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Abstract
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
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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