Advantages and Limitations of Ultrasound as a Screening Test for Ovarian Cancer

Abstract

Ovarian cancer (OC) is the seventh most common malignancy diagnosed among women, the eighth leading cause of cancer mortality globally, and the most common cause of death among all gynecological cancers. Even though recent advances in technology have allowed for more accurate radiological and laboratory diagnostic tests, approximately 60% of OC cases are diagnosed at an advanced stage. Given the high mortality rate of advanced stages of OC, early diagnosis remains the main prognostic factor. Our aim is to focus on the sonographic challenges in ovarian cancer screening and to highlight the importance of sonographic evaluation, the crucial role of the operator΄s experience, possible limitations in visibility, emphasizing the importance and the necessity of quality assurance protocols that health workers have to follow and finally increasing the positive predictive value. We also analyzed how ultrasound can be combined with biomarkers (ex. CA-125) so as to increase the sensitivity of early-stage OC detection or, in addition to the gold standard examination, the CT (Computed tomography) scan in OC follow-up. Improvements in the performance and consistency of ultrasound screening could reduce the need for repeated examinations and, mainly, ensure diagnostic accuracy. Finally, we refer to new very promising techniques such as liquid biopsies. Future attempts in order to improve screening should focus on the identification of features that are unique to OC and that are present in early-stage tumors.

Keywords: CA-125; biomarkers; ovarian cancer (OC); screening test; ultrasound.

Figure 1

Unilocular cyst. (Yellow arrows indicate the presence of a cyst with one locule, no solid components and no papillary projections, while blood flow is absent).

Figure 2

Multilocular solid tumor. (Yellow arrow indicates the presence of a cyst with multiple septums, measurable solid components, and papillary projections.)

Figure 3

Presence of solid component. (Yellow arrow indicates a multilocular solid cyst with a measurable solid component).