US results were considered abnormal if ovaries demonstrated a complex morphology or had simple cysts >60 mL or if ascites was present [24]. Rather than using standard single cutoffs for CA-125 positivity, CA-125 results were designated based on the ROCA algorithm described by Menon et al [25] in earlier work. This algorithm incorporates patient age and CA-125 trends to triage further management, and it is expected to improve CA-125 test performance, particularly its PPV and specificity [25]. MRI To our knowledge, there have been no trials evaluating the use of MRI for ovarian cancer screening in women at average risk. Although MRI is a valuable tool for characterizing adnexal masses that are indeterminate based on US features [26], there has been little interest in its use as a population screening tool given its cost and unclear advantage. CT To our knowledge, there have been no trials evaluating the use of CT for ovarian cancer screening in women at average risk. CT is routinely used for ovarian cancer staging to assess for distant metastases, but it has limited use in the evaluation of the adnexa given its limited ability to distinguish between benign and malignant lesions. For example, in a study of 2,869 postmenopausal women undergoing CT screening colonography [27], 118 (4.1% of the cohort) had incidentally detected adnexal lesions noted at interpretation. Of these, 80 were referred for additional imaging workup and/or surgery. In the 26 women who underwent surgical excision, no ovarian cancers were identified. Furthermore, four women in the cohort subsequently developed ovarian cancer after a negative CT evaluation. The limited discriminatory ability of CT renders it impractical for use as a screening tool in this setting. FDG-PET/CT To our knowledge, there have been no trials evaluating the use of FDG-PET/CT for ovarian cancer screening in women at average risk.
Ovarian Cancer Screening. US results were considered abnormal if ovaries demonstrated a complex morphology or had simple cysts >60 mL or if ascites was present [24]. Rather than using standard single cutoffs for CA-125 positivity, CA-125 results were designated based on the ROCA algorithm described by Menon et al [25] in earlier work. This algorithm incorporates patient age and CA-125 trends to triage further management, and it is expected to improve CA-125 test performance, particularly its PPV and specificity [25]. MRI To our knowledge, there have been no trials evaluating the use of MRI for ovarian cancer screening in women at average risk. Although MRI is a valuable tool for characterizing adnexal masses that are indeterminate based on US features [26], there has been little interest in its use as a population screening tool given its cost and unclear advantage. CT To our knowledge, there have been no trials evaluating the use of CT for ovarian cancer screening in women at average risk. CT is routinely used for ovarian cancer staging to assess for distant metastases, but it has limited use in the evaluation of the adnexa given its limited ability to distinguish between benign and malignant lesions. For example, in a study of 2,869 postmenopausal women undergoing CT screening colonography [27], 118 (4.1% of the cohort) had incidentally detected adnexal lesions noted at interpretation. Of these, 80 were referred for additional imaging workup and/or surgery. In the 26 women who underwent surgical excision, no ovarian cancers were identified. Furthermore, four women in the cohort subsequently developed ovarian cancer after a negative CT evaluation. The limited discriminatory ability of CT renders it impractical for use as a screening tool in this setting. FDG-PET/CT To our knowledge, there have been no trials evaluating the use of FDG-PET/CT for ovarian cancer screening in women at average risk.