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Pavlik EJ, van Nagell JR, Dietrich CS, Ueland FR. Compelling Story of Ovarian Cancer Screening. J Clin Oncol 2024:JCO2302424. [PMID: 38306587 DOI: 10.1200/jco.23.02424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024] Open
Affiliation(s)
- Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, KY
| | - John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, KY
| | - Charles S Dietrich
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, KY
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Markey Comprehensive Cancer Center, University of Kentucky, Lexington, KY
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Gorski JW, Dietrich CS, Davis C, Erol L, Dietrich H, Per NJ, Ferrell EL, McDowell AB, Riggs MJ, Hutchcraft ML, Baldwin-Branch LA, Miller RW, DeSimone CP, Gallion HH, Ueland FR, van Nagell JR, Pavlik EJ. Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram. Diagnostics (Basel) 2022; 12:diagnostics12010144. [PMID: 35054310 PMCID: PMC8774702 DOI: 10.3390/diagnostics12010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022] Open
Abstract
The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1–19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5–29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2–93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7–178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration.
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Affiliation(s)
- Justin W. Gorski
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Charles S. Dietrich
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Caeli Davis
- Denison University, Granville, OH 43023, USA;
| | - Lindsay Erol
- Tripler Army Medical Center, Honolulu, HI 96859, USA;
| | | | - Nicholas J. Per
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Emily Lenk Ferrell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (N.J.P.); (E.L.F.)
| | - Anthony B. McDowell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - McKayla J. Riggs
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Megan L. Hutchcraft
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Lauren A. Baldwin-Branch
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Rachel W. Miller
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Christopher P. DeSimone
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Holly H. Gallion
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Frederick R. Ueland
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - John R. van Nagell
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | - Edward J. Pavlik
- Division of Gynecologic Oncology, University of Kentucky Markey Cancer Center, Lexington, KY 40536, USA; (J.W.G.); (C.S.D.III); (A.B.M.); (M.J.R.); (M.L.H.); (L.A.B.-B.); (R.W.M.); (C.P.D.); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Correspondence:
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Ladegaard Baun ML, Dueholm M, Heje HN, Hamilton W, Petersen LK, Vedsted P. Direct access from general practice to transvaginal ultrasound for early detection of ovarian cancer: a feasibility study. Scand J Prim Health Care 2021; 39:230-239. [PMID: 34092179 PMCID: PMC8293964 DOI: 10.1080/02813432.2021.1922831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/31/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of providing general practitioners (GPs) direct and fast referral access to transvaginal ultrasound (TVUS). DESIGN A prospective cohort study. SETTING A total of 232 Danish general practices in parts of the Central Denmark Region. SUBJECTS Women aged ≥40 years who consulted their GP for vague and non-specific symptoms (n = 479). MAIN OUTCOME MEASURES The feasibility assessment included the GPs' referral rate, indications for referral, management of test results, and findings from TVUS. RESULTS A total of 479 women were referred to TVUS. The examinations revealed abnormalities in 104 (21.7%) women. Additional investigations were needed in 68 (14.2%) women of whom seven (1.5%) underwent major surgery. No case of ovarian cancer was diagnosed during the study period or the 6-month follow-up. However, three (0.6%) women with an abnormal transvaginal ultrasound were diagnosed with urogynecological cancer; this yielded a PPV of 4.4% (95% confidence interval: 1.5-12.2) and an NPV of 100.0% (95% confidence interval: 96.7-100.0) for urogynecological cancer. CONCLUSION Providing GPs with direct access to transvaginal ultrasound was feasible; 80% of the investigated women were referred back to the GP, 14% were further investigated, 0.6% were diagnosed with urogynecological cancer, and 1.5% had major procedures performed without complications. IMPLICATIONS Direct access to TVUS could be an important pathway to ensure fast evaluation of women presenting with vague non-specific symptoms of potential ovarian cancer. Future studies should explore the patient experience, cancer outcomes, and health economics issues.KEY POINTS Current awareness • GPs have no fast referral option for women presenting with vague non-specific symptoms that could indicate underlying ovarian cancer. Key findings • We offered GPs direct and fast referral access to TVUS; 51.7% of practices used the opportunity. • The GPs referred 479 women to TVUS; 104 had an abnormal TVUS and 68 needed additional investigations. • Seven women underwent major surgery, leading to three cases of urogynecological cancer. No woman had a false negative TVUS result.
