Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram

Justin W. Gorski, Charles S. Dietrich, Caeli Davis, Lindsay Erol, Hayley Dietrich, Nicholas J. Per, Emily Lenk Ferrell, Anthony B. McDowell, McKayla J. Riggs, Megan L. Hutchcraft, Lauren A. Baldwin-Branch, Rachel W. Miller, Christopher P. Desimone, Holly H. Gallion, Frederick R. Ueland, John R. van Nagell, Edward J. Pavlik

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1–19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5–29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2–93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7–178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration.

Original languageEnglish
Article number144
Issue number1
StatePublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Abdominal fluid
  • Free fluid
  • Ovarian cancer screening
  • Pelvic fluid
  • Transvaginal ultrasound

ASJC Scopus subject areas

  • Clinical Biochemistry


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