TVU during cervical screening detects 81.6% of ovarian cancers at stage I in large cohort

This observational study analyzed data from 483,269 women who underwent transvaginal ultrasound (TVU) concurrently with cervical cancer screening between 2014 and 2022. The intervention was TVU performed at the same time as cervical screening, with no specific comparator group reported. Among the screened population, 3,294 women (0.68%) were selected for detailed examination based on TVU findings. Of the 550 women who subsequently underwent surgery, 80 cases of ovarian cancer were confirmed, yielding a positive predictive value of 2.43% for TVU in this setting. Among 76 cases with available pathologic review, 62 (81.6%) were detected at clinical stage I. The stage I detection rate was significantly higher for type I epithelial ovarian cancers (46 of 54 cases, 87.3%) compared to type II tumors (9 of 16 cases, 56.3%; P = 0.0068). For clear cell carcinoma specifically, 22 of 23 cases (95.7%) were detected at stage I. Safety and tolerability data for the screening procedure were not reported. Key limitations include the observational design without a control group for comparison of outcomes, lack of reported mortality data, and absence of information on adverse events or procedure-related complications. The study's relevance to practice is restrained; while it demonstrates that TVU screening in this context can detect a high proportion of ovarian cancers at an early stage, particularly type I tumors, it does not establish whether this early detection translates to improved survival. The authors suggest these findings may warrant reassessment of TVU screening utility in regions like Asia where type I ovarian cancer is more common, but comparative data from other regions are lacking.