Transvaginal aspiration of ovarian cysts: long-term follow-up

Clinical efficacy of ultrasound-guided interventional therapy in patients with benign ovarian cysts: a meta-analysis

This study aimed to explore the clinical efficacy of ultrasound-guided interventional therapy in patients with benign ovarian cysts through meta-analysis. A literature search was performed on PubMed, Web of Science, Embase, CNKI, and WanFang databases to obtain clinical randomized controlled trials on ultrasound-guided interventional therapy for benign ovarian cysts published between 2010 and 2022. A total of 1395 studies were initially retrieved, and finally 12 studies were included for meta-analysis. The results showed that the observation group (ultrasound-guided interventional therapy) had higher treatment effective rate than the control group (conventional laparotomy or laparoscopic cyst resection), but the incidence of adverse reactions was markedly lower. Additionally, the length of hospital stay, intraoperative blood loss, and operation time showed significant lower levels in the observation group. In terms of ovarian function, postoperative luteinizing hormone and follicle-stimulating hormone levels in the observation group were lower than the control group, while oestradiol levels were higher. In conclusion, compared with conventional surgical treatment, ultrasound-guided interventional therapy can significantly improve the clinical effective rate, shorten the hospital stay and reduce intraoperative blood loss. Such therapy can protect ovarian reserve, with high value of clinical promotion.IMPACT STATEMENTWhat is already known on this subject? Main surgical methods for ovarian cysts consist of laparotomy, laparoscopic surgery, and interventional therapy.What the results of this study add? With the advancement of surgical techniques and instruments, many minimally invasive surgeries have been applied to treat ovarian cysts with good clinical results. However, there is no exact evidence to prove its clinical efficacy. Given the lack in this field, we conducted a meta-analysis of all clinical studies of ultrasound-guided interventional therapy for ovarian cysts to evaluate its efficacy and safety.What the implications are of these findings for clinical practice and/or further research? Compared with conventional laparotomic or laparoscopic cyst resection, ultrasound-guided interventional therapy for ovarian cysts significantly improves the treatment effectiveness, shortens the hospital stay and reduces intraoperative blood loss. This therapy with good clinical efficacy also has advantages of small wound, rapid recovery and less adverse reactions, and can protect ovarian reserve. This safe and effective surgical method for ovarian cysts is worth promoting clinically.

Transvaginal Ovarian Cyst Drainage in Third Trimester to Facilitate Vaginal Delivery

Adnexal masses in the third trimester of pregnancy may obstruct the pelvic outlet precluding labor induction and vaginal delivery. Expectant versus surgical management of adnexal cysts in pregnancy must carefully weigh maternal-fetal benefits and risks. Simple benign appearing cysts with low likelihood of malignancy may be amenable to percutaneous drainage as a bridge to interval postpartum laparoscopic cystectomy. We demonstrated posterior culdocentesis as a safe, minimally invasive technique to decompress a simple benign appearing left adnexal cyst obstructing the pelvic outlet in the third trimester at the time of labor induction to facilitate vaginal delivery and prevent primary cesarean delivery. Detailed sonographic cyst evaluation and counseling on underlying risk of malignancy must be considered to guide shared decision-making.

Transvaginal Ultrasound-Guided Fine-Needle Aspiration of Adnexal Cysts With a Low Risk of Malignancy: Our Experience and Recommendations

OBJECTIVES

The purpose of this study was to assess the effectiveness of ultrasound (US)-guided aspiration for the management of low-risk adnexal cysts.

METHODS

A longitudinal cohort of women with a low-risk adnexal cyst who underwent transvaginal US-guided aspiration from January 2012 to April 2018 were included. All procedures were performed on an outpatient basis, without anesthesia, sedation, or antibiotics. The posttreatment follow-up protocol included transvaginal US at 3 and 12 months. Potential risk factors for recurrence (ie, age, menopausal status, comorbidities, symptoms, cyst diameter, incomplete emptying, and location) were analyzed by multiple logistic regression.

RESULTS

A total of 156 patients were included. The median (interquartile range) cyst diameter was 66 (58-80) mm. Fifty-seven (36.5%) cases were resolved by US-guided aspiration. The median follow-up time was 556.5 (344-1070.25) days. The complication rate of the procedure was 2.6% (n = 4), with 3 cases of a major complication due to a pelvic abscess and 1 case of a minor complication due to self-limited vaginal spotting. A larger cyst size (odds ratio, 1.01; 95% confidence interval, 1.04-1.07; P = .002) and an older age (odds ratio, 1.01; 95% confidence interval, 1.03-1.05; P = .007) at diagnosis were independent factors related to recurrence.

CONCLUSIONS

Based on the low resolution rate, US-guided aspiration is not an effective option for the treatment of low-risk adnexal cysts. Risk factors associated with recurrence were age and cyst size at diagnosis. Larger randomized studies are necessary to assess predictive factors for cyst recurrence.

Pelvic endometriosis: Refer to the surgeon at the right moment: Pelvic endometriosis: When refer to the surgeon?