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Affiliation(s)
- Marie-Louise Ladegaard Baun
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice – Aarhus, Aarhus, Denmark
| | - Margit Dueholm
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens, Aarhus, Denmark
| | | | - William Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Lone Kjeld Petersen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice – Aarhus, Aarhus, Denmark
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Otsuka I, Matsuura T. Screening and Prevention for High-Grade Serous Carcinoma of the Ovary Based on Carcinogenesis-Fallopian Tube- and Ovarian-Derived Tumors and Incessant Retrograde Bleeding. Diagnostics (Basel) 2020; 10:E120. [PMID: 32098383 PMCID: PMC7168061 DOI: 10.3390/diagnostics10020120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023] Open
Abstract
High-grade serous carcinoma (HGSC) is the most common and lethal subtype of ovarian carcinoma. Many HGSCs are now believed to originate in the fallopian tube epithelium; ovarian surface epithelium is another possible origin. Thus, current screening methods, i.e., ultrasonography and serum CA-125 measurements, have a limitation in their early detection. Recently, circulating biomarkers, such as tumor DNA, autoantibody, and microRNA, have been investigated to detect HGSCs. As cancer cells in the fallopian tube flow into the endometrial cavity, the detection of exfoliated cells, tumor DNA, and proteome from samples obtained from the endometrial cavity or the cervix may be useful. The risk of ovarian serous carcinoma is affected by the use of oral contraceptive and menopausal hormone therapy (MHT). MHT regimens causing endometrial bleeding increase serous carcinoma risk, hence, incessant retrograde bleeding from the endometrial cavity into the Douglas pouch appears to play an important role in high-grade serous carcinogenesis. In this review, we provide an overview of current and novel screening methods and prevention approaches for ovarian and fallopian tube HGSC.
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Affiliation(s)
- Isao Otsuka
- Department of Obstetrics and Gynecology, Kameda Medical Center, Kamogawa 296-8602, Japan;
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Gorski JW, Quattrone M, van Nagell JR, Pavlik EJ. Assessing the Costs of Screening for Ovarian Cancer in the United States: An Evolving Analysis. Diagnostics (Basel) 2020; 10:diagnostics10020067. [PMID: 31991783 PMCID: PMC7168929 DOI: 10.3390/diagnostics10020067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/16/2022] Open
Abstract
The primary objective of this study is to provide an updated analysis of the cost of screening for ovarian cancer in the United States. Here, we use updated information from the University of Kentucky Ovarian Cancer Screening Trial in conjunction with new modifying factors such as U.S. national estimates of the cost of care (Truven Health MarketScan Database), recently published estimates of earnings lost due to ovarian cancer death and estimates of federal income taxes paid on those earnings. In total, 326,998 screens were performed during the Kentucky trial from 1987 to 2019. At a cost of $56 per screen, we estimate that the total base cost to operate the program over the last 32 years is $18,311,888. When accounting for the surgical cost of 381 false-positive cases, the total cost of the screening program increases by $3,030,474. However, these costs are offset by the benefit of treating more early-stage ovarian cancer in the screened population, with a total cost advantage of $4,016,475 at our institution (Kentucky) or $1,525,050 ($725,700–$3,312,650) (U.S.) nationally. Additionally, program costs are offset by approximately $3,549,000 due to the potential earnings gained by the 26 women whose lives have been saved with screening. Furthermore, the cost of the program is offset by the federal tax dollars paid on the recovered earnings and amounts to $383,292. Ultimately, the net adjusted total cost of the Kentucky screening program is an estimated $13,393,595 at our institution or $15,885,020 ($13,978,068–$16,799,083) nationally. Thus, the adjusted cost per screen is an estimated $40.96 in Kentucky or $48.58 ($42.75–$51.37) nationally.
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Affiliation(s)
- Justin W. Gorski
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0263, USA; (J.R.v.N.); (E.J.P.)
- Correspondence: ; Tel.: +1-859-562-2439
| | - McKell Quattrone
- University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536-0298, USA;
| | - John R. van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0263, USA; (J.R.v.N.); (E.J.P.)
| | - Edward J. Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0263, USA; (J.R.v.N.); (E.J.P.)
