The role of ultrasound evaluation in the detection of early-stage epithelial ovarian cancer
The role of ultrasound evaluation in the detection of early-stage epithelial ovarian cancer
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DOI：
10.1016/j.ajog.2005.01.041
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发表时间：
2005-04-01
影响因子：
9.8
通讯作者：
Schwartz, PE
中科院分区：
文献类型：
--
作者：
Fishman, DA;Cohen, L;Schwartz, PE
目的：上皮性卵巢癌导致的女性死亡人数超过所有其他妇科恶性肿瘤的总和，因为我们无法发现早期疾病。超声检查在无症状女性卵巢癌的检测中已被证明是有用的，但其在高风险女性早期上皮性卵巢癌检测中的价值尚不确定。我们研究了超声在参与国家卵巢癌早期检测计划的无症状高危妇女中检测早期上皮性卵巢癌的有用性。研究设计：只有初始妇科和超声检查正常但卵巢癌发展风险增加的无症状妇女才有资格参加机构审查委员会批准的国家卵巢癌早期检测项目。参与者每6个月进行一次全面的妇科和超声检查。患病风险增加的女性包括：至少有1名一级亲属患有卵巢癌；有乳腺癌、卵巢癌或结肠癌的个人病史；>= 1患乳腺癌和/或卵巢癌的一级和二级亲属；从受影响的家庭成员遗传乳腺癌突变，或在公认的癌症综合征的成员。结果：4526名女性的平均年龄为46岁；2610名女性处于绝经前，1916名女性处于绝经后。自1990年以来，共进行了12709次扫描。98%的绝经前妇女和94%的绝经后妇女双卵巢可见。14名女性接受了单侧输卵管卵巢切除术。在低于常规6个月间隔的妇女中，绝经前妇女的回忆率为0.4%，绝经后妇女为0.3%。共有98名女性患有持续性附件肿块，并进行了49次侵入性手术，诊断出37例良性卵巢肿瘤和12例妇科恶性肿瘤。所有癌症都是在无症状的妇女中发现的，她们在癌症诊断前12个月和6个月进行了正常的超声和体检。检测到的恶性肿瘤包括输卵管癌（IIIC期，n = 4名女性）、原发性腹膜癌（n = 4名女性，IIIA期，1名女性；IIIB期，2名女性；IIIC期，1名女性）、上皮性卵巢癌（IIIA和IIIB期，n = 2名女性）和子宫内膜腺癌（IA期，n = 2名女性）。另外，体格检查发现原发性乳腺癌37例，复发性乳腺癌12例。共有184名具有遗传易感性（乳腺癌阳性）的妇女接受了预防性双侧输卵管-卵巢切除术；23%的手术发现不典型增生，出乎意料的是，2名妇女（1%）被发现患有III期（A期和B期）原发性腹膜癌。结论：本研究表明，诊断性超声检查作为一种独立的方式，在无症状、患病风险增加的早期上皮性卵巢癌的检测中价值有限。(c) 2005爱思唯尔公司版权所有。
Objective: Epithelial ovarian cancer kills more women than all other gynecologic malignancies combined because of our inability to detect early-stage disease. Ultrasonography has demonstrated usefulness in the detection of ovarian cancer in asymptomatic women, but its value for the detection of early-stage epithelial ovarian cancer in women of increased risk is uncertain. We examined the usefulness of sonography in the detection of early-stage epithelial ovarian cancer in asymptomatic high-risk women who participated in the National Ovarian Cancer Early Detection Program.Study design: Only asymptomatic women of increased risk for the development of ovarian cancer with initial normal gynecologic and ultrasound examinations were eligible to participate in the institutional review board-approved National Ovarian Cancer Early Detection Program. Participants underwent comprehensive gynecologic and ultrasound examinations every 6 months. Increased risk includes women with at least I affected first-degree relative with ovarian cancer; a personal history of breast, ovarian, or colon cancer; >= 1 affected first- and second-degree relatives with breast and or ovarian cancer; inheritance of a breast cancer mutation from an affected family member, or membership within a recognized cancer syndrome.Results: The average age of the 4526 women who were evaluated was 46 years; 2610 women were premenopausal, and 1916 women were postmenopausal. A total of 12,709 scans have been performed since 1990. Visualization of both ovaries was noted in 98% of premenopausal and in 94% of postmenopausal women. Fourteen women had undergone unilateral salpingo-oophorectomy. Recall rates at less than the routine 6-month interval were 0.4% in the premenopausal and 0.3% in postmenopausal women. A total of 98 women with persistent adnexal Masses were identified, and 49 invasive surgical procedures were performed that diagnosed 37 benign Ovarian tumours and 12 gynecologic malignancies. All cancers were detected in asymptomatic women who had normal Ultrasound and physical examinations 12 and 6 months before the cancer diagnosis. The detected malignancies were fallopian tube carcinoma (stage IIIC; n = 4 women), primary peritoneal carcinoma (n = 4 women; stage IIIA, 1 woman; stage IIIB, 2 women; stage IIIC, I woman), epithelial ovarian cancer (stages IIIA and IIIB; n = 2 women), and endometrial adenocarcinoma (stage IA; n = 2 women). Additionally 37 primary and 12 recurrent breast carcinomas were detected by physical examination. A total of 184 women with genetic predisposition (breast cancer positive) have undergone a prophylactic bilateral salpingo-oophorectomy; 23% of these procedures found atypical hyperplasia, and unexpectedly, 2 women (1%) were found to have stage III (A and B) primary peritoneal carcinoma.Conclusion: This study demonstrates the limited value of diagnostic ultrasound examination as an independent modality for the detection of early-stage epithelial ovarian cancer in asymptomatic women who are at increased risk for disease. (c) 2005 Elsevier Inc. All rights reserved.