Results from Four Rounds of Ovarian Cancer Screening in a Randomized Trial

Abstract

Postoperative pelvic pain is a complication associated with the use of first generation endometrial ablative techniques for treatment of dysfunctional uterine bleeding. This complication usually presents a few months after surgery with a reported incidence ranging from 4.7% to 13.5%. Short-term studies have shown that microwave endometrial ablation (MEA), a second generation endometrial ablation technique, is effective in 70% to 80% of women and has low overall risk of complications. There is, however, no long-term efficacy or safety data. This retrospective, observational study assessed whether hysteroscopic adhesiolysis after MEA could avoid the need for hysterectomy or major surgery in patients with a history of pelvic pain after MEA who were at high risk of intrauterine adhesions.Among the 20 patients in the study population, 17 (85%) were found to have intrauterine adhesions at hysteroscopy that were divided. The cure rate in the group of women with no pelvic pain before the MEA procedure who received hysteroscopic adhesiolysis alone was 85.7% (6/7), whereas only 10% (1/10) of women with pain before MEA were cured with hysteroscopic adhesiolysis alone (P Ͻ 0.01). At follow-up, 45% (9/20) of patients had been cured of pain by hysteroscopic adhesiolysis and were discharged. Of the 55% (11/20) patients with lingering complaints of pain, 9 underwent hysterectomy, 1 who was found to have endometriosis at laparoscopy had a laparoscopic bilateral salpingooophorectomy, and 1 received mefenamic acid. No serious adverse reactions were noted with hysteroscopic adhesiolysis.These findings suggest that hysteroscopic adhesiolysis is beneficial for patients with no history of pain before the MEA procedure. As a result, hysterectomy can be avoided in such patients who in this study comprised nearly half of the study population. The small number of cases limits the study. GYNECOLOGYVolume 64, Number 9 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTVaginal vault dehiscence, a surgical emergency, is a rare complication of hysterectomy that can occur a few weeks, several months, or years after the operation. Its incidence in several studies ranged from 0.03% to 0.3%. There is relatively little detailed information on predisposing factors for vault dehiscence and its manifestation after hysterectomy. This retrospective case series and literature review evaluated factors predisposing to vault dehiscence after hysterectomy and its manifestation. A total of 54 cases of vault dehiscence were identified: 16 were unpublished cases of vaginal vault dehiscence after total laparoscopic hysterectomy obtained from 5 physicians participating in the American Association of Gynecologic Laparoscopists Endo Exchange List (group A) and 38 cases were found in an English-language literature search (group B). Participating physicians completed a detailed questionnaire containing demographic data, indications and type of hysterectomy, operative procedure, predisposing factors, and potential triggering factors for dehiscence. The literature search was ...

Development of an ovarian cancer screening decision model that incorporates disease heterogeneity

“…Two large, randomized controlled trials have reported the results from the early rounds of screening, and the impact on disease mortality will be judged based on longer term follow-up to be reported in the next few years. 4,5 Mathematical modeling offers the ability to estimate the effects of screening strategies on clinical outcomes and to inform the design of future strategies. In the current study, we calibrated an ovarian cancer natural history model to SEER data, validated the model by approximating key results from the UKCTOCS prevalence screen within reported 95% confidence intervals, and simulated population-based screening.…”

PAX2-null secretory cell outgrowths in the oviduct and their relationship to pelvic serous cancer

“…The absence of effective screening or risk prediction, coupled with the very high percentage presenting with advanced disease has resulted in a low cure rate and high mortality. 2 Efforts to identify the source of serous cancers have revealed that the oviduct, particularly the fimbriated end, is responsible for a larger proportion of serous cancers than previously thought, both in women with BRCA1 or BRCA2 mutations and the general population. [3][4][5][6][7] A serous cancer precursor has been proposed to arise in the distal oviduct.…”

Early Detection of Ovarian Tumors Using Ultrasound

“…Kentucky trial [21] PLCO trial [22] UKCTOCS trial [23] SCSOCS trial [24] Country USA USA UK Japan has indicated that 19.5 nonmalignancies went to surgery for each malignancy [25]. Lastly, the Kentucky trial found a significant survival benefit to TVS screening, while the PLCO trial reported similar mortalities in the screened and control group.…”

“…Second, by isolating the events of the screening period from those in the follow-up period because of the follow-up cases that may have begun well after screening as described above, it is possible to estimate the sensitivity of cases identified during screening as 66. [25].…”

“…In the last two rounds of the PLCO trial, which used CA-125 alone [22], interval cancers increased to 9 FN/year from 4.75 FN/year in the first four rounds [25] indicating that CA-125 by itself missed more cancers. In the earlier PLCO report [25], TVS alone picked up 71.4% of stage I/II cases in contrast to 11.1% by CA-125 alone; however, the summary PLCO reports that only 22% stage I/II were detected overall [22].…”