Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 4 , ISSUE 3 ( July-September, 2010 ) > List of Articles


Screening for Ovarian Cancer: The Possible Improvement by 3D Ultrasound and 3D Power Doppler

Matija Prka, Ulrich Honemeyer

Keywords : Screening methods,Early detection,Transvaginal sonography,Multimodal screening

Citation Information : Prka M, Honemeyer U. Screening for Ovarian Cancer: The Possible Improvement by 3D Ultrasound and 3D Power Doppler. Donald School J Ultrasound Obstet Gynecol 2010; 4 (3):299-319.

DOI: 10.5005/jp-journals-10009-1150

License: CC BY-NC 4.0

Published Online: 01-06-2011

Copyright Statement:  Copyright © 2010; The Author(s).


In developed countries more women die annually from ovarian cancer than from all other gynecologic malignancies combined. The fact that the ovaries are deep within the pelvic cavity and difficult to palpate is an obstacle to early diagnosis, especially in peri-post menopausal women, the group with the highest incidence of the disease. Seventy percent of patients are not diagnosed with the disease until the cancer has metastasized beyond the ovaries and is at stage 3 or 4. Patients with stage 3 or 4 have a 5-year survival rate of only 20-30%. Given the burden of suffering associated with ovarian cancer and the clear survival gradient related to the stage of disease at diagnosis, there is great need for development of effective screening methods for early detection of epithelial ovarian cancer. Better understanding of ovarian cancer etiology and increasing knowledge of tumor biology have both contributed to identify efficient Serum Tumor Markers, to screen high-risk populations. Technical advances in the field of ultrasound made transvaginal sonography (TVS) become the most important diagnostic tool, and multimodal (Serum markers plus TVS) screening appears to be a diagnostic break-through in fighting ovarian cancer. Five case reports illustrate that new ultrasound technologies such as 3D volume acquisition and 3D power Doppler imaging promise more reliable identification of an abnormal ovarian tumor vascularity and tumor-typical vascular architecture, thus facilitating early stage 1 – detection of the disease.

