Screening for ovarian cancer by transvaginal ultrasound and serum CA125 measurement in women with a familial predisposition: a prospective cohort study.
OBJECTIVE
This study evaluates the accuracy of transvaginal ultrasound (TVUS) in combination with CA125 to detect ovarian cancer in women at hereditary risk for ovarian cancer.


METHODS
A semi-annual surveillance protocol comprising CA125 measurement and TVUS was offered to 676 women including 85 BRCA mutation carriers. Surgical intervention was performed if TVUS revealed a suspicious cyst or if elevated CA125 levels or cystic lesions persisted in two consecutive examinations.


RESULTS
Ten women underwent histological verification that revealed one serous cystadenocarcinoma stage Ic. No interval ovarian cancer occurred. The specificity of surgical intervention reached 98.7% (95% confidence interval (CI): 97.5% to 99.3%) and a positive predictive value (PPV) of 10% (95% CI: 1.8% to 40.4%).


CONCLUSIONS
The low PPV is due to the unexpectedly low incidence of ovarian cancer. Large scale investigations including details on potential confounders and modifiers are needed to further evaluate accuracy and effectiveness of ovarian cancer screening for women at high risk.
Bosse
Kristin
K
Division of Molecular Gyneco-Oncology, Department for Obstetrics and Gynecology, University of Cologne, Germany.
Rhiem
Kerstin
K
Wappenschmidt
Barbara
B
Hellmich
Martin
M
Madeja
Martin
M
Ortmann
Monika
M
Mallmann
Peter
P
Schmutzler
Rita
R
D000328:Adult; D018394:CA-125 Antigen / Q000097:blood*; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000097:blood / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology; D003663:Decision Trees; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods; D014621:Vagina
D018394:CA-125 Antigen