Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1881 East Road, Unit 1902, Houston, TX, 77054, USA.
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ultrasound Obstet Gynecol. 2018 Mar;51(3):293-303. doi: 10.1002/uog.17557.
The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) recently reported a reduction in the average overall mortality among ovarian cancer patients screened with an annual sequential, multimodal strategy that tracked biomarker CA125 over time, where increasing serum CA125 levels prompted ultrasound. However, multiple cases were documented wherein serum CA125 levels were rising, but ultrasound screens were normal, thus delaying surgical intervention. A significant factor which could contribute to false negatives is that many aggressive ovarian cancers are believed to arise from epithelial cells on the fimbriae of the fallopian tubes, which are not readily imaged. Moreover, because only a fraction of metastatic tumors may reach a sonographically-detectable size before they metastasize, annual screening with ultrasound may fail to detect a large fraction of early-stage ovarian cancers. The ability to detect ovarian carcinomas before they metastasize is critical and future efforts towards improving screening should focus on identifying unique features specific to aggressive, early-stage tumors, as well as improving imaging sensitivity to allow for detection of tubal lesions. Implementation of a three-stage multimodal screening strategy in which a third modality is employed in cases where the first-line blood-based assay is positive and the second-line ultrasound exam is negative may also prove fruitful in detecting early-stage cases missed by ultrasound.
英国卵巢癌筛查协作试验（UKCTOCS）最近报告称，通过每年进行一次的序贯、多模态筛查策略，对生物标志物 CA125 进行跟踪，当血清 CA125 水平升高时提示进行超声检查，这种策略可以降低卵巢癌患者的总体死亡率。然而，有多个病例记录表明，血清 CA125 水平升高，但超声检查正常，从而导致手术干预延迟。一个可能导致假阴性的重要因素是，许多侵袭性卵巢癌被认为起源于输卵管伞端的上皮细胞，这些细胞不易成像。此外，由于只有一部分转移性肿瘤在转移前可能达到超声检测到的大小，因此每年进行超声筛查可能无法检测到很大一部分早期卵巢癌。在转移前检测卵巢癌的能力至关重要，未来的筛查工作应重点关注识别侵袭性早期肿瘤的独特特征，并提高成像敏感性以检测输卵管病变。在一线基于血液的检测呈阳性而二线超声检查呈阴性的情况下，采用第三种检测手段的三阶段多模态筛查策略，也可能有助于发现超声漏诊的早期病例。