BACKGROUND

As endometriosis is not a single condition but different morphological types, it is easy to conceive that its management allow for a diversity of approaches. The objective of this literature review is about a simplified pathway through care for patients with endometriosis, and to target the right time for surgical treatment.

METHODS

Through a literature and references review, the different surgical care arrangements according to attainment, to symptoms and to the patients demands and expectations are reviewed.

RESULTS

An existing literature and recommendations synthesis has been done, and it was found that an optimum medical or surgical care rely on a multidisciplinary approach. Asymptomatic patients should not have surgery, and the medical treatment precede surgical treatment in numerous indications. In case of a surgical need, the right moment is determined by the recommendations, as noted in this article. Different aspects are necessary, the symptomatology, the intend to be pregnant and the recurrence of lesions in particular, but also the use of medically assisted reproduction or not.

CONCLUSION

In order to optimize the surgical treatment of patients with endometriosis, it is advisable to not refer these patients to the surgeon not too soon and not too late, furthermore if he's an expert. In all cases the treatment is multidisciplinary, and the most difficult cases are referred to multidisciplinary consultative reunion. The surgical treatment relies on "centre of expertise's" existence for some specific forms of deep endometriosis. The surgical treatment is a question of both pathology and timing.

BRIEF SUMMARY

In order to optimize the surgical treatment of endometriosis, it is advisable to refer patients to the surgeon at the right moment.

Diagnostic potential of tumor DNA from ovarian cyst fluid

We determined whether the mutations found in ovarian cancers could be identified in the patients' ovarian cyst fluids. Tumor-specific mutations were detectable in the cyst fluids of 19 of 23 (83%) borderline tumors, 10 of 13 (77%) type I cancers, and 18 of 18 (100%) type II cancers. In contrast, no mutations were found in the cyst fluids of 18 patients with benign tumors or non-neoplastic cysts. Though large, prospective studies are needed to demonstrate the safety and clinical utility of this approach, our results suggest that the genetic evaluation of cyst fluids might be able to inform the management of the large number of women with these lesions.

DOI:http://dx.doi.org/10.7554/eLife.15175.001

More than a third of women develop ovarian cysts during their lifetimes. The vast majority of these cysts are harmless, but a small number are caused by ovarian cancers. These cancers often produce no symptoms until the disease has spread throughout the abdomen or to other organs, so many women go undiagnosed until their chances of being successfully treated are low. Currently, there is no reliable way to determine whether an ovarian cyst is cancerous without performing surgery. As a result, many women undergo unnecessary, invasive surgeries for harmless ovarian cysts.

Tumors shed cells and cell fragments into any fluid that surrounds them. Fluids from cysts in the pancreas, kidney, and thyroid are routinely examined to identify whether they contain cancerous cells. Now, Wang, Sundfeldt et al. show that ovarian cancers also shed DNA into the surrounding cyst fluid. Furthermore, mutations found in this DNA can provide valuable information about whether the cysts are cancerous.

The study was performed by extracting DNA from the fluid in ovarian cysts that had been surgically removed from 77 women. Of these cysts, 10 were harmless cysts, 12 were benign tumors, 31 were invasive cancers, and 24 were so-called borderline tumors, which fall somewhere between the benign tumors and invasive cancers. Only cysts associated with the borderline tumors and invasive cancers need to be surgically removed. Here, Wang, Sundfeldt et al. report that DNA mutations that are characteristic of ovarian cancers were found in 87% of the cysts associated with borderline tumors and invasive cancers. In contrast, these mutations were not found in any of the cysts that do not require surgery.

Fluid can be extracted from an ovarian cyst with a needle during an outpatient visit. Therefore, the results presented by Wang, Sundfeldt et al. suggest a relatively straightforward way of testing the DNA from ovarian cysts before deciding whether surgery is really necessary. First, however, larger studies that follow women with cysts over time will be necessary to confirm that this type of testing is effective and safe.

DOI:http://dx.doi.org/10.7554/eLife.15175.002

Transvaginal Ultrasound-Guided Biopsy of Deep Pelvic Masses: How We Do It

The purpose of this review is to discuss the rationale and indications for transvaginal ultrasound-guided biopsy. Transvaginal ultrasound-guided biopsy can be a helpful tool for diagnosis and treatment planning in the evaluation of pelvic masses, particularly when the anatomy precludes a transabdominal or posterior transgluteal percutaneous biopsy approach. A step-by-step summary of the technique with preprocedure and postprocedure considerations is included.

Ultrasound-Guided Aspiration With and Without Ethanol Sclerotherapy in the Management of Simple Adnexal Cysts: A Single-Center Experience

STUDY OBJECTIVES

To compare the efficacy of ultrasound-guided aspiration versus aspiration with ethanol sclerotherapy in the management of simple adnexal cysts measuring 3 to 10 cm, and to explore the risk factors for recurrence associated with each approach.

DESIGN

A prospective follow-up of patients after cyst aspiration with and without ethanol sclerotherapy in simple adnexal cysts in a single-center trial (Canadian Task Force classification II-1).

