经阴道超声检查在卵巢癌群体筛查中的应用价值

Usefulness of mass screening for ovarian carcinoma using transvaginal ultrasonography.

作者信息

Sato S, Yokoyama Y, Sakamoto T, Futagami M, Saito Y

机构信息

Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosaki, Japan.

出版信息

Cancer. 2000 Aug 1;89(3):582-8. doi: 10.1002/1097-0142(20000801)89:3<582::aid-cncr13>3.0.co;2-#.

DOI:10.1002/1097-0142(20000801)89:3<582::aid-cncr13>3.0.co;2-#

PMID:10931457

Abstract

BACKGROUND

International Federation of Gynecology and Obstetrics Stage I ovarian carcinoma, which has the worst prognosis among all types of gynecologic carcinoma, has a high cure rate as has been reported, but early diagnosis is difficult and to the authors' knowledge screening methods have not been established. Since 1989, the authors have performed transvaginal ultrasonography (TVS) as a form of screening for ovarian carcinoma. The purpose of the current study was to summarize and evaluate screening results for the last 10 years with respect to ovarian carcinoma diagnosis and risk factors.

METHODS

Primary screening by TVS was performed in asymptomatic women who participated in annual uterine cervical carcinoma screening. Four scanning sections by TVS were established and all sonograms were recorded. Women with abnormal sonograms (a mass > 30 mm in greatest dimension or a mass with a mixed pattern) received secondary screening and closer examination with a tumor marker and an imaging diagnostic examination. Laparotomy was conducted on all masses with a greatest dimension of >/= 60 mm or on suspected malignant masses. Subject information-related risk factors also were recorded.

RESULTS

Subjects were 183,034 women who participated in primary screening. Of these women, 51,550 were undergoing screening for the first time. The time required for primary screening was 1 minute per subject. Secondary screening was required for 5309 participants (10.3%) and surgery was performed on 324 participants. Twenty-two primary tumors and 2 metastatic tumors were detected for a diagnostic rate of 0.047%. Of the 22 primary tumors, 17 (77.3%) were classified as Stage I carcinoma, with tumor markers positive only for 5 (29.4%). The percentage of the total number of Stage I ovarian carcinoma cases increased after the induction of screening from 29.7% to 58.8%.

CONCLUSIONS

These results are significant in that 77.3% of the primary ovarian carcinomas found during the current screening were of curable Stage I. Increased use of TVS screening for ovarian carcinoma may increase the chance for early diagnosis and decrease the mortality of the disease.

摘要

背景

国际妇产科联盟（FIGO）分期为Ⅰ期的卵巢癌，在所有妇科癌症类型中预后最差，但据报道其治愈率较高，然而早期诊断困难，据作者所知，尚未建立筛查方法。自1989年以来，作者开展了经阴道超声检查（TVS）作为卵巢癌筛查的一种方式。本研究的目的是总结和评估过去10年卵巢癌诊断及危险因素的筛查结果。

方法

对参加年度宫颈癌筛查的无症状女性进行TVS初筛。确定了TVS的四个扫描切面，并记录所有超声图像。超声图像异常（最大径＞30mm的肿块或混合性肿块）的女性接受二次筛查，并通过肿瘤标志物和影像学诊断检查进行更密切的检查。对所有最大径≥60mm的肿块或疑似恶性肿块进行剖腹手术。还记录了与受试者信息相关的危险因素。

结果

183,034名女性参加了初筛。其中，51,550名是首次接受筛查。初筛每位受试者所需时间为1分钟。5309名参与者（10.3%）需要二次筛查，324名参与者接受了手术。检测到22例原发性肿瘤和2例转移性肿瘤，诊断率为0.047%。在22例原发性肿瘤中，17例（77.3%）被归类为Ⅰ期癌，其中仅5例（29.4%）肿瘤标志物呈阳性。筛查开始后，Ⅰ期卵巢癌病例总数的百分比从29.7%增加到58.8%。