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Abstract
Borderline ovarian tumor is a tumor of epithelial origin with low malignant potential. Given its good prognosis, conservative surgical treatment can be considered in younger patients of childbearing age. However, the risk of recurrence in conservatively treated patients is well described. In this prospective study we evaluated the effectiveness of transvaginal ultrasound (TVUS) in the early detection of ovarian recurrences. From March 1997 to October 2006, 60 patients underwent fertility-sparing surgery for borderline ovarian tumors and were all followed at our institution by the same two expert sonographers. All women underwent a 4-month follow-up for the first 2 years with clinical evaluation and TVUS, and every 6 months thereafter a measurement of serum biomarkers was requested as well. Fourteen patients at different FIGO stages at onset of the disease (FIGO Stage IA–IIIC) developed a recurrence after a median of 19.8 (range, 6–51) months after primary conservative surgery. All of them were diagnosed as having at least an adnexal cyst (range, 1–4 cysts), mainly unilocular with a mean diameter of 29 (range, 10–53) mm with endoluminal papillae (mean 2.1 (range, 1–4) papillae), except in one case. Ultrasonographic detection of normal ovarian tissue allowed a further conservative surgical approach in 12 cases. Five patients had a third conservative operation and one a fourth procedure. Four patients conceived after their first fertility-sparing surgery, and two after a second and third relapse respectively. Bimanual examination was suspicious in two cases and tumor biomarkers at relapse were positive in three cases. TVUS correctly identified all tumor recurrences and allowed further fertility-sparing surgery in young patients. These data show that TVUS is the most effective diagnostic procedure during follow-up and the early detection of borderline tumor recurrence in young patients treated conservatively.
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