Cysts In Premenopausal Women Research Articles

Assessment of the Adherence of Radiologists in Reporting the Ovarian Cysts to the 2010 Society of Radiologists in Ultrasound Guidelines.

The objective of this study was to determine the adherence of radiologists to the guideline of the Society of Radiologists in Ultrasound (SRU)-2010 for the follow-up of ovarian cysts in patients during 2015-2016. The patients' data, referring for transvaginal and pelvic ultrasonography, suffering from ovarian cyst were assessed in terms of menopause status, cyst size, and type, as well as follow-ups recommended by radiologist to assess the adherence of reports to SRU-2010. Three hundred and sixty-four sonography reports were investigated. Seventy-seven percent of the reports had adhered to SRU-2010, 9.9% and 9.1% had under/overmanagement, and 4.1% was incomplete. 94.2% and 5.8% of cases were in pre/postmenopause status, respectively. The highest adherence belonged to cysts in size <1 cm, 1-3 cm, 5-7 cm. The highest adherence, over/undermanagement, and incomplete reports belonged to corpus luteum, hemorrhagic, dermoid cysts, and nodules without flow. The adherence of sonography reports to SRU-2010 for accidental ovarian cysts was 76.9%. The tendency for overmanagement of simple cysts in premenopausal women and the tendency for undermanagement in simple cysts and in postmenopausal women were higher, respectively. It is expected that more training of the guideline to radiologists will lead to the reduction of unnecessary follow-up, which in turn leads to reduced patient's anxiety and cost of treatment.

Ultrasound Features for Determining the Risk of Malignancy in Unilocular-Solid Adnexal Masses in Premenopausal Women without Ascites and/or Carcinomatosis

ABSTRACT Purpose To assess what clinical and ultrasound features could be most helpful for discriminating benign from malignant unilocular cysts with solid components in premenopausal women with no signs of ascites or carcinomatosis. Materials and methods Retrospective study comprising 91 women with preoperative diagnosis of unilocular-solid cyst that underwent surgical removal. The following variables were assessed: age, complaints at presentation, bilaterality, mean size of the lesion, number of papillary projections, size of solid component, surface of solid component (smooth or irregular), amount of color within solid component (no flow, minimal flow, moderate flow, abundant flow). Definitive histopathological diagnosis was used as gold standard. Multivariate logistic regression analysis was performed to identify which variables were independent predictors of malignancy and their odds ratios (OR). Results Malignant lesions had significantly larger tumor size, more number of solid components, larger size of solid component, more frequency of irregular surface in the solid component and more frequent moderate or abundant vascularization within the solid component. Logistic regression analysis identified amount of color (OR: 48.7), solid component's surface (OR: 29.1) and mean size of the lesion (OR: 1.58) as independent predictors for malignancy. Conclusion Tumor size, irregular surface and the presence of moderate or abundant color score within the solid component are the features more frequently associated to malignancy in unilocular-solid adnexal cysts in premenopausal women. How to cite this article Juez L, Peces A, Corral TMA, Orozco R, Utrilla-Layna J, Caparros M, Alcazar JL. Ultrasound Features for Determining the Risk of Malignancy in Unilocular- Solid Adnexal Masses in Premenopausal Women without Ascites and/or Carcinomatosis. Donald School J Ultrasound Obstet Gynecol 2015;9(2):112-117.