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Pavlik EJ, Smith C, Dennis TS, Harvey E, Huang B, Chen Q, West Piecoro D, Burgess BT, McDowell A, Gorski J, Baldwin LA, Miller RW, DeSimone CP, Dietrich C, Gallion HH, Ueland FR, van Nagell JR. Disease-Specific Survival of Type I and Type II Epithelial Ovarian Cancers-Stage Challenges Categorical Assignments of Indolence & Aggressiveness. Diagnostics (Basel) 2020; 10:diagnostics10020056. [PMID: 31973035 PMCID: PMC7168156 DOI: 10.3390/diagnostics10020056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 12/20/2022] Open
Abstract
Epithelial ovarian cancers (EOC) consist of several sub-types based on histology, clinical, molecular and epidemiological features that are termed “histo-types”, which can be categorized into less aggressive Type I and more aggressive Type II malignancies. This investigation evaluated the disease-specific survival (DSS) of women with Type I and II EOC using histo-type, grade, and stage. A total of 47,789 EOC cases were identified in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) data. Survival analysis and log rank test were performed to identify a 2-tiered classification (grade 1 vs. grade 2 & 3) for serous EOC. DSS of early stage serous EOC for grade 2 was significantly different from grade 3 indicating that a 2-tier classification for serous EOC applied only to late stage. DSS of Type I EOC was much better than Type II. However, DSS was 33–52% lower with late stage Type I than with early stage Type I indicating that Type I ovarian cancers should not be considered indolent. Early stage Type II EOC had much better DSS than late stage Type II stressing that stage has a large role in survival of both Type I and II EOC.
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Affiliation(s)
- Edward J. Pavlik
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
- Correspondence: ; Tel.: +1-859-323-3830
| | - Christopher Smith
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
| | | | - Elizabeth Harvey
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 43023, USA;
| | - Bin Huang
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA; (B.H.); (Q.C.)
| | - Quan Chen
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA; (B.H.); (Q.C.)
| | - Dava West Piecoro
- Department of Pathology and the Markey Cancer Center, Lexington, KY 40536, USA;
| | - Brian T. Burgess
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Anthony McDowell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Justin Gorski
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Lauren A. Baldwin
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Rachel W. Miller
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Christopher P. DeSimone
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Charles Dietrich
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Holly H. Gallion
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - Frederick R. Ueland
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
| | - John R. van Nagell
- Department of Obstetrics & Gynecology, University of Kentucky, Lexington, KY 40536, USA; (C.S.); (B.T.B.); (A.M.); (J.G.); (L.A.B.); (R.W.M.); (C.P.D.); (C.D.III); (H.H.G.); (F.R.U.); (J.R.v.N.J.)
- Division of Gynecologic Oncology, Markey Cancer Center, Lexington, KY 40536, USA
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Elezaby M, Lees B, Maturen KE, Barroilhet L, Wisinski KB, Schrager S, Wilke LG, Sadowski E. BRCA Mutation Carriers: Breast and Ovarian Cancer Screening Guidelines and Imaging Considerations. Radiology 2019; 291:554-569. [PMID: 31038410 DOI: 10.1148/radiol.2019181814] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patients who carry the BRCA1 and BRCA2 gene mutations have an underlying genetic predisposition for breast and ovarian cancers. These deleterious genetic mutations are the most common genes implicated in hereditary breast and ovarian cancers. This monograph summarizes the evidence behind current screening recommendations, reviews imaging protocols specific to this patient population, and illustrates some of the imaging nuances of breast and ovarian cancers in this clinical setting.
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Affiliation(s)
- Mai Elezaby
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Brittany Lees
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Katherine E Maturen
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Lisa Barroilhet
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Kari B Wisinski
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Sarina Schrager
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Lee G Wilke
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
| | - Elizabeth Sadowski
- From the Department of Radiology (M.E., E.S.), Department of Obstetrics and Gynecology (B.L., E.S.), Division of Gynecologic Oncology (L.B.), Department of Medicine (K.B.W.), Carbone Comprehensive Cancer Center (K.B.W.), Department of Family Medicine and Community Health (S.S.), and Department of Surgery (L.G.W.), University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792-3252; Department of Radiology and Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor, Mich (K.E.M.)
