Transvaginal Sonography and Postmenopausal Ovarian Screening: Implementation Is Essential

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Transvaginal Sonography and Postmenopausal
Ovarian ScreeningImplementation Is Essential

• Professor Galal Lotfi
• Obstetrics Gynecology
• Suez Canal University.
• Egypt

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Introduction

• The incidence of ovarian carcinoma has increased
  and is now the commonest malignancy of the female
  genital tract in much of the western world(
  William's 1992).
• Ovarian cancer presents in its late stages, (75
  of ovarian cancer) Killing more women than does
  cancer of the cervix and uterine body combined
  (Silverberg et al l990).

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Introduction

• Ovarian cancer screening tests are the subject of
  endless debate. Some say it may progress to a
  late stage so quickly as to make screening
  impractical. This could be minimized by
  decreasing the time between follow up tests
  especially in women with family history of
  ovarian cancer. Again, this criticism could be
  said to any other screening programs.
•  The screening tests tried for ovarian cancer
  included variety of techniques. Clinical
  examination, culdocentesis, immunoscintigraphy,
  tumor marker but all are insensitive.

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Aim of Our Work

• Ultrasound has been an efficient tool for
  studying structural changes associated with human
  follicular development and ovulation, it was
  therefore a logical step to use the same
  technology for morphological changes in the ovary
  that may suggest the presence of early ovarian
  cancer. The use of ultrasound as a screening
  device for ovarian cancer was first proposed by
  Campbell et al (1982).
•  The aim of that work was to implement a
  screening test to decrease the incidence of
  advancing ovarian carcinoma.

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Material And Methods.

• 198 women who were postmenopausal.
• TVS for all women.
• Ovaries were classified with a score according to
  morphological and structural ultrasonic
  appearance on both sides.
• The TVS score (combined to both ovaries) was
  added to the clinical score, according to the
  woman's history, to get the total score.
• Another scan after a year was carried out for all
  women.

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Table (1) Scoring for US appearance of ovaries
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Table (2), Score for Womens History
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Table(3), Scoring of women, 1st Scan Result
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Table (4) Surgical Results of Cases Operated
Upon After the First Examination (N198).
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Table (5) cases with proved malignancy.
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Table (6) Surgical results after one year (N 185)
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Table(7), Scoring of women after one year, N (185)
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Table (8) Comparison Between Cases With Proved
Malignancy and Cases With Benign Lesions (first
Scan).
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Mean and SD of total score of Benign and
malignant lesions (first scan)
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Detection of abnormal, benign and malignant
lesion (first Scan) in 1st scan
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Detection of Abnormal, Benign and malignant
lesion in 2nd scan.
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Conclusion

• Abnormal ovarian conditions detection rate was
  9. 1 and 2.2 of cases in initial examination
  and subsequent year follow up.
• Malignant detection rate was 3.

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Conclusion

• Andolf Jorgensen (1989) found no malignancy in
  58 anechoic lesions less than 5cm as detected by
  ultrasound.
• Rodrigenz et al (1988) reported 3 cancers
  detected in simple cystic lesions with a diameter
  greater than 5cm.
• In the present study, small cysts were found to
  be not immune for malignancy, 3 cases with cyst
  diameter less than 3cmwere found to be malignant.
  

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Epilog.

• With small cyst and in situations where we are in
  doubt, the implemented score could help in
  deciding up. For big, multilocular, complex or
  solid cysts, the answer is straight forward,
  surgical intervention.
• TVS, cheap compared to other imaging techniques,
  non invasive, seems to provide a simple screening
  technique for early ovarian cancer.

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Epilog.

• Its strength resides in its high sensitivity
  62.5, however we cannot deny the false positive
  rates which is present in any diagnostic tool.
• Till we find another test with the least false
  positive results, TVS should be appreciated as a
  screening tool for such a lethal disease not only
  for susceptible women with family history or
  history of other malignancies but for the whole
  population.

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Epilog..

• Application of the suggested scoring system
  could help in differentiating between benign and
  malignant lesions.
• . The new advances in ultrasonography may enable
  us to better understand and recognize the
  earliest stages of oncogenesis with the ovary.