Ultrasound, physical examination, and CA 125 measurement for the detectionof recurrence after conservative surgery for early borderline ovarian tumors

Background. Borderline ovarian tumors often affect women of childbearing ag e and the prognosis is outstanding. Given the young age of several patients and the good prognosis, fertility sparing surgery is considered adequate f or stage I tumors. However, women treated conservatively have a relatively small but well-defined risk of recurrence and no study has specifically add ressed the optimal follow-up technique. Methods. From 1981 to 1997, 164 women underwent fertility-sparing surgery f or stage I borderline ovarian tumor and were followed prospectively. After surgery all women underwent physical examination and ultrasound examination every 3 months for 2 years after first diagnosis and every 6 months therea fter. Measurement of serum CA 125 levels was planned every 6 months in pati ents with a serous tumor. Results. With a median follow-up of 71, months 28 women treated with fertil ity-sparing surgery (28/164 = 17%) had either recurrence of borderline tumo r (23) or recurrence with carcinoma, Complete details of follow-up procedur es are available for 24 women and they represent the study population, An a bnormal adnexal mass was detected in 18 of 19 women with recurrent borderli ne tumor. One patient had diagnosis due to persistent free fluid. All five women with invasive carcinoma had diagnosis of a complex adnexal mass. Gyne cologic examination was suspicious (palpable mass) in 7 cases and obviously abnormal (large mass or nodules) in another 7. CA 125 serum levels were el evated in 8 cases. Conclusion. Transvaginal ultrasound is currently the most effective diagnos tic technique for the follow-up of young patients treated conservatively fo r early borderline ovarian tumor. (C) 2001 Academic Press.