Screening for early familial ovarian cancer with transvaginal ultrasonography and colour blood flow imaging

Abstract

Objective - To assess the value of transvaginal ultrasonography with colour blood flow imaging in detecting early ovarian cancer in women with a family history of the disease. Design - Study of self referred symptomless women with a close relative who had developed the disease. Each woman was screened to detect persistent lesions and denned changes in ovarian volume. Morphological score and pulsatility index were recorded. Setting - Ovarian screening clinic. Subjects - 1601 self referred women. Interventions - Women with a positive screening result were recommended to have further investigations. Main outcome measures - Findings at surgery and histology of abnormal ovaries. Morphological score ≥5 and pulsatility index < 1·0 at last scan. Results - Women were aged 17 to 79 (mean 47) years; 959 (60%) were premenopausal, 469 (29%) were naturally postmenopausal, and 173 (11%) had had a hysterectomy. 157 women had a pedigree suggestive of the site specific ovarian cancer syndrome and 288 of multiple site cancers. 61 women had a positive screening result (3·8%, 95% confidence interval 2·9 to 4·9%), six of whom had primary ovarian cancer detected at surgery (five stage Ia, one stage III). Use of a high morphological score or a low pulsatility index increased the odds of finding ovarian cancer from 1:9 to about 2:5 (1:1 in the highest risk groups). Five interval cancers were reported (three ovarian and two peritoneal). Eight of the 11 cancers developed in women with pedigrees suggestive of inherited cancer. Conclusions - Transvaginal ultrasonography with colour flow imaging can effectively detect early ovarian cancer in women with a family history of the disease. The screening interval should be less than two years.