Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram

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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Neutrophil-to-Lymphocyte Ratio in Ovarian Cancer Patients with Low CA125 Concentration

BioMed Research International ◽

10.1155/2019/8107906 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Hongyan Zhang ◽

Qianyu Huo ◽

Lunhui Huang ◽

You Cheng ◽

Yunde Liu ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Physical Examination ◽

Cancer Patients ◽

False Negative ◽

Neutrophil To Lymphocyte Ratio ◽

Healthy Controls ◽

Ovarian Cancer Screening ◽

Lymphocyte Ratio ◽

Routine Physical Examination

Ovarian cancer cases with low CA125 concentration are problematic and increase the high false negative results ratio during routine physical examination testing. Unfortunately, patients without early discovery have very low survival rates. In our study, we investigated the possible role of differential leukocyte counts and the neutrophil-to-lymphocyte ratio (NLR) in ovarian cancer patients to identify an additional discriminative marker to avoid missing diagnoses in normal physical examinations. One hundred seventy-three patients with epithelial ovarian cancer and 70 healthy controls were involved in our study. Based on the results, compared with the healthy controls, NLR was significantly different both in the low CA125 concentration group and in the complete patient group, indicating that NLR could be an effective marker for ovarian cancer screening. According to ROC, sensitivity, specificity, and NPV results, CA125 >35 U/ml is a good indicator for cancer in routine physical examination. However, in patients with low CA125 concentration, the CA125>7.65 U/ml and NLR >1.72 group yielded increased sensitivity with appropriate specificity and higher NPV results than the CA125 >35 U/ml group. We believe CA125>7.65 U/ml and NLR >1.72 should be effective makers for patients with low CA125 concentration. As a more sensitive and cost-effective strategy, this method could be conducted during routine ovarian cancer screening.

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A randomized study of screening for ovarian cancer: a multicenter study in Japan

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.01035.x ◽

2008 ◽

Vol 18 (3) ◽

pp. 414-420 ◽

Cited By ~ 153

Author(s):

H. Kobayashi ◽

Y. Yamada ◽

T. Sado ◽

M. Sakata ◽

S. Yoshida ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Postmenopausal Women ◽

Statistical Significance ◽

Intervention Group ◽

Developed Countries ◽

Control Group ◽

Ovarian Cancer Screening ◽

Gynecological Examination

Ovarian cancer is common in women from developed countries. We designed a prospective randomized controlled trial of ovarian cancer screening to establish an improved strategy for the early detection of cancers. Asymptomatic postmenopausal women were randomly assigned between 1985 and 1999 to either an intervention group (n= 41,688) or a control group (n= 40,799) in a ratio of 1:1, with follow-up of mean 9.2 years, in Shizuoka district, Japan. The original intention was to offer women in the intervention group annual screens by gynecological examination (sequential pelvic ultrasound [US] and serum CA125 test). Women with abnormal US findings and/or raised CA125 values were referred for surgical investigation by a gynecological oncologist. In December 2002, the code was broken and the Shizuoka Cohort Study of Ovarian Cancer Screening and Shizuoka Cancer Registry were searched to determine both malignant and nonmalignant diagnoses. Twenty-seven cancers were detected in the 41,688-screened women. Eight more cancers were diagnosed outside the screening program. Detection rates of ovarian cancer were 0.31 per 1000 at the prevalent screen and 0.38–0.74 per 1000 at subsequent screens; they increased with successive screening rounds. Among the 40,779 control women, 32 women developed ovarian cancer. The proportion of stage I ovarian cancer was higher in the screened group (63%) than in the control group (38%), which did not reach statistical significance (P= 0.2285). This is to our knowledge the first prospective randomized report of the ovarian cancer screening. The rise in the detection of early-stage ovarian cancer in asymptomatic postmenopausal women is not significant, but future decisions on screening policy should be informed by further follow-up from this trial.

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Prospective Study Using the Risk of Ovarian Cancer Algorithm to Screen for Ovarian Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2005.01.6642 ◽

2005 ◽

Vol 23 (31) ◽

pp. 7919-7926 ◽

Cited By ~ 170

Author(s):

Usha Menon ◽

Steven J. Skates ◽

Sara Lewis ◽

Adam N. Rosenthal ◽

Barnaby Rufford ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Postmenopausal Women ◽

