THE CURRENT STATUS OF ULTRASOUND AND COLOR DOPPLER IMAGING IN SCREENING FOR OVARIAN-CANCER

The lack of significant improvement in ovarian cancer survival in over 3 decades has focused interest on early disease detection as well as the development of more effective therapies. Ultrasound's ability to discern alterations in ovarian architecture and color doppler's ability to recognize malignancy-associated angiogenesis have resulted in the application of these techniques to ovarian cancer screening. Morphology scoring systems have been developed to quantitate the anatomic alterations seen on ultrasound. Prospective ovarian cancer ultrasound screening trials involving 11,283 women were evaluated: 486 participants underwent surgical exploration and 19 ovarian cancers were diagnosed. Thirteen cases were stage I where the impact of screening on disease survival is thought to be maximal; 5/13 were invasive epithelial malignancies, 7/13 were borderline tumors, and 1/13 was a granulosa cell tumor. Overall, 32 surgeries (95% CI = 20-58) were required to diagnose one stage I ovarian cancer; if only those women with a family history of ovarian cancer are included in the analysis, then 17 surgeries (95% CI = 14-41) would be required. Potential clinical implications of these results are discussed, as well as future directions for screening. (C) 1994 Academic Press, Inc.