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Ultrasound superior to symptoms for predicting ovarian cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Transvaginal sonography (TVS) is superior to symptom analysis for detecting ovarian cancer, while symptom analysis is better able to distinguish benign tumors, according to a report in the July 13th online issue of Cancer.

Moreover, the results show that when TVS and symptom analysis are combined, the ability to distinguish benign tumors is enhanced, but detection of malignancy is worsened.

“Although ovarian cancer has been perceived as a ‘silent killer’ that produces few specific symptoms, recent studies have indicated that certain symptoms are significantly more common in women with ovarian cancer than in women in the general population,” Dr. Edward J. Pavlik, from the University of Kentucky, Lexington, and colleagues note. Exactly how symptom analysis stacks up against TVS was unclear.

To assess the performance of TVS and symptom analysis in predicting ovarian cancer, Dr. Pavlik’s team analyzed data from 272 women who participated in annual TVS screening. Symptoms were analyzed using a symptom survey published in 2007.

In detecting ovarian cancer, TVS had a higher sensitivity than did symptom analysis: 73.3% vs. 20%. In distinguishing benign tumors, the specificity of symptom analysis was higher than that of TVS: 91.3% vs. 74.4%.

When TVS and symptom analysis were combined, the sensitivity in detecting ovarian cancer fell to 16.7%, while the specificity in distinguishing benign tumors rose to 97.9%.

“Until an effective screening test for ovarian cancer is found, the clinical challenge remains how to discriminate between significant and common symptoms to best care for patients,” Dr. Ilana Cass, from Cedars-Sinai Medical Center, Los Angeles, comments in an accompanying editorial. “Given the vague nature of these symptoms that lack an exact threshold for further costly evaluation, this is no small task.”

Cancer 2009.