title: The role of transvaginal ultrasonography for detecting ovarian cancer in an asymptomatic screening population: a systematic review.
abstract: BACKGROUND
  The purpose of this study was to systematically analyze the effect of transvaginal ultrasonography in an asymptomatic female population as an annual screening procedure with regard to mortality data. Studies were evaluated descriptively on their strengths and weaknesses considering the methods and results.
  
  
  METHODS
  We evaluated 632 international studies by selecting only randomized controlled trials (RCTs). Three RCTs concerning transvaginal ultrasonography were found, performed in Japan, the USA, and Great Britain.
  
  
  CONCLUSIONS
  Currently, no clear recommendation for the screening for ovarian cancer in an asymptomatic population can be given based on these three studies. The authors could not show a change in mortality using transvaginal ultrasonography for annual screening.
  
  
  CONCLUSIONS
  An annual palpation does not offer a beneficial effect. The development of new ultrasound machines with higher image resolution in combination with a well-standardized algorithm for ovarian cancer in upcoming years might provide an improvement regarding mortality. The current studies do not show a benefit in screening an asymptomatic population annually with transvaginal ultrasonography, but the most recent publication showed a trend toward lower mortality in patients who underwent screening after 7-14 years of follow-up. Nevertheless, all three heterogeneous RCTs had weaknesses in their methods and therefore they neither contradict the general recommendation for screening in an asymptomatic population nor do they support it.
authors.affiliation: Department of Gynecological Endocrinology, Clinic for Gynecology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. k.buehling@uke.de.
authors.forename: Kai J
authors.initials: KJ
authors.lastname: Buhling
authors.affiliation: Department of Gynecological Endocrinology, Clinic for Gynecology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Lezon
authors.affiliation: Institute for Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Eulenburg
authors.affiliation: Clinic for Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schmalfeldt
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014621:Vagina
keywords: CA125; Ovarian cancer; Screening; Ultrasonography