症状触发式卵巢癌筛查：一项可行性和可接受性的初步研究。
Symptom triggered screening for ovarian cancer: a pilot study of feasibility and acceptability.
机构信息
University of Washington, Department of Obstetrics and Gynecology, Seattle, WA 98195-6460, USA.
出版信息
Gynecol Oncol. 2012 Feb;124(2):230-5. doi: 10.1016/j.ygyno.2011.10.032. Epub 2011 Nov 6.
PURPOSE
Our goal was to determine if symptom-based ovarian cancer screening was feasible in a primary care clinic and acceptable to women and practitioners. In addition, we wanted to describe the outcomes for a pilot group of screened women.
METHODS
A prospective study of 2262 women over age 40 with at least one ovary participated in symptom-based screening using a symptom index (SI). The first 1001 were in a non-intervention study arm and 1261 were screened for symptoms and referred on to testing with CA125 and transvaginal ultrasound (TVS) if the SI result was positive. Patients and practitioners were surveyed about acceptability of study procedures. All patients were linked to the Western Washington SEER Cancer Registry to determine if ovarian cancer was diagnosed in any women.
RESULTS
Of the eligible women visiting the clinic, 72.5% were interested in participating, and the participation rate was 62.1%. Of the 1261 who participated in the screening arm 51 (4%) were SI positive and 47 participated in CA125 (45/47 normal) and TVS (32/47 normal). Two endometrial biopsies and one hysteroscopy D&C were performed secondary to study enrollment (pathology negative). No laparotomies or laparoscopies were performed secondary to study involvement. A survey of patient acceptability, on a scale of 1-5, revealed a mean score of 4.8 for the acceptability of SI screening and 4.7 for TVS and CA125 testing among SI positive women. Providers also rated the SI procedures highly acceptable with a mean score of 4.8. Two participating patients were diagnosed with ovarian cancer; one had a true positive SI in the non-intervention arm and one had a false negative SI in the screened arm.
CONCLUSION
While our pilot study is not large enough to assess sensitivity or specificity of a symptom-based screening approach, we did find that this type of screening was feasible and acceptable at the time of a primary care visit and referred approximately 4% of women for additional diagnostic testing. Symptom-based screening also resulted in minimal additional procedures.
目的
我们的目标是确定基于症状的卵巢癌筛查在初级保健诊所是否可行，以及是否被女性和医生接受。此外，我们还想描述一组接受筛查的女性的初步结果。
方法
一项针对 2262 名年龄在 40 岁以上、至少有一个卵巢的女性的前瞻性研究，使用症状指数（SI）进行基于症状的筛查。前 1001 名女性处于非干预研究组，1261 名女性因症状筛查并转诊至 CA125 和经阴道超声（TVS）检查，如果 SI 结果阳性。患者和医生接受了关于研究程序可接受性的调查。所有患者都与华盛顿西部 SEER 癌症登记处联系，以确定是否有女性被诊断出患有卵巢癌。
结果
在符合条件的就诊女性中，72.5%有兴趣参与，参与率为 62.1%。在参与筛查组的 1261 名女性中，51 名（4%）SI 阳性，47 名接受了 CA125（45/47 正常）和 TVS（32/47 正常）检查。由于研究招募，进行了两次子宫内膜活检和一次宫腔镜刮宫术（病理阴性）。由于研究参与，没有进行剖腹手术或腹腔镜手术。对患者可接受性进行的调查（1-5 分制）显示，SI 筛查的可接受性平均得分为 4.8，SI 阳性女性对 TVS 和 CA125 检测的可接受性平均得分为 4.7。提供者对 SI 程序的评价也非常高，平均得分为 4.8。两名参与的患者被诊断为卵巢癌；一名在非干预组中 SI 为真阳性，一名在筛查组中 SI 为假阴性。
结论
虽然我们的试点研究还不够大，无法评估基于症状的筛查方法的敏感性或特异性，但我们确实发现，这种类型的筛查在初级保健就诊时是可行和可接受的，并将大约 4%的女性转介进行额外的诊断性检测。基于症状的筛查也导致了最小的额外程序。
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