每年经阴道超声进行卵巢癌筛查：25000名受筛查女性的结果

Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened.

作者信息

van Nagell John R, DePriest Paul D, Ueland Frederick R, DeSimone Christopher P, Cooper Amy L, McDonald J Matt, Pavlik Edward J, Kryscio Richard J

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, Kentucky 40536, USA.

出版信息

Cancer. 2007 May 1;109(9):1887-96. doi: 10.1002/cncr.22594.

DOI:10.1002/cncr.22594

PMID:17373668

Abstract

BACKGROUND

Ovarian cancer has the highest mortality rate of all gynecologic malignancies, and most women present with advanced-stage disease. The current investigation was performed to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer.

METHODS

Annual TVS screening was performed on 25,327 women from 1987 to 2005. Asymptomatic women aged>or=50 years and women aged>or=25 years who had a family history of ovarian cancer were eligible for participation in this trial.

RESULTS

Among 364 patients (1.4%) with a persisting ovarian tumor on TVS who underwent exploratory laparoscopy or laparotomy with tumor removal, 35 primary invasive ovarian cancers, 9 serous ovarian tumors of low malignant potential, and 7 cancers metastatic to the ovary were detected. Stage distribution was as follows: 28 patients had stage I disease, 8 patients had stage II disease, and 8 patients had stage III disease. Four patients died of disease, 2 patients died of other causes, and 38 patients were alive and well from 0.5 years to 15.8 years after diagnosis (mean, 5.3 years). Nine women developed ovarian cancer within 12 months of a negative screen (false-negative results), and 3 of these patients died of disease. TVS screening had a sensitivity of 85.0%, specificity of 98.7%, positive predictive value of 14.01%, and negative predictive value of 99.9%. After 107,276 screening years, there have been 7 ovarian cancer deaths in the annually screened population and 3 ovarian cancer deaths among women who were noncompliant. Excluding patients with nonepithelial or borderline ovarian malignancies, the survival of patients with ovarian cancer in the annually screened population was 89.9%+/-10.1% at 2 years and 77.2%+/-22.8% at 5 years.

CONCLUSIONS

TVS screening, when it was performed annually, was associated with a decrease in disease stage at detection and with case-specific ovarian cancer mortality, but it was not effective in detecting ovarian cancers in women who had normal ovarian volume.

摘要

背景

卵巢癌是所有妇科恶性肿瘤中死亡率最高的，大多数女性就诊时已处于晚期。本研究旨在确定每年进行经阴道超声检查（TVS）作为卵巢癌筛查方法的有效性。

方法

1987年至2005年对25327名女性进行了每年一次的TVS筛查。年龄≥50岁的无症状女性以及有卵巢癌家族史的年龄≥25岁的女性符合参与本试验的条件。

结果

在364例TVS检查发现有持续存在的卵巢肿瘤并接受了探索性腹腔镜检查或剖腹手术切除肿瘤的患者中，检测到35例原发性浸润性卵巢癌、9例低恶性潜能的浆液性卵巢肿瘤以及7例转移至卵巢的癌症。分期分布如下：28例患者为I期疾病，8例为II期疾病，8例为III期疾病。4例患者死于疾病，2例死于其他原因，38例患者在诊断后0.5年至15.8年（平均5.3年）存活且情况良好。9名女性在筛查结果为阴性后的12个月内患卵巢癌（假阴性结果），其中3例患者死于疾病。TVS筛查的敏感性为85.0%，特异性为98.7%，阳性预测值为14.01%，阴性预测值为99.9%。经过107276个筛查年，在每年接受筛查的人群中有7例卵巢癌死亡，在未遵守筛查的女性中有3例卵巢癌死亡。排除非上皮性或交界性卵巢恶性肿瘤患者后，每年接受筛查人群中卵巢癌患者的2年生存率为89.9%±10.1%，5年生存率为77.2%±22.8%。