NEW YORK (Reuters Health), Mar 17 - The results of the largest ovarian cancer screening trial to date suggest that a transvaginal ultrasound strategy or a multimodal approach that includes CA125 testing and ultrasound are both effective in detecting early-stage disease.
In the U.K. Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) trial, 202,638 postmenopausal women were randomized to receive no ovarian cancer screening or screening with the multimodal strategy or ultrasound alone.
With the multimodal approach, CA125 testing was performed annually and women found to have an intermediate or high risk of ovarian cancer were referred for transvaginal ultrasound. With the ultrasound only approach, by contrast, ultrasound was performed in all women annually.
The results are reported in the March 10 Online First issue of the Lancet Oncology.
Primary ovarian cancers and tubal cancers were detected in 42 women in the multimodal screening group and in 45 women screened by ultrasound alone. Of the 58 invasive cancers, 28 (43%) were stage I/II, lead author Dr. Usha Menon, from University College London, and colleagues report.
In detecting primary ovarian and tubal cancers, the multimodal approach yielded a sensitivity of 89.4%, a specificity of 99.8%, and a positive predictive value of 43.3%. With the annual ultrasound strategy, the corresponding values were 84.9%, 98.2%, and 5.3%.
In detecting primary invasive epithelial ovarian and tubal cancers, the multimodal approach was associated with a sensitivity of 89.5%, a specificity of 99.8%, and a positive predictive value of 35.1%. With the annual ultrasound strategy, the corresponding values were 75.0%, 98.2%, and 2.8%%.
With the exception of significantly higher specificities with the multimodal approach, the two screening strategies were comparable in their ability to detect ovarian and tubal malignancies.
The higher specificity with the multimodal approach resulted in lower rates of repeat testing and surgery, the authors note. This is due, at least in part, to ultrasound detecting more benign adnexal abnormalities and borderline tumors.
This study has established the feasibility of screening strategies of ovarian cancer, Dr. Menon and colleagues conclude. "The results of ongoing screening are awaited so that the effect of screening on mortality can be determined."
Lancet Oncol 2009.
Last Updated: 2009-03-17 8:00:38 -0400 (Reuters Health)
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![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
