Context
Ovarian cancer is common and has significant morbidity and mortality, partly because
it is often diagnosed at a late stage. This study sought to determine the accuracy
of individual symptoms and combinations of symptoms for the diagnosis of ovarian cancer.
Evidence acquisition
MEDLINE was searched, identifying 2,492 abstracts, reviewing 71 articles in full,
and ultimately identifying 17 studies published between 2001 and 2014 that met the
inclusion criteria. Data were abstracted by two researchers, and quality was assessed
using the QUADAS-2 criteria adapted to the study question. Bivariate random effects
meta-analysis was used where possible, and heterogeneity and threshold effects were
explored using receiver operating characteristic curves. Data were analyzed in 2015.
Evidence synthesis
Most studies were at high risk of bias, primarily because of case-control design or
differential verification bias. The highest positive likelihood ratios (LRs+) were
found for presence of abdominal mass (LR+, 30.0); abdominal distension or increased
girth (LR+, 16.0); abdominal or pelvic pain (LR+, 10.4); abdominal or pelvic bloating
(LR+, 9.3); loss of appetite (LR+, 9.2); and a family history of ovarian cancer (LR+,
7.5). No symptoms were helpful at ruling out ovarian cancer when absent. The Ovarian
Cancer Symptom Index was validated in five studies and (after excluding one outlier
with different inclusion criteria) was 63% sensitive and 95% specific (LR+, 12.6;
LR–, 0.39). Two other symptom scores had not been validated prospectively.
Conclusions
Several individual signs and symptoms significantly increase the likelihood of ovarian
cancer when present. More work is needed to validate decision rules and develop new
decision support tools integrating risk factors, symptoms, and possibly biomarkers
to identify women at increased ovarian cancer risk.
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Article info
Publication history
Published online: November 02, 2015
Identification
Copyright
© 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