OC19.01: Additional value of CA‐125 to ultrasound for predicting specific diagnosis of benign adnexal cysts in premenopausal women

OC19.01: Additional value of CA‐125 to ultrasound for predicting specific diagnosis of benign adnexal cysts in premenopausal women

On a cold winter's day

Winter is here, it is cold outside. From my windows I can see that the Sound between Denmark and Sweden is covered with ice – like in the cold winter of 1658 when the Swedes used the frozen waterways to transport military troops. We were defeated and lost one third of Denmark to the Swedes. Like in those days, we did not expect a cold winter this year. Leading up to the Climate Summit in Copenhagen last December we had all expected a warm winter. Based on observational studies and extrapolations – admittedly poor evidence not higher than level 5 – we believed that the carbon dioxide we produced in recent years had changed the climate. And we thought that we would be able to control the weather by a slight change in behaviour. Did we insult the weather gods? Did we get too close to their jurisdiction? Was it Hybris to even suggest and discuss a plan for how to avoid climate changes? The answer is blowing in the cold wind. In times of uncertainty and even despair, it is nice to know that we have ACTA – the journal that publishes only scientific papers. Even if this issue of ACTA does not provide evidence that changes the World, it may give you some thoughts and ideas to come closer to an understanding of the nature of women, and the results of our care and interventions. In this issue of ACTA you will find an invitation to come to the European (EBCOG) and Nordic (NFOG) meetings this late spring. The chairman of EBCOG, Peter Hornnes, appraises the state of the current level of collaboration and harmonisation within Europe: It is too soon to have common European guidelines – they are simply unattainable. However, EBCOG wants to develop common standards – not to regulate the actual medical treatment – but to set up a framework to point out which issues we need to address and how. Examples of such standards are found in the guest comment. A European project on serious rare complications at delivery has been initiated by Marian Knight and Peter Brocklehurst from NPEU, Oxford. The project is based on reportings from delivery units in UK, who does not collect background data like the Nordic countries. In this issue of ACTA, colleagues from Italy (Stivanello et al.) report on peripartum hysterectomy and how far you can get with routine registration, without prospective collection of data in a specific project. The Nordic countries have started to collect case based data on peripartum hystertectomy, uterine rupture, placenta accreta and excessive postpartum bleeding using identical specific questionnaires – the NOSS project (www.noss.nu) – and will in this way update our knowledge on risk factors and current treatment modalities in these serious complications. We already have information on the background population and medical history and follow up in cases and controls in our medical birth registries and patient registers, which will enable us to get a more complete picture of the consequences of different attitudes towards cesarean delivery in obstetrics. In a commentary three UK researchers convey a dream that serum biomarkers may be used for a diagnosis of ectopic pregnancies in the future. Admittedly, we will need a lot of research before we have a kit – and we still need to select the women to test. Bols et al. have written an outstanding and very detailed systematic review of longitudinal studies on fecal incontinence after delivery – one of the subjects raised when we discuss mode of delivery and when we repair sphincter ruptures. They found that a third or fourth degree tear was the only factor that was associated with subsequent fecal incontinence. Now we only need good studies on how to prevent the ruptures – it seems that good Norwegian studies are on their way. Tyldum et al. in a well-defined cohort could not find any protective effect of pre-pregnancy physical activity on preeclampsia risk. This is an important message to convey to the prepregnant women who are on endorphins. The study is a good example of

Seven years' experience in laparoscopic dissection of intact ovarian dermoid cysts

A large case series on laparoscopic removal of dermoid cysts with a diameter between 3 and 12 cm, via an endobag, is reported (127 cysts in 121 premenopausal women). The incidence of spillage and recurrence rate of laparoscopic ovarian dermoid cystectomy, the duration of the surgical procedure, the length of hospitalization, the incidence of recurrence and pregnancies was evaluated. In 2.5% of cases, the endobag ruptured during removal, and a total spillage rate of 12% was seen. No signs or symptoms of peritonitis were observed regardless of cystic spillage or not. Laparoscopic cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as an endobag is used and the peritoneal cavity is washed out thoroughly.

Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women

To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women. Stored three-dimensional (3D) volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age, 37 (range, 22-50) years) were analyzed to calculate the MGV from cyst content. Cysts with solid components or septations were excluded. MGV was calculated in all cases with the Virtual Organ Computer-aided AnaLysis technique. The B-mode presumptive diagnosis based on the examiner's subjective impression was also recorded. Sixteen of the cysts resolved spontaneously and were given a final clinical diagnosis of hemorrhagic functional cyst, while 38 cysts were removed surgically (diagnosed histologically as seven simple cysts, three hemorrhagic cysts, 20 endometriomas, five mucinous cysts and three paraovarian cysts). B-mode diagnoses were as follows: seven simple cysts, 18 hemorrhagic cysts, 24 endometriomas, three mucinous cysts and two paraovarian cysts. MGV was significantly higher in ovarian endometrioma when compared with all other kinds of cyst. The receiver-operating characteristics curve showed that using an MGV cut-off >or= 15.560 had a sensitivity of 85% and a specificity of 76.5% for diagnosing ovarian endometrioma (area under the curve, 0.831; 95% CI, 0.718-0.944). These figures were similar to those for B-mode diagnosis (sensitivity, 90%; specificity, 82%) (McNemar test, P = 1.000). Combining B-mode and MGV gave a sensitivity of 80% and a specificity of 91%. Cyst content MGV is higher in ovarian endometrioma than it is in other unilocular ovarian cysts. The diagnostic performance of MGV is similar to that of the examiner's subjective impression. The combination of both criteria achieves the highest specificity.

OC13.05: Assessment of cyst content by using mean grey value for discriminating ovarian endometrioma from other unilocular cysts in premenopausal women

OC13.05: Assessment of cyst content by using mean grey value for discriminating ovarian endometrioma from other unilocular cysts in premenopausal women

High prevalence of ovarian cysts in premenopausal women receiving sirolimus and tacrolimus after clinical islet transplantation

We encountered an unexpectedly high rate of ovarian cysts in premenopausal women receiving sirolimus and tacrolimus following islet transplantation. The goal of this retrospective chart review was to determine the frequency of ovarian cysts found on pelvic ultrasound examinations of female islet transplant recipients and to look for potential causal factors. Fifty-seven women with a median age of 42.5 years underwent islet transplantation at the University of Alberta. Ovarian cysts were found in 31 out of 44 (70.5%) premenopausal and two out of 13 (15.4%) postmenopausal women (P = 0.001). No women using combined oral contraception developed ovarian cysts. Eight women required surgery; in four women undergoing cystectomy or unilateral oophorectomy, ovarian cysts recurred. Sirolimus withdrawal was associated with a reduction in cyst size and resolution of cysts in 80% of subjects. The risk of ovarian cysts should be discussed with female islet transplant candidates and pelvic ultrasounds performed routinely post-transplant.

Tamoxifen Prevents Premalignant Changes of Breast, but not Ovarian, Cancer in Rats at High Risk for Both Diseases

Women at increased risk for breast cancer are at increased risk for ovarian cancer as well, reflecting common risk factors and intertwined etiology of the two diseases. We previously developed a rat model of elevated breast and ovarian cancer risk, allowing evaluation of dual-target cancer prevention strategies. Tamoxifen, a Food and Drug Administration-approved breast cancer chemoprevention drug, has been shown to promote ovarian cysts in premenopausal women; however, the effect of tamoxifen on ovarian cancer risk is still controversial. In the current experiment, Fischer 344 rats (n = 8 per treatment group) received tamoxifen (TAM) or vehicle (control) in factorial combination with combined breast and ovarian carcinogen (17beta-estradiol and 7,12 dimethylbenza[a]anthracene, respectively). Mammary and ovarian morphologies were normal in the control and TAM groups. Carcinogen (CARC) treatment induced mammary dysplasia with elevated cell proliferation and reduced estrogen receptor-alpha expression and promoted preneoplastic changes in the ovary. In the CARC + TAM group, tamoxifen reduced preneoplastic changes and proliferation rate in the mammary gland, but not in the ovary, compared with rats treated with carcinogen alone. Putative stem cell markers (Oct-4 and aldehyde dehydrogenase 1) were also elevated in the mammary tissue by carcinogen and this expansion of the stem cell population was not reversed by tamoxifen. Our study suggests that tamoxifen prevents early progression to mammary cancer but has no effect on ovarian cancer progression in this rat model.