SETTING

Bellvitge Teaching Hospital, Barcelona, Spain.

PATIENTS

Cyst aspiration and ethanol sclerotherapy were performed in 66 and 75 patients, respectively, between 2002 and 2014. Women enrolled before March 2009 underwent simple aspiration (group 1), and those enrolled after March 2009 underwent ethanol sclerotherapy (group 2).

INTERVENTIONS

Ultrasound-guided fine-needle aspiration with and without ethanol sclerotherapy.

MEASUREMENTS AND MAIN RESULTS

Potential risk factors for recurrence-age, menopausal status, symptoms, cyst diameter, laterality, aspirated volume, simple US-guided aspiration or alcohol sclerotherapy, and complications-were analyzed by logistic regression. The recurrence rates were analyzed by the Kaplan-Meier and Mantel-Haenszel methods. The overall recurrence rates were 72.7% (48 of 66) in group 1 and 22.7% (17 of 75) in group 2 (p < .0001). Risk factors significantly associated with recurrence were simple aspiration without ethanol sclerotherapy (odds ratio [OR], 19.7; 95% confidence interval [CI], 6.756-57.714), postmenopausal status (OR, 9.3; 95% CI, 1.720-50.956), and cyst size (OR, 1.04; 95% CI, 1.005-1.093).

CONCLUSION

Based on the lower recurrence rate, ethanol sclerotherapy was more efficacious than simple aspiration in the management of simple adnexal cysts measuring <10 cm.

Ultrasound-guided aspiration of adnexal cysts with a low risk of malignancy: is it a recommendable option?

OBJECTIVES

The purpose of this study was to establish the viability of ultrasound (US)-guided adnexal cyst aspiration and identify a target group in which this procedure would be advisable.

METHODS

A prospective cohort of 96 women with a low risk of malignant adnexal cysts was studied between 2002 and 2009, using recurrence after the procedure as the primary outcome measure. All procedures were performed on an outpatient basis without anesthesia. Patients were followed by US imaging at 6, 12, 24, 48, and 72 months. Potential risk factors for recurrence (menopausal status, previous hysterectomy, symptoms, US pattern, cyst diameter, and aspirated fluid volume and color) were analyzed by multivariate logistic regression. The association between recurrence and cyst size was calculated by Kaplan-Meier curves.

RESULTS

The median diameter of the cysts was 61 (range, 30-150) mm. Multivariate logistic regression analysis showed that an increased risk of recurrence was associated with a cyst diameter of greater than 70 mm (odds ratio, 4.2; 95% confidence interval, 1.2-14.1) and the presence of symptoms (odds ratio, 5.03; 95% confidence interval, 1.02-24.6). The median follow-up time was 24 (range, 2-78) months. Surgery was avoided in 64 patients (73.6%). Full cyst recurrence was observed in 34 patients (39.0%).

CONCLUSIONS

Ultrasound-guided aspiration is a viable alternative to surgery for treatment of adnexal cysts with a low risk of malignancy, especially when the cyst diameter is less than 70 mm.

Transvaginal ovarian cystectomy for adnexal torsion during pregnancy

Ovarian torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of ovarian torsion that was managed by transvaginal ovarian cystectomy in a 27 week gravid patient.

Transvaginal drainage of pelvic fluid collections: results, expectations, and experience

OBJECTIVE

The purpose of this study was to review our 13-year experience with sonographically guided transvaginal drainage procedures in terms of type of transvaginal procedure, that is, aspiration or catheter drainage, complication rate, and long-term success.

MATERIALS AND METHODS

A search of an interventional radiology database identified 85 transvaginal drainage procedures on 67 patients. Pertinent medical records and images were reviewed. Clinical success was defined as no need for surgery.

RESULTS

The mean follow-up period was 36.6 months (range, 7 days-132 months). Forty-five aspiration and 40 catheter drainage procedures were performed on 67 patients. Indications for the procedures included postoperative fluid collection (n = 25), tuboovarian abscess unresponsive to medical therapy (n = 17), symptomatic ovarian cyst (n = 17), and miscellaneous causes (n = 8). Clinical success was achieved in 50 of 67 cases (75%), including all cases of 25 postoperative fluid collection, 12 of 17 tuboovarian abscesses (71%), and seven of 17 ovarian cysts (41%). No complications were found in patients who underwent aspiration alone. The following minor complications occurred in patients who underwent catheter drainage: two cases of bladder transgression, one case of infection, and one case of catheter-related pain. Premature dislodgment of the catheter was an issue for four of 40 patients (10%).

CONCLUSION

Postoperative fluid collections can be managed with a high rate of success by means of transvaginal aspiration or catheter drainage. Transvaginal catheter drainage is an alternative to surgery in the management of tuboovarian abscesses unresponsive to medical management. Aspiration alone is sufficient to drain ovarian cysts and provide symptomatic relief. Most cysts recur, however, ultimately necessitating surgery. Aspiration is safe, but catheter drainage is associated with a 10% rate of minor complications.