Criteria for a Positive Screening Examination and Classification of Diagnostic Follow-Up Procedures
| Diagnostic Follow-Up Procedures | ||||
|---|---|---|---|---|
| Screening Modality | Definition of a Positive Screening Result | Minimally Invasive Procedures | Moderately Invasive Procedures | Major Surgical Procedures |
| CA-125 = cancer antigen 125; CXR = chest radiograph; DRE = digital rectal examination; FSG = flexible sigmoidoscopy; PSA = prostate-specific antigen; TVU = transvaginal ultrasonography. | ||||
| a Assuming a perfect sphere and using the prolate ellipsoid formula, this volume correlates to an approximate diameter of 2.67 cm. A 10-cc cutoff was chosen, as it corresponds to 2 standard deviations above mean ovarian volume for postmenopausal women.24 | ||||
| b We define a true-positive FSG as both overt cancer and advanced adenomas (lesions with villous histologic findings, severe cellular dysplasia, and/or ≥1 cm in diameter). | ||||
| PSA | >4 ng/mL | Endoscopy | Biopsy | Prostatectomy |
| Cystourethroscopy | ||||
| Cystoscopy | ||||
| Cystopanendoscopy | ||||
| Lymphadenectomy | ||||
| Ureterogram | ||||
| Transurethral resection of the prostate (TURP) | ||||
| DRE | One or more of the following findings: | As for PSA | As for PSA | As for PSA |
| Nodularity | ||||
| Induration | ||||
| Asymmetry | ||||
| Loss of anatomic landmarks | ||||
| CA-125 | >35 U/mL | Colonoscopy | Biopsy | Hysterectomy |
| Culdocentesis | Laparotomy | |||
| Hysteroscopy | Omentectomy | |||
| Intra-abdominal washings | Oophorectomy | |||
| Laparoscopy | Ovarian lymphadenectomy (with laparotomy) | |||
| Paracentesis | ||||
| TVU | One or more of the following findings: | As for CA-125 | As for CA-125 | As for CA-125 |
| Ovary or cyst >10 cca | ||||
| Solid area or papillary projection extending into the cavity of a cystic ovarian tumor of any size | ||||
| Mixed (solid/cystic) component within a cystic ovarian tumor | ||||
| CXR | One or more of the following findings: | Bronchoscopy | Biopsy | Lung resection |
| Nodule | Lymphadenectomy | Thoracotomy | ||
| Mass | Mediastinoscopy | |||
| Hilar or mediastinal lymph node enlargement | Thoracoscopy | |||
| Major atelectasis or lobar collapse | Transbronchial aspiration | |||
| Infiltrate, consolidation, or alveolar opacity | Transthoracic aspiration | |||
| FSG | One or more of the following findingsb: | Colonoscopy (with- out biopsy) | Biopsy | Colon resection |
| Rectal nodule(s) | Cystoscopy | Hemicolectomy | ||
| Rectal and/or colon mass(es) | Endoscopy | Lymphadenectomy | Laparotomy | |
| Colon polyp(s) | Rigid sigmoidoscopy | |||