The Role of Ultrasound Evaluation in the Detection of Early-Stage Epithelial Ovarian Cancer

To determine the usefulness of sonography in the detection of early-stage ovarian cancer, 4526 asymptomatic women at high risk for ovarian cancer participated in a trial of ultrasound screening. The definition of high risk included 1 or more of the following criteria: 1) at least 1 first-degree relative with ovarian cancer; 2) a personal history of breast or ovarian cancer; 3) multiple first- and second-degree relatives with breast or ovarian cancer; 4) positivity for a BRCA mutation; or 5) a recognized family cancer syndrome. All patients underwent ultrasound examination, serum biomarker analysis, and a comprehensive physical examination at 6-month intervals. All adnexal masses identified with ultrasound were graded as cystic, multiloculated, complex, or solid. Risk of malignancy was determined with a combination of gray-scale morphologic parameters and Doppler investigation. Simple cysts or hemorrhagic-like cysts in premenopausal women were rescanned in 6 to 8 weeks to confirm resolution. In menopausal women, stable, simple, thin-walled masses less than 5 cm with no evidence of central blood flow were rescanned in 2 months and at the 6-month visit to confirm stability. A similar protocol was followed for suspected hydrosalpinges or pelvic adhesive disease. Study subjects were enrollees in the National Ovarian Cancer Early Detection Program (NOCEDP) of the National Institutes of Health. Their average age was 46 years. Since 1990, 4526 women, of whom 2610 were premenopausal and 1916 were postmenopausal, have undergone a total of 12,709 ultrasound scans. Both ovaries could be identified in 98% of premenopausal women and 94% of postmenopausal women, of whom 12.6% and 6.4%, respectively, had cystic masses larger than 2.5 cm. In all, 0.4% of premenopausal and 0.3% of postmenopausal women were referred for reexamination before the usual 6-month visit. Of 98 women with persistent adnexal masses, 44 underwent surgical treatment. Suspicious masses were identified using 3-dimensional ultrasonography to determine the presence of a central vascular flow characteristic of ovarian carcinoma. Twelve women were diagnosed with gynecologic malignancy and 37 with benign conditions. Four primary peritoneal carcinomas, 4 fallopian tube carcinomas, 2 epithelial ovarian carcinomas, and 2 endometrial carcinomas were diagnosed (Table 1). Within the study group, there were 184 subjects who had a BRCA-1 or BRCA-2 mutation and elected to undergo prophylactic bilateral salpingo-oophorectomy. Atypical ovarian or fallopian hyperplasia was found in 23% of these women, and 2 cases of primary peritoneal carcinoma were discovered during preoperative laparoscopy. These 2 women and 2 with cancer of the fallopian tube were BRCA-1. Early-stage breast cancer was detected on physical examination in 37 women, of whom 6 were positive for BRCA-1 or -2.

The management of ovarian cysts in premenopausal women

As high‐resolution transvaginal ultrasound becomes more widely available, asymptomatic cysts are diagnosed with increasing frequency. Womens' anxieties centre on the risk of cancer and possible loss of fertility due to the cyst and treatment complications. Investigations include measurement of serum tumour markers, basic assessment of ovarian function, transvaginal ultrasonography and possibly cyst fluid cytology. While a proportion of simple cysts will resolve spontaneously, others require surgical management. Laparoscopic surgery is the treatment of choice in young women at low risk of malignancy.

