Ovarian Cysts In Postmenopausal Women Research Articles

Management of ovarian cysts in postmenopausal women

Management of ovarian cysts in postmenopausal women

Natural history and malignant potential of simple ovarian cysts in postmenopausal women: a systematic review and meta-analysis.

Postmenopausal ovarian masses are not uncommon, and the incidence of ovarian cancer rises sharply after menopause. We conducted a systematic review and meta-analysis to investigate the natural history and malignant potential of postmenopausal simple ovarian cysts. PubMed, MEDLINE, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), ClinicalTrials.gov , and ISRCTN (International Standard Randomized Controlled Trial Number Register) were searched from inception to January 31, 2022. Meta-analyses were conducted using R software. Twelve cohort studies with 1,672 participants and 1,513 ovarian cysts were included. The rates of simple cysts remaining unchanged (38.90%; 95% CI, 19.79%-59.85%; P < 0.01) or disappearing (34.17%; 95% CI, 19.13%-50.93%; P < 0.01) were the highest during conservative observation. The surgery rate for the simple cyst was 19.04% (95% CI, 8.19%-32.92%; P < 0.01). The malignancy rate (including borderline tumors) was very low, approximately 1/10,000 (95% CI, 0% to 0.23%; P = 0.79). Simple ovarian cysts in postmenopausal women were most likely to remain unchanged or disappear during follow-up. The malignancy rate was approximately 1 in 10,000. Personal preference is the most common reason for surgery.

Intracystic Injection of Methotrexate in Postmenopausal Female Suffering from Simple Ovarian Cyst with Low Malignancy Index

Although ovarian cysts are more prevalent in premenopausal women, but ovarian cysts in postmenopausal women are common also, this attributed to the advances in the use of ultrasound in the screening and diagnosis of different lesions [1]. Before the era of use of ultrasound, most gynecologists were depending on palpable postmenopausal ovaries in their management, and it was considered as an indication for surgery [2].

When Less is Not More: Population-level Perspective on Adnexal Cyst Surveillance for Post-Menopausal Women.

Ovarian simple cysts are found with high frequency in older women, and at least a third eventually regress in a year. Multiple large studies, including the sample from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial, have found no direct association with ovarian cancer incidence, corroborating earlier, smaller studies [ 1 Hartge P. Hayes R. Reding D. et al. Complex ovarian cysts in postmenopausal women are not associated with ovarian cancer risk factors: preliminary data from the prostate, lung, colon, and ovarian cancer screening trial. Am J Obstet Gynecol. 2000; 183: 1232-1237 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 2 Menon U. Gentry-Maharaj A. Hallett R. et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009; 10: 327-340 Abstract Full Text Full Text PDF PubMed Scopus (631) Google Scholar ]. The current practice of safely following, rather than resecting, asymptomatic ovarian cystic lesions accompanied a rejection of an older, simple biologic model of ovarian cystic lesions as cancer precursors or markers of subsequent cancer onset in either ovary. Instead, it is now widely accepted that aggressive or high-grade ovarian neoplasms arise via a solid tumor pathway from serous tubal intraepithelial carcinoma [ 3 Erickson B.K. Conner M.G. Landen Jr., C.N. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol. 2013; 209: 409-414 Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar ]. In this decision-analytic modeling study by Pandharipande et al, the question of managing ovarian cystic lesions in postmenopausal women is revisited within the practical and highly informative context of overall health status and wide-ranging life expectancy [ 4 Seguin C.L. Lietz A.P. Wright J.D. et al. Surveillance in older women with incidental ovarian cysts: Maximal projected benefits by age and comorbidity level. J Am Coll Radiol. 2020; 18: 10-18 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. Surveillance in Older Women With Incidental Ovarian Cysts: Maximal Projected Benefits by Age and Comorbidity LevelJournal of the American College of RadiologyVol. 18Issue 1PreviewThe aim of this study was to estimate effects on life expectancy (LE) of imaging-based ovarian surveillance after detection of incidental postmenopausal ovarian cysts, under different assumptions of patient age, comorbidity level, and cancer risk and detection. Full-Text PDF

Conservative management of unilateral and unilocolor ovarian cysts ≥ 10 cm in diameter in postmenopausal women

