Hartge P, Hayes R, Reding D, Sherman M E, Prorok P, Schiffman M, Buys S
Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD 20892, USA.
Am J Obstet Gynecol. 2000 Nov;183(5):1232-7. doi: 10.1067/mob.2000.107401.
We assessed whether asymptomatic ovarian abnormalities detected on ultrasonography in postmenopausal women are precursors to ovarian cancer.
We compared the transvaginal ultrasonographic findings from the initial examination of 20,000 postmenopausal women enrolled to date in an ongoing randomized trial of cancer screening with data on the established risk factors for ovarian cancer obtained from self-administered questionnaires. We distinguished cysts with the suggestive characteristic(s) of a septum, a solid component, or an irregular or thick wall ("complex cysts") from simple sonolucent cysts with none of those features.
High parity, a strong ovarian cancer protective factor, was negatively associated with complex cysts (odds ratio for > or =5 births vs no births, 0.72; 95% confidence interval, 0.53-0.97), but long-term oral contraceptive use, another strong ovarian cancer protective factor, was not associated with complex cysts (odds ratio, 0.96; 95% confidence interval, 0.76-1.20). A family history of ovarian cancer or multiple breast cancers, a strong risk factor for cancer, was not associated with complex cysts (odds ratio, 0.99; 95% confidence interval, 0.68-1.44). Other abnormalities found on ultrasonography (including simple cysts, bilateral cysts, or all abnormalities combined) also did not share the established risk factors for ovarian malignancy. We did not identify any combination of features of abnormalities (septum, echogenicity, size, or papillary projections) that manifested the cancer risk factor profile.
Although a very small proportion of the clinically silent ovarian abnormalities found on ultrasonography are determined to be ovarian cancers, the remaining complex cysts and other clinically suspicious abnormalities do not appear to be the immediate precursors of ovarian cancer. The eventual identification of such precursors will yield opportunities for earlier diagnosis, screening of high-risk groups, and better understanding of the cause of this often lethal malignancy.
我们评估了绝经后妇女超声检查发现的无症状卵巢异常是否为卵巢癌的先兆。
我们将目前纳入一项正在进行的癌症筛查随机试验的20000名绝经后妇女首次检查的经阴道超声检查结果，与通过自行填写问卷获得的卵巢癌既定风险因素数据进行了比较。我们将具有隔膜、实性成分、不规则或厚壁等提示性特征的囊肿（“复杂囊肿”）与不具备这些特征的单纯无回声囊肿区分开来。
高生育次数是一种强大的卵巢癌保护因素，与复杂囊肿呈负相关（生育5次及以上与未生育相比的优势比为0.72；95%置信区间为0.53 - 0.97），但长期使用口服避孕药，另一种强大的卵巢癌保护因素，与复杂囊肿无关（优势比为0.96；95%置信区间为0.76 - 1.20）。卵巢癌或多发性乳腺癌家族史是一种强大的癌症风险因素，与复杂囊肿无关（优势比为0.99；95%置信区间为0.68 - 1.44）。超声检查发现的其他异常（包括单纯囊肿、双侧囊肿或所有异常合并）也与既定的卵巢恶性肿瘤风险因素不相关。我们没有发现任何异常特征组合（隔膜、回声性、大小或乳头状突起）表现出癌症风险因素特征。
尽管超声检查发现的临床无症状卵巢异常中只有极小一部分被确定为卵巢癌，但其余的复杂囊肿和其他临床可疑异常似乎并非卵巢癌的直接先兆。最终确定这些先兆将为早期诊断、高危人群筛查以及更好地理解这种常致命恶性肿瘤的病因带来机会。
