PREVALENCE IN A VOLUNTEER POPULATION OF PELVIC CANCER DETECTED WITH TRANSVAGINAL ULTRASOUND AND COLOR-FLOW DOPPLER

Our objective was to find the prevalence of non-symptomatic endometria l and ovarian neoplasms in a volunteer population of women, aged 40 an d over. We offered a free volunteer screening program to asymptomatic women for a study using transvaginal ultrasound and color flow Doppler for the detection of pelvic cancer. In the first 2 years, 2117 women were examined, 51.3% postmenopausal. An ovarian cyst was defined as ha ving a maximum diameter of more than 2.4 cm. Color flow was used to id entify blood vessels feeding pelvic organs and adnexal enlargements. A n abnormal Doppler flow velocity for the ovary was defined as a resist ance index of less than 0.41. Ovarian cysts of less than 5 cm with nor mal Doppler indices were followed up in 6 months to 1 year. An adnexal morphology score was created to quantify the usefulness of this param eter, particularly in postmenopausal women. Indications for surgery we re pre-defined as a persistent ovarian cyst of more than 5 cm, a persi stent suspicious Doppler and a total endometrial thickness of greater than 0.59 cm in postmenopausal women not taking hormones. A total of 2 02 women (9.5%) had ovarian cysts. Fourteen women were operated upon b ecause of size criteria, one because of family history and three for p ersistent abnormal flow. By Doppler study, 15 cysts were predicted to be benign and histology was confirmatory. There were two false positiv es and one true positive, a stage Ib ovarian cancer. There were no fal se negatives, although a stage I endometrioid cancer of the ovary was detected 8 months after a negative scan. In those cases in which follo w-up data were available, 56% of the cysts regressed in premenopausal women. In postmenopausal women, 28% regressed. Twenty of 1086 postmeno pausal women had endometrial biopsies. Three had endometrial cancer, t wo stage I and one stage IIA. Five had atypical or adenomatous hyperpl asia, and seven had benign polyps. So many women have small asymptomat ic cysts of the ovary that a major reorientation of physicians' attitu des towards the ovary will have to be introduced to adapt to this new information. In this population, the prevalence of benign epithelial o varian neoplasms was 7/1000, and of malignancy was 0.5/1000. In postme nopausal women, the prevalence rate for endometrial cancer was 3/1000, with 5/1000 hyperplasias and 7/1000 benign polyps. When endometrial a nd ovarian cancer screening are combined, the yield is comparable to t hat seen in breast and cervical cancer screening.