Stuart Campbell

St George's, University of London | SGUL · Obstetrics and Gynaecology

Background: In UKCTOCS, there was a decrease in the diagnosis of advanced stage tubo-ovarian cancer but no reduction in deaths in the multimodal screening group compared with the no screening group. Therefore, we did exploratory analyses of patients with high-grade serous ovarian cancer to understand the reason for the discrepancy. Methods: UKCT...

Randomised controlled trials are challenging to deliver. There is a constant need to review and refine recruitment and implementation strategies if they are to be completed on time and within budget. We present the strategies adopted in the United Kingdom Collaborative Trial of Ovarian Cancer Screening, one of the largest individually randomised co...

Background Ovarian and tubal cancers are lethal gynaecological cancers, with over 50% of the patients diagnosed at advanced stage. Trial design Randomised controlled trial involving 27 primary care trusts adjacent to 13 trial centres based at NHS Trusts in England, Wales and Northern Ireland. Methods Participants Postmenopausal average-risk wome...

Objective: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. Design: Prospective cohort study. Setting: 13 NHS Trusts in England, Wales and Northern Ireland. Population: 202,506 postmenopausal women recruited between 2001-2005 to the UK Collaborative Trial of Ovarian Can...

(Abstracted from Lancet 2021;397:2182–2193) Ovarian cancer is most commonly diagnosed at an advanced stage (3 or 4) and remains the deadliest gynecologic malignancy. When diagnosed at stage 1, a survival rate of greater than 90% has been demonstrated, compared with a 5-year survival rate of 27% and 13% for stage 3 and stage 4 disease, respectively.

Objective: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. Design: Prospective cohort study. Setting: 13 NHS Trusts in England, Wales and Northern Ireland. Population: 202,506 postmenopausal women recruited between 2001-2005 to the UK Collaborative Trial of Ovarian Cancer Scr...

Background Ovarian cancer continues to have a poor prognosis with the majority of women diagnosed with advanced disease. Therefore, we undertook the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to determine if population screening can reduce deaths due to the disease. We report on ovarian cancer mortality after long-term follow-up i...

Background During trials that span decades, new evidence including progress in statistical methodology, may require revision of original assumptions. An example is the continued use of a constant-effect approach to analyse the mortality reduction which is often delayed in cancer-screening trials. The latter led us to re-examine our approach for the...

Simple Summary The United Kingdom Collaborative Trial of Ovarian Cancer Screening was undertaken to assess whether screening postmenopausal women from the general population might result in detection of ovarian/tubal cancers at an earlier stage and thus save lives. One of the screening strategies tested was a yearly transvaginal ultrasound scan of...

Background There is a trend to increasing use of routinely collected health data to ascertain outcome measures in trials. We report on the completeness and accuracy of national ovarian cancer and death registration in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Methods Of the 202,638 participants, 202,632 were suc...

Background During trials that span decades, new evidence including progress in statistical methodology, may require revision of original assumptions. An example is the continued use of a constant-effect approach to analyse the mortality reduction which is often delayed in cancer-screening trials. The latter led us to re-examine our approach for the...

Objective There are widespread efforts to increase symptom awareness of ‘pelvic/abdominal pain, increased abdominal size/bloating, difficulty eating/feeling full and urinary frequency/urgency’ in an attempt to diagnose ovarian cancer earlier. Long-term survival of women with these symptoms adjusted for known prognostic factors is yet to be determin...

Background: There is a trend to increasing use of routinely collected health data to ascertain outcome measures in trials. We report on completeness and accuracy of national ovarian cancer and death registration in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Methods: Of the 202638 participants, 202584 were successf...

Background: There is a trend to increasing use of routinely collected health data to ascertain outcome measures in trials. We report on completeness and accuracy of national ovarian cancer and death registration in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Methods: Of the 202638 participants, 202632 were successf...

Objectives: Estrogen is a well-established risk factor for various cancers. It causes endometrial proliferation which is routinely assessed as endometrial thickness (ET) by transvaginal ultrasound (TVS). Only one study, restricted to endometrial and breast cancer, has previously considered ET and risk of a non-endometrial cancer. This study seeks...

Background: Transvaginal ultrasound and serum CA125 are routinely used for differential diagnosis of pelvic adnexal mass. Use of human epididymis 4 was approved in the United States in 2011. However, there is scarcity of studies evaluating the additional value of human epididymis 4. Objective: The objective of the study was to evaluate the perfo...

