disease. To date, there is no reliable method to screen for ovarian cancer; therefore, the majority of cases are diagnosed with advanced disease. For early ovarian cancer, appropriate surgical staging and adjuvant chemotherapy for selected cases will result in survival rates of 90-95%. For advanced ovarian cancer, survival depends primarily on the success of the initial surgical procedure. Patients with complete cytoreduction to microscopic disease are often cured with adjuvant chemotherapy. There is growing evidence that these patients with microscopic residual disease are excellent candidates for intraperitoneal chemotherapy, and this mode of chemotherapy delivery may be their best opportunity for cure. Patients with optimal cytoreduction also may benefit from intraperitoneal chemotherapy, but cure is less likely. For patients with suboptimal cytoreduction, intravenous chemotherapy with a combination of carboplatin and paclitaxel is the current standard therapy. Most of these patients will experience recurrence of the cancer, with small chance of cure. Salvage chemotherapy is important in ovarian cancer because many patients respond to several salvage regimens. Because of the high response rate of ovarian cancer, even after relapse, it is probably better to consider 10-year survival as the ideal end point. Finally, new biologic agents, in combination with traditional surgery and chemotherapy, may result in further improvement in survival for patients with ovarian cancer.
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Affiliation(s)
- Snehal Bhoola
- Curtis and Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center, Savannah, Georgia 31403, USA
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50
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Abstract
Familial predisposition accounts for approximately 10% of epithelial ovarian cancer. Identification and management of at-risk families is therefore an important area that bridges gynaecological and clinical genetic practice. The efficacy of screening for ovarian cancer in both high- and low-risk populations is currently of unproven benefit and is associated with some risks related to false-positive results. In contrast to the general population, preventive surgery is a realistic proposition for many women at high-risk. Although prophylactic bilateral salpingo-oophorectomy prevents ovarian and tubal cancer and reduces the risk of breast cancer, this option is unsuitable for women who have yet to complete their families or who are unwilling to undergo surgery. There is therefore a continued demand for screening in the high-risk population. This chapter discusses the limitations of screening, the circumstances under which screening is appropriate and current screening guidelines. Ongoing and future research that should help to provide additional information about this area is also reviewed.
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Affiliation(s)
- Adam Rosenthal
- UCL Elizabeth Garrett Anderson Institute for Women's Health, Elizabeth Garrett Anderson Hospital, University College London, Huntley Street, London WC1E 6DH, UK.
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