The search for meaning—Symptoms and transvaginal sonography screening for ovarian cancer

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. Cancer 2009. © 2009 American Cancer Society.

Symptoms Associated With Ovarian Cancer

“…In a study by Pavlik et al, 24 only 6 of the 30 patients (20%) who had undergone surgery for ovarian cancer had a positive symptom index. The authors did not provide information as to how long after surgery symptom information was collected.…”

Symptoms Relevant to Surveillance for Ovarian Cancer

“…In total, 24,526 women completed the questionnaire and 17,623 women completed the questionnaire more than once on subsequent screens, for a total of 70,734 evaluated questionnaires. The questionnaire was in the exact form as published by Goff, [8] but was modified to include the confidence of the responder as reported [9]. This modification added the question: “How confidently did you answer these questions?” The possible responses were: “ no confidence ” = 0, “ minimally sure ” = 1, “ more than minimally sure ” = 2, “ pretty sure ” = 3, “ sure ” = 4 and “ absolutely sure ” = 5.…”

“…We have employed a questionnaire containing a constellation of symptoms (both related and not related to ovarian cancer) that was reported on by Goff [8]. While data challenging the power of this symptoms index to identify early-stage ovarian cancer has been reported [9,10], symptoms information cannot be ignored, otherwise delays in diagnosis can occur [11]. We have added a self-administered evaluation of reporting confidence to the Goff symptoms questionnaire in order to assess the degree to which women are confident in their responses and have analyzed serially completed questionnaires to determine how time and repeated exposure to symptoms reporting affect confidence.…”

Complications from Surgeries Related to Ovarian Cancer Screening

“…A specific symptom profile has been described in patients with ovarian cancer; however, it is most often reported in those with advanced stage disease [4]. Early stage disease rarely demonstrates this symptom profile [5,6]. …”