Background: We report on a unique audit of seven sonographers self-reporting high visualization rates of normal postmenopausal ovaries in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). This audit was ordered by the trial’s Ultrasound Management Subcommittee after an initiative taken in 2008 to improve the quality of s...

DataKey.txt – description of data fields; UKCTOCS TVC audit data biprobit format-0.csv; UKCTOCS TVC audit data biprobit format-0.dta; UKCTOCS TVC audit data do file.do

Table S1 Visualization rates (VR) from expert review for ‘match’ and ‘no match’ subsets of the study dataset categorized by visualization definition given in Table 2. The ‘match’ subset contains exams for which the exact images used to measure left and right ovaries can be identified by the software and the ‘no match’ subset contains the remaining...

Objective: In UKCTOCS self-reported visualization rates(srVR) at annual TVS scan was a key quality control(QC) metric. Our objective was to independently assess srVR using expert review and develop software capable of monitoring it. Methods: Images from 1,000 examinations randomly selected from 68,951 archived annual TVS exams undertaken between...

Background: To assess the within-trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy. Methods: Within-trial economic evaluation of no screening (C) vs either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ova...

Picture of the Month: Monochorionic diamniotic quadruplet pregnancy: physical models from prenatal three-dimensional ultrasound and magnetic resonance imaging data

Objective: There has been considerable interest in the impact of reproductive factors on health but there are little data on how these have varied over time. We explore trends in reproductive/lifestyle factors of postmenopausal British women by analysing self-reported data from participants of the UK Collaborative Trial of Ovarian Cancer Screening...

Monochorionic diamniotic quadruplet pregnancy; Three-dimensional ultrasound; Magnetic resonance imaging; 3D physical models

Introduction The poor prognosis for ovarian cancer 1 motivated us to start a programme of screening research 30 years ago. 2 We have since reported CA125 as a predictor of ovarian cancer risk, 3,4 high specifi city 2 and preliminary evidence of a survival benefi t 5 of multimodal screening using CA125 interpreted with a cutoff with transvaginal ult...

Zika virus; Intrauterine infection; Microcephaly; Ultrasound; Magnetic resonance imaging; Computed tomography; 3D virtual physical model

Background: Ovarian cancer has a poor prognosis, with just 40% of patients surviving 5 years. We designed this trial to establish the effect of early detection by screening on ovarian cancer mortality. Methods: In this randomised controlled trial, we recruited postmenopausal women aged 50-74 years from 13 centres in National Health Service Trust...

Background: Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin gestation, which has a high risk of perinatal morbidity and mortality. Fetoscopic laser photocoagulation of the vascular anastomoses is the preferred treatment. Nowadays, Solomon technique which consists the vascular coagulation of all anastomoses...

Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates.

To describe the quality assurance (QA) processes and their impact on visualisation of postmenopausal ovaries in the ultrasound arm of a multicentre ovarian cancer screening trial. In UKCTOCS, 50,640 women aged 50-74 at recruitment were randomised to the ultrasound arm and underwent annual transvaginal scans. QA processes were developed during the c...

Cancer screening strategies have commonly adopted single-biomarker thresholds to identify abnormality. We investigated the impact of serial biomarker change interpreted through a risk algorithm on cancer detection rates. In the United Kingdom Collaborative Trial of Ovarian Cancer Screening, 46,237 women, age 50 years or older underwent incidence sc...

We report on quality control (QC) metrics from software analysis of images in a random selection of 1000 ultrasound scans from 264,011 TVS scans performed by UKCTOCS in a study of ovarian cancer screening efficacy.

To evaluate the validity of self-reported hysterectomy against the gold standard of uterine visualisation using pelvic ultrasound. Prospective cohort study. UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) based in 13 National Health Service (NHS) Trusts in England, Wales and Northern Ireland. Between April 2001 and October 2005, 48 215...

Objective: Transvaginal sonography (TVS) is core to any ovarian cancer screening strategy. General-population screening involves older postmenopausal women in whom ovarian visualization is difficult because of decreasing ovarian size and lack of follicular activity. We report on factors affecting the visualization of postmenopausal ovaries in the...

The history of sonography in Obstetrics and Gynaecology dates from the classic 1958 Lancet paper of Ian Donald and his team from Glasgow. Fifty years on it is impossible to conceive of practising Obstetrics and Gynaecology without one of the many forms of ultrasound available today. Technological developments such as solid state circuitry, real tim...