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  1. Cancer statistics 2000. CA Cancer J Clin 2000;50:7-33.
  2. The detection, treatment, and biology of epithelial ovarian cancer. J Ovarian Res 2010;3:8.
  3. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.
  4. The temporal stability of the Symptom Index among women at high-risk for ovarian cancer. Gynecol Oncol 2009;114: 225-30.
  5. Epidemiology of ovarian cancer. Methods Mol Biol 2009;72:413-37.
  6. Carcinoma of the ovary. In: 24th Volume of the FIGO Annual Report on the Results of Treatment in Gynecological Cancer. J Epidemiol Biostat 2001;6(1):107-38.
  7. Effect of delays in primary care referral on survival of women with epithelial ovarian cancer: Retrospective audit. BMJ 2002;324:148-51.
  8. Ovarian cancer: Epidemiology, biology, and prognostic factors. Semin Surg Oncol 2000;19(1):3-10.
  9. Principles and Practice of Gynecologic Oncology. Philadelphia: Lippincott-Raven Publishers, 1997.
  10. The distribution of secondary growths in cancer of the breast. Cancer Metastasis Rev 1989;8:98-101.
  11. Mesothelin-MUC16 binding is a high affinity, N-glycan dependent interaction that facilitates peritoneal metastasis of ovarian tumors. Mol Cancer 2006;5:50.
  12. Screening for the major malignancies affecting women: Current guidelines. Am J Obstet Gynecol 2001;184:1021-30.
  13. Screening for ovarian cancer. BMJ 1999;319: 1317-18
  14. Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: A combined analysis of 22 studies. Am J Hum Genet 2003;72:1117-30.
  15. Ovarian surface epithelium: Biology, endocrinology, and pathology. Endocr Rev 2001;22:255-88.
  16. Epithelial-mesenchymal interconversions in normal ovarian surface epithelium and ovarian carcinomas: An exception to the norm. J Cell Physiol 2007;213:581-88.
  17. Tissue expression of CA 125 in benign and malignant lesions of ovary and fallopian tube: A comparison with CA 19-9 and CEA. Gynecol Oncol 1989; 32:297-302.
  18. Incessant ovulation: A factor in ovarian neoplasia? Lancet 1971;2:163.
  19. Focus on epithelial ovarian cancer. Cancer Cell 2004;5:19-24.
  20. Ovulation-induced DNA damage in ovarian surface epithelial cells of ewes: Prospective regulatory mechanisms of repair/survival and apoptosis. Biol Reprod 2001;65:1417-24.
  21. The cell of origin of ovarian epithelial tumors and the ovarian surface epithelium dogma: does the emperor have no clothes? Gynecol Oncol 1999;72:437-42.
  22. The performance of screening tests for ovarian cancer: Results of a systematic review. Br J Obstet Gynecol 1998;105:1136-47.
  23. The efficacy of transvaginal sonographic screening in asymptomatic women at risk for ovarian cancer. Gynecol Oncol 2000;77:350-56.
  24. Bilateral oophorectomy in asymptomatic women over 50 years old selected by ovarian cancer screening. Gynecol Obstet Invest 1999;47:58-64.
  25. Feasibility study of a randomised trial of ovarian cancer screening. J Med Screen 1994;1:215-19.
  26. Transabdominal ultrasound screening for early ovarian cancer. BMJ 1989;299:1363-67.
  27. Screening for ovarian cancer. Clin Obstet Gynecol 1983;10:621-43.
  28. Evaluation of ovarian findings in asymptomatic postmenopausal women with color Doppler ultrasound. Cancer 1995;76:1214-18.
  29. An attempt to screen asymptomatic women for ovarian and endometrial cancer with transvaginal color and pulsed Doppler sonography. J Ultrasound Med 1994; 13:295-301.
  30. Prevalence in a volunteer population of pelvic cancer detected with transvaginal ultrasound and color flow Doppler. Ultrasound Obstet Gynecol 1994;4:414-20.
  31. Usefulness of mass screening for ovarian carcinoma using transvaginal ultrasonography. Cancer 2000;89:582-88.
  32. Feasibility study of a randomised trial of ovarian cancer screening among the general population. J Med Screen 1994;1:209-14.
  33. Screening transvaginal ultrasonography of postmenopausal women in a private office setting. Am J Obstet Gynecol 1994;170:1699-703.
  34. Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer. Obstet Gynecol 1992;80:14-18.
  35. Screening for ovarian cancer: A pilot randomised controlled trial. Lancet 1999;353:1207-10.
  36. Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: A prospective cohort study. BMJ 1996;313:1355-58.
  37. A combined approach for the early detection of ovarian cancer in asymptomatic women. Eur J Obstet Gynecol Reprod Biol 1996;65:221-25.
  38. Screening for ovarian cancer using serum CA 125 and vaginal examination: Report on 2550 females. Int J Gynecol Cancer 1995;5:291-95.
  39. Role of tumour markers in monitoring epithelial ovarian cancer. Br J Cancer 2000;82:1535-38.
  40. Ovarian cancer antigen CA125 is encoded by the MUC16 mucin gene. Int J Cancer 2002;98: 737-40.
  41. CA125 antigen levels in obstetric and gynecologic patients. Obstet Gynecol 1984;64:703-07.
  42. Ovarian cancer screening. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000;215Suppl:861-71.
  43. Toward an optimal algorithm for ovarian cancer screening with longitudinal tumor markers. Cancer 1995;76:2004-10.
  44. Ovarian cancer screening in the general population. Ultrasound Obstet Gynecol 2000;15:350-53.
  45. Benign conditions associated with raised serum CA 125 concentration. J Surg Oncol 2000;75:264-65.
  46. CA 125: Fundamental and clinical aspects. Semin Cancer Biol 1999;9:117-24.
  47. Lysophospholipid growth factors in the initiation, progression, metastases, and management of ovarian cancer. Ann N Y Acad Sci 2000;905:188-208.
  48. Lysophosphatidic acid as a potential biomarker for ovarian and other gynaecologic cancers. JAMA 1998;280:719-23.
