Size threshold for follow-up of postmenopausal adnexal cysts: 1cm versus 3cm.

Abstract

To assess 3cm size threshold for follow-up of simple cysts in postmenopausal women. Radiology information system was retrospectively queried for "US pelvis complete" over 8years in women > 50years, with keywords ovarian cyst, adnexal cyst, ovarian mass, cystic mass, cystic neoplasm, ovarian neoplasm, and ovarian mass. Premenopausal women were excluded. Cysts, were classified as ≤ 1cm, 1-3cm, 3-5cm, and ≥ 7cm. Largest cysts on each ovary was recorded. EMR and imaging archives were reviewed for assessing size, stability duration, and surgical records. Descriptive statistics and confidence interval were performed. 4388 patients met the initial search criteria. 919 cysts in 896 women (age: 50-91years, mean: 61.5years) were identified. We found 162 cysts ≤ 1cm, 352 1-3cm, 296 3-7cm , and 51 ≥ 7cm cysts. 127 patients with 1-3cm cysts had no follow-up. Final analysis of 225 1-3cm cysts included 203 ovarian and 22 paraovarian cysts (average size = 1.95cm (1.1-3.0cm)). 103 ovarian cysts had less than 2years, and 100 cysts had more than 2years follow-up. All except one ovarian cyst were stable for the entire duration of their follow-up (Mean duration of follow-up 5.4years) (0.3%, 95% CI 0.0-0.05). 40 cysts resolved. One simple cyst increased in size (followed over 3.25years) without suspicious imaging features and benign on surgery. 1-3cm cysts represented the most common size range (> 40%) in postmenopausal women, majority of which are stable over follow-up with benign outcome. 3cm size threshold is appropriate for simple cyst follow-up in postmenopausal women.