We report four cases of cervical tumors (three lymphangiomas and one teratoma) evaluated by ultrasound and magnetic resonance imaging (MRI) between 26 and 37 weeks gestation. The aim was to investigate the use of Virtual Bronchoscopy (VB) to evaluate fetal airway patency on each case. A 3D file of the airway was created by overlapping layers genera...

Objective To assess pain and overall experience of transvaginal sonography (TVS) in asymptomatic postmenopausal women. Methods In the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), 50 639 postmenopausal women were randomized to undergo annual TVS at 13 trial centers in England, Wales and Northern Ireland. Together with th...

To estimate the risk of primary epithelial ovarian cancer (EOC) and slow growing borderline or Type I and aggressive Type II EOC in postmenopausal women with adnexal abnormalities on ultrasound. This was a prospective cohort study in the ultrasound group of the UK Collaborative Trial of Ovarian Cancer Screening of postmenopausal women with ultrasou...

Objective To assess pain and overall experience of transvaginal sonography ( TVS ) in asymptomatic postmenopausal women . Methods In the United Kingdom Collaborative Trial of Ovarian Cancer Screening ( UKCTOCS ), 50 639 postmenopausal women were randomized to undergo annual TVS at 13 trial centers in England, Wales and Northern Ireland. Together w...

K. Klein1, L. Rode2,3, K. Nicolaides4, E. Krampl-Bettelheim1, H. Larsen5, A. Holmskov6, K. Riis Andreasen7, N. Uldbjerg8, J. Ramb9, B. Bødker10, L. Skibsted11, L. Sperling12, S. Hinterberger13, L. Krebs14, H. Zingenberg15, E. Weiss16, I. Strobl17, L. Laursen18, J. Tranberg Christensen19, I. Vogel20, B.M. Hansen21, A. Lando21, A. Tabor2,3. 1Departme...

PURPOSE The aim of this work is to demonstrate fetal abnormalities through the 3D reconstruction of ultrasonography (US) as well as magnetic resonance (MR) imaging, correlating such morphological alterations with postnatal findings. METHOD AND MATERIALS A total of 25 fetuses were studied, between 20 and 38 weeks (average of 28.5 weeks), including...

The term ‘virtual bronchoscopy’ describes the creation and evaluation of representations of the bronchial tree and surrounding structures using spatial information derived from imaging sources other than the bronchoscope itself. Initially, this referred to two-dimensional and later three-dimensional (3D) bronchial tree representations generated fro...

To evaluate the malignant potential of ultrasound-detected ovarian inclusion cysts in the development of ovarian cancer (OC) in postmenopausal women. Prospective cohort study. UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Postmenopausal women. In UKCTOCS, women in the ultrasound group have annual scans. Women with inclusion cysts (s...

Background: Participants in trials evaluating preventive interventions such as screening are on average healthier than the general population. To decrease this 'healthy volunteer effect' (HVE) women were randomly invited from population registers to participate in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and not...

Participants in trials evaluating preventive interventions such as screening are on average healthier than the general population. To decrease this 'healthy volunteer effect' (HVE) women were randomly invited from population registers to participate in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and not allowed to s...

The increase in the worldwide incidence of endometrial cancer relates to rising obesity, falling fertility, and the ageing of the population. Transvaginal ultrasound (TVS) is a possible screening test, but there have been no large-scale studies. We report the performance of TVS screening in a large cohort. We did a nested case-control study of post...

The aim of this study was to assess conventional two-dimensional (2D) ultrasound enhanced with a three-dimensional (3D) ultrasound technique, the 'reverse-face' view (3D-RF) in prenatal evaluation of the involvement of the lips, alveolar ridge and secondary palate in suspected isolated orofacial clefting. One hundred and twenty-four cases of suspec...

To generate physical fetal models using images obtained by three-dimensional ultrasonography (3DUS), magnetic resonance imaging (MRI) and computed tomography (CT) to guide additive manufacturing technology. Images from 33 fetuses, including three sets of twins, were used. Fifteen fetuses were normal and evaluated only by 3DUS. Eighteen cases had ab...

Ladies and gentlemen, the recipient of this year's Ian Donald gold medal is a quiet unassuming man who has made huge contributions to advancing our understanding of fetal physiology and, in particular, fetal echocardiography by meticulous and innovative research. Ulrich Gembruch was born in September 1954 in Frankfurt and received his medical degre...