Objective: To evaluate and follow up the native behaviour of large ovarian cysts in postmenopausal women and establish the best approach based on advanced imaging technology. Study Design: The number of patients that were evaluated from January 2015 to September 2019 were 417. At the end of this study period, 375 patients were considered for this prospective evaluation. The patients with an ultrasound diagnosis of unilateral and unilocular ovarian cysts with regular septa ≥ 10 cm in diameter at menopause were enrolled in this study. During the follow-ups, the patients who developed irregular or thick septa, papillary formation or solid areas, exhibited any suspicious sign of malignancy in magnetic resonance imaging (MRI) results or displayed an augmentation in CA-125 levels were excluded from the study. In this study cancer antigen-125 (CA-125) values &gt; 65 IU/mL were considered abnormal. The patients who met these criteria were followed with periodical ultrasounds and yearly MRI. Results: The 42 patients who were excluded from the study had significant morphological changes. These patients were showing an increase in CA-125 levels along with abnormal MRI findings during the follow-ups and in addition, they had surgical removal of cysts. All the significant morphological changes were detected by transvaginal ultrasounds. Postoperative histopathological diagnosis of these ovarian cysts revealed no abnormality. From 375 patient’s cysts samples one hundred and twenty-five (33.3%) cysts had significantly decrease in size, one hundred and eleven (29.6%) of the cysts had spontaneous resolution and one hundred thirty-nine (37%) cysts persistently remained unchanged during the follow up period. The diameter of the cysts ranged from 10.4 to 18.4 cm. The cysts were categorized into three groups corresponding to a range of diameters i.e., 10–12.9 cm (62%), 13–15.9 cm (24.1%) and ≥ 16 cm (13.8%) respectively. The patients who showed spontaneous resolution were discontinued with the follow-ups while the rest of the patients were continued with their regular follow up examinations. Conclusion: The cysts should be monitored conservatively as long as possible before proceeding to a surgical treatment regardless of the size of the unilateral and unilocular ovarian cysts at postmenopausal period with limited oncogenic potential and without significant morphological changes.

Abbreviated MRI Protocols for the Abdomen.

Technical advances in MRI have improved image quality and have led to expanding clinical indications for its use. However, long examination and interpretation times, as well as higher costs, still represent barriers to use of MRI. Abbreviated MRI protocols have emerged as an alternative to standard MRI protocols. These abbreviated MRI protocols seek to reduce longer MRI protocols by eliminating unnecessary or redundant sequences that negatively affect cost, MRI table time, patient comfort, image quality, and image interpretation time. However, the diagnostic information is generally not compromised. Abbreviated MRI protocols have already been used successfully for hepatocellular carcinoma screening, for prostate cancer detection, and for screening for nonalcoholic fatty liver disease as well as monitoring patients with this disease. It has been reported that image acquisition time and costs can be considerably reduced with abbreviated MRI protocols, compared with standard MRI protocols, while maintaining a similar sensitivity and accuracy. Nevertheless, multiple applications still need to be explored in the abdomen and pelvis (eg, surveillance of metastases to the liver; follow-up of cystic pancreatic lesions, adrenal incidentalomas, and small renal masses; evaluation of ovarian cysts in postmenopausal women; staging of cervical and uterine corpus neoplasms; evaluation of müllerian duct anomalies). This article describes some successful applications of abbreviated MRI protocols, demonstrates how they can help in improving the MRI workflow, and explores potential future directions. ©RSNA, 2019.

Surgical management of ovarian cysts in postmenopausal women

Many ovary cysts are asymptomatic especially in postmenopausal women. In the case of large cysts, the risk of malignancy becomes increase and if conservatively treated could remain unchanged. Although the laparoscopy still represents the main abort pathway, in the cases when cysts present the signs of malignancy or even extraovarian dissemination, the treatment should involved laparotomy. Anyway, the technique which should be applied in ovarian cysts should take into consideration the patient will and the surgeon’s experience in which the staging can be performed when indicated. The present review systematizes the pathology, ovarian masses evaluation, laparoscopy vs. laparotomy techniques, the role of CA125 marker and surgical management of the cysts in postmenopausal women.