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8
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Ormsby EL, Pavlik EJ, McGahan JP. Ultrasound Monitoring of Extant Adnexal Masses in the Era of Type 1 and Type 2 Ovarian Cancers: Lessons Learned From Ovarian Cancer Screening Trials. Diagnostics (Basel) 2017; 7:diagnostics7020025. [PMID: 28452952 PMCID: PMC5489945 DOI: 10.3390/diagnostics7020025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 11/16/2022] Open
Abstract
Women that are positive for an ovarian abnormality in a clinical setting can have either a malignancy or a benign tumor with probability favoring the benign alternative. Accelerating the abnormality to surgery will result in a high number of unnecessary procedures that will place cost burdens on the individual and the health delivery system. Surveillance using serial ultrasonography is a reasonable alternative that can be used to discover if changes in the ovarian abnormality will occur that favor either a malignant or benign interpretation. Several ovarian cancer screening trials have had extensive experiences with changes in subclinical ovarian abnormalities in normal women that can define growth, stability or resolution and give some idea of the time frame over which changes occur. The present report examines these experiences and relates them to the current understanding of ovarian cancer ontology, presenting arguments related to the benefits of surveillance.
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Affiliation(s)
- Eleanor L Ormsby
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
- Department of Radiology, Kaiser Permanente Sacramento, 2025 Morse Ave, CA 95825, USA.
| | - Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536, USA.
| | - John P McGahan
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA.
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9
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Ten Important Considerations for Ovarian Cancer Screening. Diagnostics (Basel) 2017; 7:diagnostics7020022. [PMID: 28406427 PMCID: PMC5489942 DOI: 10.3390/diagnostics7020022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 04/05/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022] Open
Abstract
The unique intricacies of ovarian cancer screening and perspectives of different screening methods are presented as ten considerations that are examined. Included in these considerations are: (1) Deciding on the number of individuals to be screened; (2) Anticipating screening group reductions due to death; (3) Deciding on the duration and frequency of screening; (4) Deciding on an appropriate follow-up period after screening; (5) Deciding on time to surgery when malignancy is suspected; (6) Deciding on how screen-detected ovarian cancers are treated and by whom; (7) Deciding on how to treat the data of enrolled participants; (8) Deciding on the most appropriate way to assign disease-specific death; (9) Deciding how to avoid biases caused by enrollments that attract participants with late-stage disease who are either symptomatic or disposed by factors that are genetic, environmental or social; and (10) Deciding whether the screening tool or a screening process is being tested. These considerations are presented in depth along with illustrations of how they impact the outcomes of ovarian cancer screening. The considerations presented provide alternative explanations of effects that have an important bearing on interpreting ovarian screening outcomes.
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10
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Baldwin LA, Pavlik EJ, Ueland E, Brown HE, Ladd KM, Huang B, DeSimone CP, van Nagell JR, Ueland FR, Miller RW. Complications from Surgeries Related to Ovarian Cancer Screening. Diagnostics (Basel) 2017; 7:diagnostics7010016. [PMID: 28282907 PMCID: PMC5373025 DOI: 10.3390/diagnostics7010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/24/2017] [Accepted: 02/28/2017] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to evaluate complications of surgical intervention for participants in the Kentucky Ovarian Cancer Screening Program and compare results to those of the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. A retrospective database review included 657 patients who underwent surgery for a positive screen in the Kentucky Ovarian Cancer Screening Program from 1988–2014. Data were abstracted from operative reports, discharge summaries, and office notes for 406 patients. Another 142 patients with incomplete records were interviewed by phone. Complete information was available for 548 patients. Complications were graded using the Clavien–Dindo (C–D) Classification of Surgical Complications and considered minor if assigned Grade I (any deviation from normal course, minor medications) or Grade II (other pharmacological treatment, blood transfusion). C–D Grade III complications (those requiring surgical, endoscopic, or radiologic intervention) and C–D Grade IV complications (those which are life threatening) were considered “major”. Statistical analysis was performed using SAS 9.4 software. Complications were documented in 54/548 (10%) subjects. For women with malignancy, 17/90 (19%) had complications compared to 37/458 (8%) with benign pathology (p < 0.003). For non-cancer surgery, obesity was associated with increased complications (p = 0.0028). Fifty patients had minor complications classified as C–D Grade II or less. Three of 4 patients with Grade IV complications had malignancy (p < 0.0004). In the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, 212 women had surgery for ovarian malignancy, and 95 had at least one complication (45%). Of the 1080 women with non-cancer surgery, 163 had at least one complication (15%). Compared to the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial, the Kentucky Ovarian Cancer Screening Program had significantly fewer complications from both cancer and non-cancer surgery (p < 0.0001 and p = 0.002, respectively). Complications resulting from surgery performed as a result of the Kentucky Ovarian Cancer Screening Program were infrequent and significantly fewer than reported in the Prostate, Lung, Colorectal and Ovarian Cancer Screening trial. Complications were mostly minor (93%) and were more common in cancer versus non-cancer surgery.
