A FEASIBILITY STUDY OF OVARIAN-CANCER SCREENING - DOES FINE-NEEDLE ASPIRATION IMPROVE ULTRASOUND SPECIFICITY

Aims and background. The prognosis for ovarian cancer patients depends on the stage at diagnosis. As a prerequisite for any proposed procedu re for ovarian cancer screening, high levels of specificity should be obtained using combinations of tests. Based on preliminary data from a n ongoing feasibility study, this report is focused on the possible ga in in specificity provided by fine-needle aspiration of occult ovarian masses detected by ultrasound. Methods: Ultrasonography was used as a basic test, and fine-needle aspiration was obtained from selected pat ients. Those with (a) positive aspiration cytology or histology, (b) c omplex or solid masses showing volume increase, (c) complex or irregul ar masses and inadequate samples, and (d) recurrent cystic lesions wer e operated on. Results: A total of 3541 asymptomatic patients 50-69 ye ars of age underwent ultrasonography, and 98 were selected for fine-ne edle aspiration. Of these, 19 (positivity rate 19/3541 or 0.5%) were o perated on. Two ovarian cancer cases (FIGO Stage II and III) were dete cted (detection rate 2/3541 or 0.6 x 1,000; positive predictive value 2/19 or 10.5%). Specificity was 3443/3539 or 97.3% for ultrasound alon e and 3522/3539 or 99.5% for the procedure as a whole. Surgical explor ation for relapses of benign cysts reduced by some 50% the potential g ain in positive predictive value provided by aspiration cytology compa red with ultrasound alone. Conclusions: Although fine-needle aspiratio n has improved the performance of ultrasound, this 2-level procedure d oes not appear to achieve acceptable levels of specificity.