  49. Searching for a biomarker for ovarian cancer. JAMA 1998;280:739.
  50. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol 2008;108(2):402-08.
  51. Assessing lead time of selected ovarian cancer biomarkers: A nested case-control study. J Natl Cancer Inst 2010;102(1):26-38.
  52. Is transvaginal ultrasound effective for screening asymptomatic women for the detection of earlystage epithelial ovarian carcinoma? Gynecol Oncol 2000;77: 347-49.
  53. Malignant potential of small cystic ovarian tumors in postmenopausal women. Gynecol Oncol 1998;69:3-7.
  54. Ovarian volume related to age. Gynecol Oncol 2000;77:410-12.
  55. Early detection and treatment of ovarian cancer: Shifting from early stage to minimal volume of disease based on a new model of carcinogenesis. Am J Obstet Gynecol 2008;198(4):351-56.
  56. Ultrasound assessment of ovarian cancer risk in postmenopausal women with CA 125 elevation. Br J Cancer 1999;80:1644-47.
  57. Performance of ultrasound as a second line test to serum CA 125 in ovarian cancer screening. Br J Obstet Gynaecol 2000;107:165-69.
  58. The efficacy of sonographic morphology indexing and serum CA 125 for preoperative differentiation of malignant from benign ovarian tumors in patients after operation with ovarian tumors. J Gynecol Oncol 2008;19(4):229-35.
  59. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: Results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009 Mar 10.
  60. A randomized study of screening for ovarian cancer: A multicenter study in Japan. Int J Gynecol Cancer 2008;18(3):414-20.
  61. The importance of age in screening for cancer. J Med Screen 1999;6:16-20.
  62. Molecular genetics of hereditary ovarian cancer. Oncology (Huntigt) 1998;12:399-406.
  63. Screening for breast and ovarian cancer: The relevance of family history. Br Med Bull 1998;54:823-38.
  64. Current policies for surveillance and management in women at risk of breast and ovarian cancer: A survey among 16 European family cancer clinics. European Familial Breast cancer Collaborative Group. Eur J Cancer 1998;34:1922-26.
  65. Ovarian cancer screening with annual transvaginal sonography - Findings of 25,000 women screened 2007 American Cancer Society DOI 10.1002/cncr.22594 Published online 20 March 2007 in Wiley InterScience http://(
  66. Peritoneal serous papillary carcinoma, a phenotypic variant of familial ovarian cancer: Implications for ovarian cancer screening. Am J Obstet Gynecol 1999;180:917-28.
  67. Three-dimensional ultrasound evaluation of ovarian masses. Gynecol Oncol 1995;59:129-35.
  68. Evaluation of adnexal masses using three-dimensional ultrasonographic technology: Preliminary report. J Ultrasound Med 1997;16:349-54.
  69. The assessment of ovarian tumor angiogenesis: What does threedimensional power Doppler add? Ultrasound Obstet Gynecol 1998;12:136-46.
  70. Three-dimensional ultrasonographic and power Doppler characterization of ovarian lesions. Ultrasound Obstet Gynecol 2000;16:365-71.
  71. Transvaginal sonographic characterization of ovarian disease: Evaluation of a new scoring system to predict ovarian malignancy. Obstet Gynecol 1991;78:70-76.
  72. Transvaginal ultrasonographic characterization of ovarian masses with an improved weighted scoring system. Am J Obstet Gynecol 1994;170:81-85.
  73. A morphology index based on sonographic findings in ovarian cancer. Gynecol Oncol 1993;51:7-11.
  74. New scoring system for prediction of ovarian malignancy based on transvaginal color Doppler sonography. J Ultrasound Med 1992;11:631-38.
  75. Three-dimensional ultrasound and power Doppler improve the diagnosis of ovarian lesions. Gynecol Oncol 2000;76:28-32.
  76. Three-dimensional power Doppler ultrasound improves the diagnostic accuracy for ovarian cancer prediction. Gynecol Oncol 2001;82:40-48.
  77. Centralization of care for patients with advanced-stage ovarian cancer. Cancer 2007;109(8):1513-22.
  78. Contrast-enhanced three-dimensional power Doppler sonography for the differentiation of adnexal masses. Obstet Gynecol 2000;96:452-58.
  79. Evaluation of two different methods for vascular sampling by three-dimensional power Doppler angiography in solid and cystic-solid masses. Ultrasound Obstet Gynecol 2009;33:349-54.
  80. Three-dimensional power Doppler sampling: A new method for predicting ovarian cancer in vascularised complex adnexal masses. J Ultrasound Med 2005;24:689-96.
  81. A scoring system to differentiate malignant from benign masses in specific ultrasound-based subgroups of adnexal tumors. Ultrasound Obstet Gynecol 2009;33:92-101.
  82. The detection of stage I ovarian cancer by three-dimensional sonography and power Doppler. Gynecologic Oncology 2003;90(2):258-64.
  83. Preoperative evaluation of pelvic tumors by Doppler and three-dimensional sonography. J Ultrasound Med 2001;20:829-40.
  84. The cystic adnexal mass: Patient selection, surgical techniques and long-term follow-up. Curr Opin Obstet Gynecol 2001;13:389-97.
  85. Endometriosis and the development of malignant tumours of the pelvis. A review of literature. Best Pract Res Clin Obstet Gynaecol 2004;18(2):349-71.
  86. Screening transvaginal ultrasonography of postmenopausal women in a private office setting. Am J Obstet Gynecol 1994;170:1699-704.
  87. Screening for ovarian cancer by different modes of transvaginal sonography. In: Textbook of Transvaginal Sonography. Kurjak A, Bajo Arenas J (Eds). Jaypee Brothers: New Delhi 2005;465-78.
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