Ovarian cysts in post-menopausal women

Abstract not availableBangladesh J Obstet Gynaecol, 2016; Vol. 31(1) : 1-2

Management of unilocular or multilocular cysts more than 5 centimeters in postmenopausal women

ObjectiveTo evaluate the malignancy potential of large unilocular and multilocular ovarian cysts in postmenopausal women and to discuss their appropriate management. Study designThis retrospective study included 204 postmenopausal patients who underwent surgery for simple adnexal cysts or cysts with isolated septal structures at the Gynecology and Obstetrics Clinic of Bakirkoy Dr Sadi Konuk Training and Research Hospital. Data obtained from patient and computer records included patient age, follow-up period, ultrasonography reports, surgery information, histopathological evaluation results, and cancer antigen-125 (CA-125) levels at diagnosis and during follow-up. The Kruskal–Wallis test was used to compare three or more groups. The Chi-square test or Fisher's exact test was used to compare qualitative parameters, while relationships between parameters were analyzed by using Spearman's correlation analysis. ResultsA total of 236 cysts were identified in 204 postmenopausal women who underwent surgery. The cysts were categorized as having unilocular cyst morphology or complex structures without morphological abnormalities other than septa in 182 (77.1%) and 54 cases (22.9%), respectively. The mean cyst diameter was 6.6±3.1cm (range, 2.7–30cm) with diameters ≥5cm in 176 cysts (75%). The median cyst volume was 88.5 cm3 (range, 10–2636; interquartile range: 81) and the mean morphology index was 1.2 (range, 1–6), with 16 cysts (6.8%) ≥5. No malignancy or borderline histology was observed in any patient. ConclusionsAmong postmenopausal women, cysts that are unilocular or contain isolated septa, have a low-risk of malignancy even when they are larger than 5cm. Rather than undergoing emergency surgery, these patients may be followed up conservatively with intermittent transvaginal ultrasonography.

Ovarian cysts in postmenopausal women. Surgery and surgical approach

Ovarian cysts in postmenopausal women. Surgery and surgical approach

Asymptomatic Simple Ovarian Cyst in Postmenopausal Women: Syndrome of ‘Visible Ovary’

ABSTRACT Simple cysts of the ovary are quite common, with a prevalence of 5 to 17%. Advances in the technology of ultrasound and the increasing frequency of use of TVS has made it all the more important to have knowledge of the natural history of simple asymptomatic postmenopausal cysts. Previously, due to the paucity of data, postmenopausal women with asymptomatic simple cysts were managed much too aggressively. Current available data suggest a more conservative approach with serial ultrasounds, Doppler evaluation and CA-125 levels. Further studies are needed in order to have definitive guidelines for the gynecologic practitioner. How to cite this article Zalud I, Busse R, Kurjak BF. Asymptomatic Simple Ovarian Cyst in Postmenopausal Women: Syndrome of ‘Visible Ovary’. Donald School J Ultrasound Obstet Gynecol 2013;7(2):182-186.

OP29.09: Accuracy and reproducibility of ultrasonography for the diagnosis of ovarian cancer in operators with different degrees of experience

according to the IOTA protocol. A proper counselling on a low ovarian cancer risk was given and an adequate informed consent was obtained. Sonographic follow-up was proposed at 3 and 9 months, than yearly. Surgery was proposed in case of changes of ovarian cyst volume (>50%) and/or sonographic parameters at TVS-CD. Demographic, medical, sonographic and pathologic data were recorded. Results: 98 post-menopausal patients with 106 ovarian cysts were enrolled. Median age (IR) was 69 years (59–74). Median years after menopause (IR) were 18 (8–24). Median BMI (IR) was 26 kg/m2 (24–29). Mean parity (±sd) was 2 ± 1.8 women reported bilateral cysts. 53 cysts were unilocular, 53 multilocular. Median cyst diameter (IR) of unilocular and multilocular ovarian cysts was 50 mm (34–56). At a median follow-up period of 36 months, surgery was performed in 28 cases: 14 patients required immediate removal, 5 drop-out, 9 volume changes. One successfully managed cardiac arrest occurred during laparoscopic procedure. No malignant lesions were reported at histology. Conclusions: Sonographic follow-up might be a useful option in the clinical management of incidental unilocular >5 cm and multilocular <7 cm ovarian cysts in post-menopausal women. Larger and longer multicentres studies with strict sonographic parameters are needed to support this potentially safe conservative management.

