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Symptoms index screening added little benefit to ultrasound screening for ovarian cancer detection
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Transvaginal sonography alone performed better as a screening tool than symptoms index screening or a combination of the two for detection of ovarian cancer.
Researchers enrolled 272 participants who reported confident responses to a symptoms questionnaire from the University of Kentucky Ovarian Screening Program.
Participants were scored positive if they had any of the six symptoms from an index published by Goff et al for >12 days per month for <12 months. Symptoms included pelvic pain, abdominal pain, increased abdominal size, bloating, feeling full and having difficulty eating.
Sensitivity was minimal using the symptoms index, with 20% of women with ovarian cancer showing a positive symptoms index, according to the researchers.
Transvaginal sonography had greater sensitivity (73.3%) than symptoms index screening (20%) for detecting malignancies; however, symptoms index screening was more effective (91.3%) than transvaginal sonography (74.4%) at distinguishing benign tumors.
The combined use of transvaginal sonography and symptoms index screening demonstrated poorer detection of malignancies with sensitivity of 16.7%, yet showed improved performance for distinguishing benign tumors with specificity of 97.9%.
Screening that was negative with transvaginal sonography and symptoms index screening was likely to be benign with specificity >97%. Furthermore, the ability to distinguish malignancies was only slightly improved with a sensitivity increase of 3.3% when using both transvaginal sonography and the symptoms index.
These findings are valuable because they will generate discussion regarding ovarian cancer symptoms, according to Ilana Cass, MD, faculty physician in the department of obstetrics and gynecology at Cedars-Sinai Medical Center in Los Angeles.
“The optimal constellation of symptoms to screen for ovarian cancer may never be defined; however, progress has been made to recognize that such symptoms does exist,” Cass said in an accompanying editorial.
Pavlik EJ. Cancer. 2009;doi:10.1002/cncr.24407.