title: The search for meaning-Symptoms and transvaginal sonography screening for ovarian cancer: predicting 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.
authors: Department of Obstetrics and Gynecology, The University of Kentucky Chandler Medical Center, Lexington, Kentucky, USA. epaul1@uky.edu
authors: Edward J
authors: EJ
authors: Pavlik
authors: Brook A
authors: BA
authors: Saunders
authors: Stacey
authors: S
authors: Doran
authors: Katherine W
authors: KW
authors: McHugh
authors: Frederick R
authors: FR
authors: Ueland
authors: Christopher P
authors: CP
authors: Desimone
authors: Paul D
authors: PD
authors: Depriest
authors: Rachel A
authors: RA
authors: Ware
authors: Richard J
authors: RJ
authors: Kryscio
authors: John R
authors: JR
authors: van Nagell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007114:Immunization; D008403:Mass Screening; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology; D011795:Surveys and Questionnaires; D014463:Ultrasonography / Q000379:methods; D014621:Vagina