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超声作为卵巢癌筛查中血清CA125的二线检测方法的性能。

Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening.

作者信息

Menon U, Talaat A, Rosenthal A N, Macdonald N D, Jeyerajah A R, Skates S J, Sibley K, Oram D H, Jacobs I J

机构信息

Gynaecology Cancer Research Unit, St Bartholomew's Hospital, The Royal Hospitals NHS Trust, London, UK.

出版信息

BJOG. 2000 Feb;107(2):165-9. doi: 10.1111/j.1471-0528.2000.tb11685.x.

Abstract

OBJECTIVE

To assess the performance of ultrasonography in a multimodal ovarian cancer screening strategy.

DESIGN

Prospective ovarian cancer screening trial between December 1986 and June 1993.

SETTING

General practice, occupational health departments and an ovarian cancer screening clinic at a London teaching hospital.

POPULATION

Postmenopausal women, > or = 45 years with a raised CA125.

METHODS

Volunteers with a CA125 > or = 30 U/mL underwent a pelvic ultrasound. Scans were classified as normal, abnormal (ovarian volume > or = 8.8 mL) or equivocal (normal volume with abnormal morphology). Abnormal ovarian morphology was subclassified as simple cyst (single, thin walled cyst with no septa or papillary projections) or complex (all other abnormalities). Volunteers with abnormal scans were referred for a gynaecological opinion. Follow up was via the cancer registry and postal questionnaires.

MAIN OUTCOME MEASURES

Sensitivity, specificity and positive predictive value of different ultrasound criteria for detection of index cancer (e.g. primary invasive epithelial carcinoma of the ovary and fallopian tube).

RESULTS

Seven hundred and forty-one women underwent 1,219 scans and 20 index cancers occurred during a median follow up of 6 x 8 years. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal morphology, 89 x 5% for abnormal volume and 84% for complex morphology. The highest specificity (97%) and positive predictive value (37 x 2%) was achieved using complex morphology.

CONCLUSION

A variety of ultrasound criteria can achieve high sensitivity, specificity and positive predictive value for index cancers in postmenopausal women with an elevated CA125. Use of ovarian morphology to interpret ultrasound may increase sensitivity and use of complex ovarian morphology may increase the positive predictive value.

摘要

目的

评估超声检查在多模式卵巢癌筛查策略中的表现。

设计

1986年12月至1993年6月间的前瞻性卵巢癌筛查试验。

地点

综合医疗、职业健康部门以及伦敦一家教学医院的卵巢癌筛查诊所。

研究对象

年龄≥45岁、CA125升高的绝经后女性。

方法

CA125≥30 U/mL的志愿者接受盆腔超声检查。扫描结果分为正常、异常(卵巢体积≥8.8 mL)或可疑(体积正常但形态异常)。异常卵巢形态进一步分为单纯囊肿(单个、薄壁、无隔或乳头样突起的囊肿)或复杂型(所有其他异常)。扫描结果异常的志愿者被转诊以获取妇科专业意见。通过癌症登记处和邮寄问卷进行随访。

主要观察指标

不同超声标准检测索引癌(如卵巢和输卵管原发性浸润性上皮癌)的敏感性、特异性和阳性预测值。

结果

741名女性接受了1219次扫描,在中位随访6.8年期间发生了20例索引癌。不同超声标准检测卵巢癌的敏感性,形态异常为100%,体积异常为89.5%,复杂形态为84%。使用复杂形态时特异性最高(97%),阳性预测值最高(37.2%)。

结论

对于CA125升高的绝经后女性,多种超声标准对索引癌可实现高敏感性、特异性和阳性预测值。利用卵巢形态解读超声检查可能会提高敏感性,而利用复杂卵巢形态可能会提高阳性预测值。

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