Original Article

You have full text access to this OnlineOpen article

The search for meaning—Symptoms and transvaginal sonography screening for ovarian cancer†

Predicting malignancy

  1. Edward J. Pavlik PhD1,‡,*,
  2. Brook A. Saunders MD1,
  3. Stacey Doran BS1,
  4. Katherine W. McHugh BA1,
  5. Frederick R. Ueland MD1,
  6. Christopher P. DeSimone MD1,
  7. Paul D. DePriest MD1,
  8. Rachel A. Ware MD1,
  9. Richard J. Kryscio PhD2,
  10. John R. van Nagell Jr MD1

Article first published online: 14 JUL 2009

DOI: 10.1002/cncr.24407

Issue

Cancer

Cancer

Volume 115, Issue 16, pages 3689–3698, 15 August 2009

Additional Information

How to Cite

Pavlik, E. J., Saunders, B. A., Doran, S., McHugh, K. W., Ueland, F. R., DeSimone, C. P., DePriest, P. D., Ware, R. A., Kryscio, R. J. and van Nagell, J. R. (2009), The search for meaning—Symptoms and transvaginal sonography screening for ovarian cancer. Cancer, 115: 3689–3698. doi: 10.1002/cncr.24407

Author Information

  1. 1

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

  2. 2

    Department of Biostatistics, The University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, Kentucky

  1. ‡

    Fax: (859) 323-1018

*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, 800 Rose Street, Lexington, KY 40536

  1. †

    See editorial on pages 3606-8, this issue.

Publication History

  1. Issue published online: 3 AUG 2009
  2. Article first published online: 14 JUL 2009
  3. Manuscript Accepted: 26 NOV 2008
  4. Manuscript Revised: 4 NOV 2008
  5. Manuscript Received: 12 SEP 2008

Funded by

  • Telford Foundation
  • Department of Health and Human Services, Commonwealth of Kentucky

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (267K)

Keywords:

  • ovary;
  • screening;
  • symptoms;
  • ultrasound

Symptoms can identify ovarian malignancies, but not as well as transvaginal sonography. The current findings indicated that: 1) tumors that screen negative by both ultrasound and a symptoms index are likely to be benign, and 2) adding symptoms information that has weight equal to the weight of ultrasound only slightly improves the discrimination of malignancy.

Abstract

BACKGROUND:

The mortality rate of ovarian cancer is greater than that of all other major gynecologic malignancies. Detecting ovarian cancer at an early and curable stage long has been an objective of oncologists. Recently, it was reported that certain symptom patterns are informative for the presence of ovarian malignancy. In this article, the authors report on how symptoms and ultrasound predict ovarian malignancy.

METHODS:

Two hundred seventy-two women who were participating in annual transvaginal sonography (TVS) screening were selected from among 31,748 women who were enrolled. Symptom results were correlated with ultrasound and surgical pathology findings.

RESULTS:

TVS performed better than symptoms analysis for detecting malignancies (sensitivity, 73.3% vs 20%), and symptoms analysis performed better for distinguishing benign tumors (specificity, 91.3% vs 74.4%). The use of TVS and symptoms analysis in series resulted in poorer identification of malignancy (sensitivity, 16.7%) but improved the ability to distinguish benign tumors (specificity, 97.9%). Decisions using either symptoms or TVS combined in parallel had small increases in sensitivity (+3.3%) and had coordinated, small decreases in specificity (−5.8%).

CONCLUSIONS:

Symptoms did identify ovarian malignancies, but not as well as TVS. The current findings indicated that: 1) tumors that are negative by both ultrasound and a symptoms index are likely to be benign (specificity, >97%), and 2) adding symptoms information that has weight equal to the weight of ultrasound only slightly improves the discrimination of malignancy (sensitivity increase, +3.3%). Thus, a major benefit in discriminating malignancy was achieved through ultrasound, whereas the absence of symptoms in conjunction with an abnormal ultrasound (characterized by a low morphology index) indicated that the mass was benign and that surgery may not be required. Finally, informative symptoms can be expected to be absent in 80% of patients with ovarian malignancies. Cancer 2009. © 2009 American Cancer Society.

View Full Article (HTML) Get PDF (267K)