Simple ovarian cysts in postmenopausal women: scope of conservative management

This study was done to evaluate/investigate the natural history of simple ovarian cysts in postmenopausal women and to determine the risk for malignant transformation of these cysts. Ultrasound reports of all the postmenopausal women who attended St. Francis Hospital and Medical Center, Hartford, USA from January 1997 to April 2010 with an ultrasound diagnosis of simple cysts of ovary were reviewed retrospectively. A total of 619 patients with 743 simple ovarian cysts were evaluated. It was found that 305 out of 619 patients (49.27%) were lost in follow-up. Therefore, 314 patients (50.73%) with 378 cysts could be followed further by ultrasound study. One hundred and seventy-five (46.30%) of the 378 cysts that could be followed further had spontaneous resolution and 166 cysts (43.91%) persisted unchanged over the follow-up period. Thirty cysts (7.94%) turned into complex cysts and four cysts (1.06%) significantly increased in size. One cyst significantly decreased in size, though it did not resolve. Only one patient developed papillary serous carcinoma (high grade) of the ovary. This occurred three years after her last ultrasound for simple cyst surveillance. Simple ovarian cysts during the menopause can be followed conservatively because their risk for malignant transformation is low. The majority of these cysts either resolve spontaneously or persist unaltered on follow-up.

Ultrasonographic evaluation of simple ovarian cysts in postmenopausal women

The aim of our study was to evaluate the possibility of ultrasonography in differentiating malignant from nonmalignant cysts in postmenopausal women. The study included 100 postmenopausal women with diagnosis of simple ovarian cysts who were treated surgically at our clinic during the study period. In the group of operated patients the histopathological diagnosis confirmed benign cysts in most cases. In 1% of patients histopathological diagnosis was borderline or malignant tumor of the ovary. The risk of malignancy ranged from 0% in the cyst with a diameter below 50 mm, to 3.57% in cysts over 80 mm. Cyst diameter smaller than 50 mm and the volume of cyst less than 50 cm3 in correlation with the values of serum CA125 and clinical findings represent good algorithm for differentiating malignant from nonmalignant simple cyst.

Prevalence, Incidence, and Natural History of Simple Ovarian Cysts Among Women &gt;55 Years Old in a Large Cancer Screening Trial

Many simple ovarian cysts are being detected in postmenopausal women with increasing use of transvaginal ultrasound. In the past, aggressive surgical approaches were used for management of simple cysts. Some investigators recommend careful monitoring and others question if simple cysts should be monitored at all. This observational cohort study investigated the occurrence and natural history of simple ovarian cysts within a cohort of 15,535 mostly postmenopausal women in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Four annual serial transvaginal ultrasound screening examinations were performed. Simple ovarian cysts were detected in 14% (2217/15,735) of the cohort during the first fully visualized screen of the ovaries (incident cyst). The incidence of new simple cysts during the first year was 8%, and remained relatively constant throughout the course of the trial. At the second ultrasound screen 1 year later, 54% of the ovaries with 1 simple cyst at the first screen retained 1 simple cyst and 32% had no cyst. The presence of simple cysts was not associated with increased risk of subsequent invasive ovarian cancer. These findings show that the occurrence of simple ovarian cysts in postmenopausal women is a common incidental finding on ultrasound, and support recent recommendations that such cysts should be followed in older women without intervention.

Watch Simple Ovarian Cysts In Postmenopausal Women

Watch Simple Ovarian Cysts In Postmenopausal Women

Incidentally Detected Ovarian Cysts in Postmenopausal Women

Incidentally Detected Ovarian Cysts in Postmenopausal Women

Management of asymptomatic ovarian cysts in postmenopausal women

Management of asymptomatic ovarian cysts in postmenopausal women

Whither the simple ovarian cyst in postmenopausal women?

Whither the simple ovarian cyst in postmenopausal women?

Management of the incidental finding of an asymptomatic small ovarian cyst in postmenopausal women

Management of the incidental finding of an asymptomatic small ovarian cyst in postmenopausal women