Frequency and Disposition of Ovarian Abnormalities Followed With Serial Transvaginal Ultrasonography Edward J. Pavlik, PhD, Frederick R. Ueland, MD, Rachel W. Miller, MD, Jessalyn M. Ubellacker, BS, MPH, Christopher P. DeSimone, MD, Jeffrey Elder, MD, John Hoff, MD, Lauren Baldwin, MD, Richard J. Kryscio, PhD, and John R. van Nagell, Jr, MD OBJECTIVE: To examine the prevalence, incidence, per- sistence, and resolution of ovarian abnormalities using serial transvaginal ultrasonography. METHODS: A group of 39,337 women in the University of Kentucky Ovarian Cancer Screening Program were monitored with 221,576 baseline and interval transvagi- nal ultrasonography. RESULTS: The transvaginal ultrasonogram was normal for first and all subsequent visits for 31,834 participants (80.9%), whereas 6,807 women (17.3%) had transvaginal ultrasono- grams interpreted as abnormal and were monitored over 21,588 ultrasonograms. Ovarian cysts were more common in premenopausal (prevalence 34.9%, incidence 15.3%) than in postmenopausal women (prevalence 17.0%, incidence 8.2%). For the group with abnormalities, the initial trans- vaginal ultrasonogram was abnormal in 46.7% of the cases, of which 63.2% resolved to normal on subsequent ultra- sonograms. Of 35,314 cases classified as normal on the first examination, 9.9% were abnormal on subsequent annual examinations. The abnormal findings were classified as follows: unilocular cysts (11.5%), cysts with septations (9.8%), cysts with solid areas (7.1%), and solid masses (1.8%). Many transvaginal ultrasonographic abnormalities were followed to resolution. Surgery was performed on 557 participants for 85 ovarian malignancies and 472 nonma- lignancies. Over the duration of the study, the positive predictive value (PPV) increased from 8.1% to 24.7%. CONCLUSION: Serial ultrasonography has shown that many ovarian abnormalities resolve, even if the initial appearance is complex, solid, or bilateral. Thus, it is advantageous to avoid a single transvaginal ultrasono- graphic abnormality as the sole trigger for surgery and to take a measured serial approach to reduce false-positive results and increase the PPV. (Obstet Gynecol 2013;122:210–7) DOI: 10.1097/AOG.0b013e318298def5 LEVEL OF EVIDENCE: II O varian cancer is one of the top five causes of cancer death for women in the United States, with more than 14,000 American women expected to die of this disease in 2013. 1 Bimanual pelvic examination, espe- cially in postmenopausal women, has limited accuracy in detecting subtle changes in ovarian size and morphol- ogy. 2,3 Transvaginal ultrasonography has an accepted and significant role in the management of suspected ovarian malignancies. 4–6 Transvaginal ultrasonography has also been explored in healthy women without symp- toms for the detection of early-stage ovarian cancer, which is often curable by conventional therapy. 7–13 The literature contains reports on the occurrence of ovarian abnormalities detected by transvaginal ultraso- nography. 14–18 However, absent from the literature is information on the frequency and disposition of ovarian abnormalities under serial ultrasonographic surveil- lance, specifically those with a complex structure. In this See related editorial on page 198. From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and the Department of Biostatistics, the University of Kentucky Chandler Medical Center-Markey Cancer Center, Lexington, Kentucky. Supported by grants from the Telford Foundation and the Department of Health and Human Services, Commonwealth of Kentucky. The authors are solely responsible for subject development, data collection and analysis, composition, and revision. Presented in part at the 2012 Annual Meeting of the Society of Gynecologic Oncology, March 24–27, 2012, Austin, Texas. Corresponding author: Edward J. Pavlik, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Medical Center, 800 Rose Street, Lexington, KY 40536; e-mail: epaul1@uky.edu. Financial Disclosure Dr. Ueland serves on the speaker’s bureau for Vermillion Inc. The other authors did not report any potential conflicts of interest. © 2013 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/13 210 VOL. 122, NO. 2, PART 1, AUGUST 2013 OBSTETRICS & GYNECOLOGY