Laparoscopy or laparotomy in the management of benign adnexal cysts in premenopausal women

ABSTRACTObjective To compare the outcome of laparoscopy and laparotomy in the management, in premenopausal women, of adnexal cysts which were not suspected to be malignant.Patients and methods In a prospective study, 98 premenopausal patients requiring surgical management for adnexal cystic swellings were assigned to receive laparoscopy (n = 48), or laparotomy (n = 50), at Mansoura University Hospital between April 1997 and July 2001. Inclusion criteria were the presence of adnexal cysts, not suspected to be malignant, with a maximum diameter ≤15 cm by ultrasonography, in non‐pregnant women, aged ≤40 years. Statistical analysis included the t test and the χ2 test.Results There were no differences in patient characteristics between the two groups including the size of adnexal cysts, adnexal adhesion score or the frequency of bilateral disease. All the cysts were benign. Endometriotic cyst, dermoid cyst and ovarian cystademoma were the most common disorders in the two groups. Cystectomy was performed in the majority of cases (87.5% of laparoscopies and 70% of laparotomies). The laparoscopic approach was associated with significantly less operative morbidity and postoperative analgesic requirement, and shorter hospital stay and recovery period. The percentage of patients who achieved pregnancy was higher after laparoscopy than after laparotomy. There was no adverse effect caused by the spillage of cyst contents during laparoscopic open cystectomy.Conclusions Operative laparoscopy could replace laparotomy in the management of premenopausal adnexal cysts which are not suspected to be malignant.

The characterization of common ovarian cysts in premenopausal women.

The evaluation of the predictive value of transvaginal ultrasound in the assessment of benign adnexal pathology in premenopausal women, based on the recognition of characteristic morphologic patterns particular to endometriotic and dermoid ovarian cysts. This was a prospective study. All premenopausal women undergoing surgery for a suspected ovarian cyst underwent a transvaginal ultrasound examination in the week prior to surgery. Between June 1997 and January 2000, 132 women underwent surgery for a suspected ovarian endometrioma or dermoid cyst. The endpoints were either the direct visualization of the cyst wall and contents at surgery, or the histologic evaluation of removed tissues. Of 83 suspected endometriomas (11 bilateral), 80 were confirmed at surgery and of 68 suspected benign cystic teratomas (eight bilateral), 66 were confirmed by histology. The positive predictive value of transvaginal ultrasonography for the diagnosis of endometrioma and dermoid cysts was 96.4% and 97.1%, respectively. The false positive rates were 3.8% and 3.0%, respectively. There were no malignancies in either group. Based on the recognition of characteristic ultrasound patterns alone, the positive predictive value of transvaginal ultrasonography for the diagnosis of these common, benign cysts in premenopausal women is very high and can be used reliably to select women for appropriate surgery.

Follow Up of Women With Simple Ovarian Cysts Detected by Transvaginal Sonography in the Tokyo Metropolitan Area

