Gynaecology Cancer Research Unit, St Bartholomew's Hospital, The Royal Hospitals NHS Trust, London.
BJOG. 2014 Dec;121 Suppl 7:35-9. doi: 10.1111/1471-0528.13211.
To assess the performance of ultrasonography in a multimodal ovarian cancer screening strategy.
Prospective ovarian cancer screening trial between December 1986 and June 1993.
General practice, occupational health departments and an ovarian cancer screening clinic at a London teaching hospital.
Postmenopausal women, ≥ 45 years with a raised CA125.
Volunteers with a CA125 ≥ 30 U/mL underwent a pelvic ultrasound. Scans were classified as normal, abnormal (ovarian volume ≥ 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.
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).
Seven hundred and forty-one women underwent 1219 scans and 20 index cancers occurred during a median follow up of 6.8 years. The sensitivity for detection of ovarian cancer of different ultrasound criteria was 100% for abnormal morphology, 89.5% for abnormal volume and 84% for complex morphology. The highest specificity (97%) and positive predictive value (37.2%) was achieved using complex morphology.
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.
评估超声在多模式卵巢癌筛查策略中的表现。
1986 年 12 月至 1993 年 6 月进行的前瞻性卵巢癌筛查试验。
普通诊所、职业健康部门和伦敦教学医院的卵巢癌筛查诊所。
绝经后妇女，年龄≥45 岁，CA125 升高。
CA125≥30U/ml 的志愿者进行盆腔超声检查。扫描结果分为正常、异常（卵巢体积≥8.8ml）或不确定（体积正常但形态异常）。异常卵巢形态分为单纯囊肿（单个、薄壁囊肿，无隔膜或乳头状突起）或复杂（所有其他异常）。异常扫描的志愿者被转诊妇科意见。随访通过癌症登记处和邮寄问卷进行。
不同超声标准对检测指数癌（如原发性上皮性卵巢癌和输卵管癌）的敏感性、特异性和阳性预测值。
741 名妇女接受了 1219 次扫描，中位数随访 6.8 年后发生 20 例指数癌。不同超声标准检测卵巢癌的敏感性分别为异常形态 100%、异常体积 89.5%和复杂形态 84%。特异性最高（97%）和阳性预测值（37.2%）采用复杂形态。
在 CA125 升高的绝经后妇女中，多种超声标准可实现对指数癌的高敏感性、特异性和阳性预测值。使用卵巢形态学解释超声可能会提高敏感性，使用复杂的卵巢形态学可能会提高阳性预测值。