Cancer Genetics ◽

Transvaginal Ultrasound ◽

Prospective Trial ◽

The United States ◽

Elevated Risk ◽

Control Group ◽

Ovarian Cancer Screening

Purpose To evaluate prevalence screening in the first prospective trial of a new ovarian cancer screening (OCS) strategy (risk of ovarian cancer or ROC algorithm) on the basis of age and CA125 profile. Patients and Methods Postmenopausal women, ≥ 50 years were randomly assigned to a control group or screen group. Screening involved serum CA125, interpreted using the ROC algorithm. Participants with normal results returned to annual screening; those with intermediate results had repeat CA125 testing; and those with elevated values underwent transvaginal ultrasound (TVS). Women with abnormal or persistently equivocal TVS were referred for a gynecologic opinion. Results Thirteen thousand five hundred eighty-two women were recruited. Of 6,682 women randomly assigned to screening, 6,532 women underwent the first screen. After the initial CA125, 5,213 women were classified as normal risk, 91 women elevated, and 1,228 women intermediate. On repeat CA125 testing of the latter, a further 53 women were classified as elevated risk. All 144 women with elevated risk had TVS. Sixteen women underwent surgery. Eleven women had benign pathology; one woman had ovarian recurrence of breast cancer; one woman had borderline; and three women had primary invasive epithelial ovarian cancer (EOC). The specificity and positive predictive value (PPV) for primary invasive EOC were 99.8% (95% CI, 99.7 to 99.9) and 19% (95% CI, 4.1 to 45.6), respectively. Conclusion An OCS strategy using the ROC algorithm is feasible and can achieve high specificity and PPV in postmenopausal women. It is being used in the United Kingdom Collaborative Trial of Ovarian Cancer Screening and in the United States in both the Cancer Genetics Network and the Gynecology Oncology Group trials of high-risk women.

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Prostate Specific Antigen Changes as Related to the Initial Prostate Specific Antigen: Data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial

Yearbook of Medicine ◽

10.1016/s0084-3873(08)70102-0 ◽

2007 ◽

Vol 2007 ◽

pp. 153-154

Author(s):

P.J. Loehrer

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Prostate Specific Antigen ◽

Specific Antigen ◽

Ovarian Cancer Screening ◽

Cancer Screening Trial ◽

Screening Trial

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Validation of Self-Report of Chest X-Ray Exam at a Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Center

Reviews on Recent Clinical Trials ◽

10.2174/1574887110666150731145929 ◽

2015 ◽

Vol 10 (3) ◽

pp. 194-199 ◽

Cited By ~ 1

Author(s):

Lisa Gren ◽

Lois Lamerato ◽

Patrick Wright ◽

Pamela Marcus

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Self Report ◽

Ovarian Cancer Screening ◽

X Ray ◽

Cancer Screening Trial ◽

Chest X Ray ◽

Screening Trial

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Motivators of Inappropriate Ovarian Cancer Screening: A Survey of Women and Their Clinicians

JNCI Cancer Spectrum ◽

10.1093/jncics/pkaa110 ◽

2020 ◽

Author(s):

Courtney Macdonald ◽

Danielle Mazza ◽

Martha Hickey ◽

Morgan Hunter ◽

Louise A Keogh ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Screening ◽

Familial Breast Cancer ◽

Social Role ◽

Theoretical Domains Framework ◽

Family Physicians ◽

Environmental Context ◽

Ovarian Cancer Screening ◽

Peace Of Mind ◽

Knowledge And Practice

Abstract Background This study examined why women and doctors screen for ovarian cancer (OC) contrary to guidelines. Methods Surveys, based on the Theoretical Domains Framework (TDF), were sent to women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab), and family physicians (FPs) and gynecologists who organised their screening. Results 832 of 1,264 (65.8%) kConFab women responded. 126 (15.1%) had screened in the last two years. Most of these (101, 80.2%) would continue even if their doctor told them it is ineffective. For women, key OC screening motivators operated in the domains of social role and goals (staying healthy for family, 93.9%), emotion and reinforcement (peace of mind, 93.1%) and beliefs about capabilities (tests are easy to have, 91.9%). 252 of 531 (47.5%) clinicians responded; a minority (FPs 45.8%, gynecologists 16.7%) thought OC screening was useful. For gynecologists, the main motivators of OC screening operated in the domains of environmental context (lack of other screening options, 27.6%), and emotion (patient peace of mind, 17.2%, difficulty discontinuing screening, 13.8%). For FPs, the strongest motivators were in the domains of social influence (women ask for these tests, 20.7%), goals (a chance these tests will detect cancer early, 16.4%), emotion (patient peace of mind, 13.8%) and environmental context (no other OC screening options, 11.2%). Conclusion Reasons for OC screening are mostly patient driven. Clinician knowledge and practice are discordant. Motivators of OC screening encompass several domains, which could be targeted in interventions to reduce inappropriate ovarian cancer screening.

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