From late 1990 through 1991, 10,294 asymptomatic women participated in a screening program for ovarian tumors at the Tokyo Metropolitan Cancer Detection Center. The screening examination included a Papanicolaou test, colposcopy, digital vaginal examination, and transvaginal ultrasonography using a 5.0-MHz transducer with a 100-Hz sump filter to eliminate low-frequency sounds. Women with abnormalities (ovary greater than 2 cm in diameter, ovarian cyst or mass) underwent a second scan 6 weeks later to exclude functional cysts. Apparent simple cysts in premenopausal women (no papillary component, thick septa, or solid tumor) were rescanned every 3 months and watched carefully for any changes in the nature or size of the cyst. Women with other abnormalities underwent further evaluation, including measurement of serum levels of CA-125, CA-199, and carcinoembryonic antigens (CEAs) and in some cases computed tomographic scanning. Results of the screening program are presented in Figure 1. Of the 372 women with abnormal findings, 32 were diagnosed with a uterine fibroid, and 340 were found to have an adnexal mass. Of these patients, 115 had either an ovarian mass larger than 6 cm in diameter or an elevated blood serum CA-125 level and were referred for exploratory surgery. Eight women refused to undergo surgery and were followed up elsewhere. In the remaining 107, two stage Ia mucinous cyst adenocarcinomas, one stage Ic endometrioid adenocarcinoma, and one endometrial carcinoma metastatic to the ovary were found. In addition, three borderline malignancies were diagnosed.Fig. 1: Breakdown of patients with adnexal masses screened by transvaginal ultrasonography (TV-UST).Two hundred twenty-five of the 340 women had an adnexal mass less than 6 cm in diameter with normal blood serum CA-125 levels and were followed up every 3 months for 75 months. One hundred sixty-five (73 percent) of the masses had regressed by the end of the follow-up period, 80 at the first follow-up examination and most (146) within 12 months. None of the cysts recurred. In 31 (41 percent) women, the mass persisted throughout the follow-up period, and in 29 (13 percent), progression of the adnexal mass occurred, most often (21) within 24 months. Three cysts persisted for 5 years before beginning to grow; one of these was found to have enlarged in the 75th month. Of the 29 women with progression, 9 had either rising CA-125 levels, greatly enlarged cysts (>6 cm), or a multiloculated cyst and underwent surgery. Three women were diagnosed with endometriosis, three with mature teratoma, two with cystadenoma (one serous and one mucinous), and one with an endosalpingeal cyst. In women with normal blood serum CA-125 levels and cysts less than 6 cm in diameter at the time of initial diagnosis, the outcome at 75 months was significantly correlated with ultrasound findings (cystic mass vs. solid or mixed mass, P = .01), mass diameter (<4 cm compared with >5 cm, P = .05), blood serum CEA levels (<0.7 vs. >1.0, P = .02), and blood serum CA-199 levels (<7 vs. >20, P = .001). A multivariate analysis of risk factors for tumor growth was conducted for the 140 women with complete information recorded. Blood serum CA-199 and CEA levels at the time of initial diagnosis were found to be significant predictors of tumor regression (P = .004 and P = .02, respectively). A CA-199 level of 20 IU/mL or higher had a relative probability of tumor regression of 0.34. Similarly, a CEA level of 1.0 IU/mL or higher had relative probability of regression of 0.53.

Laparoscopic convervative excision of ovarian dermoid cysts with and without an endobag

To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B). Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I). Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome. Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve. We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence. Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women

Objective: To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women. Design: A prospective study. Setting: Tertiary hospital-based ultrasonographic unit. Patient(s): Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts <6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel. Intervention(s): Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered. Main Outcome Measure(s): Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up. Result(s): For the premenopausal and postmenopausal women, the mean age (±SD) at diagnosis was 32.3 ± 8.2 and 61.1 ± 6.9 years, the mean duration of follow-up was 34.5 ± 21.6 and 35.3 ± 26.8 months, the mean cyst size at diagnosis was 3.7 ± 1.2 and 4.1 ± 1.5 cm, and the calculated mean growth rate was 1.77 ± 3.86 and -1.59 ± 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases. Conclusion(s): Premenopausal women with ovarian dermoid cysts of <6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

Ultrasound guided fine needle aspiration of ovarian cysts: Diagnosis and treatment in pregnant and non-pregnant women

Ovarian cysts are conventionally managed by laparoscopy or laparotomy. Twenty-two patients underwent fine needle aspiration of ovarian cysts under ultrasound control. Four patients were pregnant, and in two of these, aspiration of the cyst was performed transvaginally. The aspirate was examined cytologically and correlated with histology where available. The technique and results are discussed. No complications occurred. It is concluded that fine needle aspiration under ultrasound guidance is simple, safe and useful in the management of ultrasonically benign unilocular ovarian cysts in pre-menopausal women. It is of particular use in pregnancy, and in patients unsuitable for laparoscopy or surgery. Surgery can be reserved for cysts which recur after aspiration, cysts with a haemorrhagic aspirate, cysts in post-menopausal women and those with ultrasonic criteria of malignancy.