The short-term psychological effects on the mother of real-time ultrasound examination early in pregnancy have been evaluated. Primiparae were randomly assigned to one of two groups: a high feedback, where they saw the monitor screen; b low feedback, where the scan was accompanied by a global evaluation of progress. Women were assessed before and a...

The psychological reaction of primiparae to the routine use of ultrasound in prenatal care was studied. Women attending between 10 and 14 weeks menstrual age were assigned at random to 2 conditions of real time ultrasound: (a) high feedback (n = 67) in which the monitor screen was visible and feedback as to fetal size, shape and movement was provid...

Summary Summary Ten women with uncomplicated pregnancies were studied cross-sectionally to assess the variation in blood flow at different points along the uteroplacental circulation. In each patient the flow velocity waveforms were obtained at the level of the cervix (uterine artery), just within the myometrium (arcuate artery or branch thereof),...

Summary Whether or not Doppler studies of the utero-placental circulation can help indicate which hypertensive pregnancies will develop other features of pre-eclampsia was investigated. A prospective, longitudinal study of utero-placental blood velocity waveform by continuous wave Doppler ultrasound in third trimester hypertensive pregnancies was c...

Ovarian cancer has a high case-fatality ratio, with most women not diagnosed until the disease is in its advanced stages. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is a randomised controlled trial designed to assess the effect of screening on mortality. This report summarises the outcome of the prevalence (initial...

Ovarian cancer has a high case-fatality ratio, with most women not diagnosed until the disease is in its advanced stages. The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is a randomised controlled trial designed to assess the effect of screening on mortality. This report summarises the outcome of the prevalence (initial...

Objective To describe the factors that contributed to successful recruitment of more than 200 000 women to the UK Collaborative Trial of Ovarian Cancer Screening, one of the largest ever randomised controlled trials.Design Descriptive study.Setting 13 NHS trusts in England, Wales, and Northern Ireland.Participants Postmenopausal women aged 50- 74;...

Ultrasonic measurement of the fetus during the antenatal period is an important means of assessing fetal maturity, size and growth rate. Measurement of the fetal biparietal diameter by the combined A and B-scan technique is the most precise fetal measurement which can be obtained antenatally. Single measurements are superior to abdominal palpation...

To describe the factors that contributed to successful recruitment of more than 200,000 women to the UK Collaborative Trial of Ovarian Cancer Screening, one of the largest ever randomised controlled trials. Descriptive study. 13 NHS trusts in England, Wales, and Northern Ireland. Postmenopausal women aged 50-74; exclusion criteria included ovarian...

Severe ovarian hyperstimulation syndrome (OHSS) is a rare but potentially fatal condition associated with conventional IVF treatment. It is found predominantly in women with polycystic ovaries who have an exaggerated response to exogenous FSH, leading to a large number of follicles and an overproduction of vascular endothelial growth factor with re...

Aspirin therapy from the first trimester of pregnancy may benefit women at high risk for preeclampsia. We review publications from the past year that examine first-trimester screening studies for preeclampsia. For a false positive rate of 5%, first-trimester uterine artery Doppler studies will detect 50-65% of women who will develop severe preeclam...

The prophylactic use of vitamins E and C for the prevention of preeclampsia is currently being evaluated in multiple clinical trials in Canada, Mexico, the United Kingdom, the United States, and other developing countries. In addition to its antioxidant capacity, exogenous vitamin E may prevent an immunologic switch (Th1 to Th2) that is vital for e...

To compare sonographic endometrial characteristics in in-vitro fertilization (IVF) cycles between women who conceive and those who do not. Thirty-five women undergoing IVF treatment participated in the study. Using three-dimensional (3D) power Doppler ultrasound, we assessed endometrial patterns, volume and vascularization, after follicle stimulati...

The incidence of fetal breathing movements (FBM)†, fetal trunk movements (FTM), and total fetal activity (TFA) was assessed in 100 normal pregnancies between 28 weeks and term. One 30-minute recording was made from each patient between 0900 and 1700 hours. The mean incidences of FBM, FTM and TFA were respectively 37±26 (SD) per cent, 18±10 per cent...

Uterine artery flow velocity waveforms (FVW) were obtained prospectively by continuous wave Doppler at 18–22 weeks gestation from 98 women with an unexplained elevation in maternal serum alpha-fetoprotein (MSAFP). A notch in either the left or right uterine artery FVW was present in 18 pregnancies of which seven resulted in perinatal death and six...