John R. van Nagell Jr, MD 1 ,
Paul D. DePriest, MD 1,
Frederick R. Ueland, MD 1,
Christopher P. DeSimone, MD 1,
Amy L. Cooper, MD 1,
J. Matt McDonald , MD 1,
Edward J. Pavlik, PhD 1,

¹Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University of Kentucky Chandler Medical Center-Markey Cancer Centre, Lexington, Kentucky

BACKGROUND
Ovarian cancer has the highest mortality rate of all gynaecologic malignancies, and most women present with advanced-stage disease. The current investigation was performed to determine the efficacy of annual transvaginal sonography (TVS) as a screening method for ovarian cancer.
METHODS
Annual TVS screening was performed on 25,327 women from 1987 to 2005. Asymptomatic women aged 50 years and women aged 25 years who had a family history of ovarian cancer were eligible for participation in this trial.
RESULTS
Among 364 patients (1.4%) with a persisting ovarian tumour on TVS who underwent exploratory laparoscopy or laparotomy with tumour removal, 35 primary invasive ovarian cancers, 9 serous ovarian tumours of low malignant potential, and 7 cancers metastatic to the ovary were detected. Stage distribution was as follows: 28 patients had stage I disease, 8 patients had stage II disease, and 8 patients had stage III disease. Four patients died of disease, 2 patients died of other causes, and 38 patients were alive and well from 0.5 years to 15.8 years after diagnosis (mean, 5.3 years). Nine women developed ovarian cancer within 12 months of a negative screen (false-negative results), and 3 of these patients died of disease. TVS screening had a sensitivity of 85.0%, specificity of 98.7%, positive predictive value of 14.01%, and negative predictive value of 99.9%. After 107,276 screening years, there have been 7 ovarian cancer deaths in the annually screened population and 3 ovarian cancer deaths among women who were noncompliant. Excluding patients with nonepithelial or borderline ovarian malignancies, the survival of patients with ovarian cancer in the annually screened population was 89.9% ± 10.1% at 2 years and 77.2% ± 22.8% at 5 years.
CONCLUSIONS
TVS screening, when it was performed annually, was associated with a decrease in disease stage at detection and with case-specific ovarian cancer mortality, but it was not effective in detecting ovarian cancers in women who had normal ovarian volume. Cancer 2007; Vol 109:1887-96. © 2007 American Cancer Society.