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Affiliation(s)
- Lauren A Baldwin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Emma Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Hannah E Brown
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Kelsey M Ladd
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Bin Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Christopher P DeSimone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293, USA.
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11
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Pavlik EJ. Ovarian cancer screening effectiveness: A realization from the UK Collaborative Trial of Ovarian Cancer Screening. ACTA ACUST UNITED AC 2016; 12:475-479. [PMID: 27595999 DOI: 10.1177/1745505716666096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 12/15/2022]
Abstract
Effects on survival in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was reported in The Lancet, and demonstrate that reductions in disease-specific mortality in this randomized control trial (RCT) indicate that ovarian cancer screening works. The UKCTOCS was large enough for sufficient accrual and follow-up, using two intervention arms: MMS (a multimodal strategy using the biomarker Ca125 combined with ultrasound as a secondary test) and USS (ultrasound alone) compared against a no-screen control group. MMS and USS performed similarly, showing a statistically significant reduction in mortality that increased with follow-up surveillance (8% reduction in years 0-7 vs 28% in years 7-14). The data led to the estimate that 641 screens are needed to prevent one ovarian cancer death.
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Affiliation(s)
- Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center and the Markey Cancer Center, Lexington, KY, USA
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12
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Lefringhouse JR, Neward E, Ueland FR, Baldwin LA, Miller RW, DeSimone CP, Kryscio RJ, van Nagell JR, Pavlik EJ. Probability of fallopian tube and ovarian detection with transvaginal ultrasonography in normal women. ACTA ACUST UNITED AC 2016; 12:303-11. [PMID: 27189894 PMCID: PMC5384515 DOI: 10.2217/whe.15.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Some ovarian malignancies may originate in the fallopian tube. The feasibility of ultrasonographically visualizing the fallopian tube is presented. Methods: In total, 549 normal women participated in the fallopian tube visualization trial, while ovarian visualization was studied in 43,521. Chi-square analysis, t-tests and multivariate analysis determined significance and interactions. Results: Ovaries were observed in 82.7% while fallopian tubes were detected in 77.2% of women and 85.2% of the time when an ovary was detected. Age, BMI or parity was not significantly different when one or both fallopian tubes were visualized. Elevated BMI had slightly greater influence than age in limiting visualization of the fallopian tubes in multivariate analysis. Conclusion: Fallopian tubes can often be identified sonographically. Ovarian visualization provides the strongest indicator favoring fallopian tube detection. Thus, ultrasonographic examinations for adnexal cancer could include evaluation of fallopian tubes even in women >60 years and in women with BMI ≥25.
