Trans-vaginal sonography could improve screening

Abstract

Ovarian cancer screening with annual trans-vaginal sonography (TVS) might represent a promising examination for earlier detection and increased casespecifi c survival, according to results of the University of Kentucky Ovarian Cancer Screening Project, done from 1987 to 2005 and which enrolled 25 327 women (Cancer, published online March 20, 2007; DOI:10.1002/ cncr.22594). TVS screening had a sensitivity of 85%, specifi city of 98·7%, positive predictive value of 14·0%, and negative predictive value of 99·9%. Excluding borderline tumours, the survival of patients with ovarian cancer was 89·9% at 2 years and 77·2% at 5 years, which was signifi cantly higher (p<0·001) than survival in the unscreened control group, where it was 70·9% and 48·7%, respectively. “What we are really [trying to do] is to detect the cancer early, and we believe that the usually tested biomarker CA-125 is valuable for advanced stages of disease, but not for early stages”, says author John van Nagell (University of Kentucky Chandler Medical CenterMarkey Cancer Center, Lexington, KY, USA). “On the other hand, our trial showed that 82% of women with ovarian cancer detected by TVS had stage I or II disease versus 34% of women in the unscreened control group (p<0·0001)”, he stresses. However, TVS poorly detects cancers limited to the surface epithelium in women who have normal ovarian volume. “We have always been a strong proponent of combining non-invasive imaging with serum biomarkers”, comments Emanuel Petricoin (George Mason University, Manassas, VA, USA). “They will likely be synergistic and increase the specifi city of the test. Indeed, a combined workfl ow whereby a positive serum test result leads to a non-invasive imaging procedure could be clinically superior, by reducing false positives, as well as economically attractive. This would be particularly helpful for ovarian cancer screening, especially for women being followed for recurrence or at high risk”, he adds.