Screening for ovarian cancer in women with breast cancer with transvaginal sonography and color flow imaging

Abstract

The aim of the present study was to determine the efficacy of transvaginal color flow imaging as a screening tool for ovarian cancer. Six hundred patients with previous breast carcinoma were screened for ovarian cancer. Screening was performed using transvaginal sonography with color flow imaging. Serum CA 125 levels were measured in patients with abnormal sonographic findings. Eighty-three percent of the ovaries were detected in the premenopausal patients by ultrasonographic scanning and only 26% of the ovaries were detected in the postmenopausal patients. Intraovarian blood vessels were detected in 11% of the premenopausal women. The PI was less than 1 in 80% of these ovaries, but, on repeated examinations, the values of PI increased in all the blood vessels to greater than 1. Intraovarian blood vessels were detected in 1.8% of the normal ovaries observed in the postmenopausal women, but PI was always greater than 1. Eleven women with complex ovarian cysts (not simple) and one woman with enlarged ovaries underwent explorative laparotomy. In three women, primary malignant ovarian tumors were diagnosed and in one woman metastatic ovarian cancer was diagnosed. The specificity of sonography in detecting malignant ovarian tumors was 97.5% and the positive predictive value was 25%. The specificity of color flow imaging in detecting primary malignant ovarian tumors was 99.8% and the positive predictive value was 60%. In selected groups of women, screening for ovarian cancer with transvaginal color flow imaging may be justified.

Adnexal Masses in Women with Breast Cancer: US Findings with Clinical and Histopathologic Correlation

“…Seven of these patients with breast cancer and with US-histopathologic correlation had benign ovarian abnormalities, three had primary ovarian carcinoma, and one had metastases to the ovaries. In that study (8), the frequency of primary ovarian carcinoma in patients with breast cancer who underwent endovaginal US screening was one (0.5%) in 200 patients.…”

“…Some ovarian screening studies have been performed in patients who are considered to be at high risk for ovarian disease because of a family history of ovarian carcinoma (6-8), but to our knowledge few researchers have investigated the incidence of ovarian disease in patients with a personal history of breast cancer (8). Weiner et al (8) screened 600 patients with breast cancer prospectively with endovaginal US and found 14 patients with persistent abnormal screening examination findings, 11 of whom consented to surgery. Seven of these patients with breast cancer and with US-histopathologic correlation had benign ovarian abnormalities, three had primary ovarian carcinoma, and one had metastases to the ovaries.…”

“…Investigators in prior studies have used US to screen for adnexal disease in high-risk patients, who include women with a breast cancer (6)(7)(8), but, to our knowledge, no investigators have previously addressed the relatively frequent clinical problem of the patient with breast cancer who has an adnexal mass found at US. We performed this study to correlate the US, clinical, and histopathologic findings in patients with breast cancer who underwent surgery because of adnexal masses that were evident at US.…”

Pelvic incidentalomas

“…[ 35 ] prospectively screened 600 patients with breast cancer using endovaginal ultrasound to assess the frequency of synchronous ovarian neoplasms. Of 11 patients who consented to surgery, seven had benign ovarian abnormalities, three had primary ovarian carcinoma and one had metastases to the ovaries.…”

Le dépistage du cancer ovarien

“…Les résultats principaux de ces deux études ont été confirmés par d'autres études, avec cependant des effectifs plus faibles (13)(14)(15)(16)(17)(18)(19). Deux notions ressortent : l'échographie endovaginale permet de réduire le stade des cancers ovariens détectés et ainsi améliore le pronostic de ces cancers (tendance à une diminution de la mortalité par cancer ovarien dans le groupe dépisté), mais au prix d'un taux élevé de faux positifs (environ 12 femmes opérées de lésions bénignes pour 1 cancer ovarien dépisté) (4).…”