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Affiliation(s)
- Jason R Lefringhouse
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Erin Neward
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Frederick R Ueland
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Lauren A Baldwin
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Rachel W Miller
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Christopher P DeSimone
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Richard J Kryscio
- Department of Statistics, University of Kentucky, Lexington, KY 40536-0293, USA
| | - John R van Nagell
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
| | - Edward J Pavlik
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, KY 40536-0293, USA
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13
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Mosch CG, Jaschinski T, Eikermann M. Impact of epithelial ovarian cancer screening on patient-relevant outcomes in average-risk postmenopausal women. Hippokratia 2014. [DOI: 10.1002/14651858.cd011210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Christoph G Mosch
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Thomas Jaschinski
- University Witten/Herdecke; Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research; Ostmerheimer Str. 200 (Building 38) Cologne Germany 51109
| | - Michaela Eikermann
- Medical advisory service of social health insurance (MDS); Department of Evidence-based medicine; Theodor-Althoff-Straße 47 Essen North Rhine Westphalia Germany 51109
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14
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Ovarian cancer screening practices of obstetricians and gynecologists in puerto rico. BIOMED RESEARCH INTERNATIONAL 2014; 2014:920915. [PMID: 25371904 PMCID: PMC4209753 DOI: 10.1155/2014/920915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/13/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022]
Abstract
Background. Ovarian cancer is the most fatal malignancy of the female genital tract and is associated with high mortality. The American Congress of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) recommend against screening for ovarian cancer in asymptomatic, average-risk women. Objective. To assess the ovarian cancer screening practices in asymptomatic, average-risk women among obstetricians and gynecologists (Ob/Gyn) in Puerto Rico. Methodology. From 2011 to 2012, self-administered anonymous questionnaires were mailed to all licensed obstetricians and gynecologists in PR. Results. Response rate was 25%. Overall, 53.9% were screening for the disease. Reported screening methods were CA-125 and transvaginal ultrasound (TVUS), 39.2%, TVUS only, 30.4%, and CA-125 only, 9.8%. In the logistic regression model, the odds that a given health practitioner routinely screened for ovarian cancer in the asymptomatic, average-risk population increased by 8% with every unit increase in his or her years in practice. Conclusion. The majority of the practicing Ob/Gyn in PR who participated are not following the guidelines established by the ACOG and the USPSTF for ovarian cancer screening.
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15
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van Nagell JR, Hoff JT. Transvaginal ultrasonography in ovarian cancer screening: current perspectives. Int J Womens Health 2013; 6:25-33. [PMID: 24379701 PMCID: PMC3873201 DOI: 10.2147/ijwh.s38347] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transvaginal ultrasonography (TVS) is an integral part of all major ovarian cancer screening trials. TVS is accurate in detecting abnormalities in ovarian volume and morphology, but is less reliable in differentiating benign from malignant ovarian tumors. When used as the only screening test, TVS is sensitive, but has a low positive predictive value. Therefore, serum biomarkers and tumor morphology indexing are used together with TVS to identify ovarian tumors at high risk for malignancy. This allows preoperative triage of high-risk cases to major cancer centers for therapy while decreasing unnecessary surgery for benign disease. Ovarian cancer screening has been associated with a decrease in stage at detection in most trials, thereby allowing treatment to be initiated when the disease is most curable.
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Affiliation(s)
- John R van Nagell
- Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center/Markey Cancer Center, Lexington, KY, USA
| | - John T Hoff
- Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center/Markey Cancer Center, Lexington, KY, USA
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16
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Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol 2013; 122:210-217. [PMID: 23969786 DOI: 10.1097/aog.0b013e318298def5] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the prevalence, incidence, persistence, and resolution of ovarian abnormalities using serial transvaginal ultrasonography. METHODS A group of 39,337 women in the University of Kentucky Ovarian Cancer Screening Program were monitored with 221,576 baseline and interval transvaginal ultrasonography. RESULTS The transvaginal ultrasonogram was normal for first and all subsequent visits for 31,834 participants (80.9%), whereas 6,807 women (17.3%) had transvaginal ultrasonograms interpreted as abnormal and were monitored over 21,588 ultrasonograms. Ovarian cysts were more common in premenopausal (prevalence 34.9%, incidence 15.3%) than in postmenopausal women (prevalence 17.0%, incidence 8.2%). For the group with abnormalities, the initial transvaginal ultrasonogram was abnormal in 46.7% of the cases, of which 63.2% resolved to normal on subsequent ultrasonograms. Of 35,314 cases classified as normal on the first examination, 9.9% were abnormal on subsequent annual examinations. The abnormal findings were classified as follows: unilocular cysts (11.5%), cysts with septations (9.8%), cysts with solid areas (7.1%), and solid masses (1.8%). Many transvaginal ultrasonographic abnormalities were followed to resolution. Surgery was performed on 557 participants for 85 ovarian malignancies and 472 nonmalignancies. Over the duration of the study, the positive predictive value (PPV) increased from 8.1% to 24.7%. CONCLUSION Serial ultrasonography has shown that many ovarian abnormalities resolve, even if the initial appearance is complex, solid, or bilateral. Thus, it is advantageous to avoid a single transvaginal ultrasonographic abnormality as the sole trigger for surgery and to take a measured serial approach to reduce false-positive results and increase the PPV. LEVEL OF EVIDENCE II.
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