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Levine D, Patel MD, Suh-Burgmann EJ, Andreotti RF, Benacerraf BR, Benson CB, Brewster WR, Coleman BG, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow MM, Hur HC, Marnach ML, Pavlik E, Platt LD, Puscheck E, Smith-Bindman R, Brown DL. Simple Adnexal Cysts: SRU Consensus Conference Update on Follow-up and Reporting. Radiology 2019; 293:359-371. [DOI: 10.1148/radiol.2019191354] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The limited oncogenic potential of unilocular adnexal cysts: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 225:101-109. [DOI: 10.1016/j.ejogrb.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
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3
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Guraslan H, Dogan K. Management of unilocular or multilocular cysts more than 5 centimeters in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2016; 203:40-3. [DOI: 10.1016/j.ejogrb.2016.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/25/2016] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
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Castellarnau M, García-Tejedor A, Carreras R, Cayuela E, Ponce J. Ultrasound-Guided Aspiration With and Without Ethanol Sclerotherapy in the Management of Simple Adnexal Cysts: A Single-Center Experience. J Minim Invasive Gynecol 2016; 23:242-51. [PMID: 26496806 DOI: 10.1016/j.jmig.2015.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/29/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Marta Castellarnau
- Consorci Sanitari Integral, Obstetrics and Gynecology, Hospitalet de Llobregat, Barcelona, Spain; Department of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | | | - Ramon Carreras
- Department of Obstetrics and Gynecology, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Obstetrics and Gynecology, Parc de Salut Mar, Barcelona, Spain
| | - Enric Cayuela
- Consorci Sanitari Integral, Obstetrics and Gynecology, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Bellvitge Teaching Hospital, Barcelona, Spain
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Castellarnau Visus M, Ponce Sebastia J, Carreras Collado R, Cayuela Font E, Garcia Tejedor A. Preliminary Results: Ethanol Sclerotherapy After Ultrasound-Guided Fine Needle Aspiration Without Anesthesia in the Management of Simple Ovarian Cysts. J Minim Invasive Gynecol 2015; 22:475-82. [DOI: 10.1016/j.jmig.2014.12.158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
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Ozbay PO, Ekinci T, Caltekin MD, Yilmaz HT, Temur M, Yilmaz O, Uysal S, Demirel E, Kelekci S. Comparative evaluation of the risk of malignancy index scoring systems (1-4) used in differential diagnosis of adnexal masses. Asian Pac J Cancer Prev 2015; 16:345-9. [PMID: 25640377 DOI: 10.7314/apjcp.2015.16.1.345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. MATERIALS AND METHODS 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. RESULTS Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. CONCLUSIONS RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.
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Affiliation(s)
- Pelin Ozun Ozbay
- Department of Obstetrics and Gynecology, Aydin Obstetrics and Pediatrics Hospital, Aydin, Turkey E-mail :
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JAMMAL MILLENAPRATA, DA SILVA ALLISONARAÚJO, FILHO AGRIMALDOMARTINS, DE CASTRO CÔBO ELIÂNGELA, ADAD SHEILAJORGE, MURTA EDDIEFERNANDOCANDIDO, NOMELINI ROSEKEILASIMÕES. Immunohistochemical staining of tumor necrosis factor-α and interleukin-10 in benign and malignant ovarian neoplasms. Oncol Lett 2015; 9:979-983. [PMID: 25624918 PMCID: PMC4301559 DOI: 10.3892/ol.2014.2781] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/21/2014] [Indexed: 01/29/2023] Open
Abstract
Ovarian cancer is the ninth most common malignancy and the fifth leading cause of cancer death in women in the USA. The majority of malignant tumors of the ovary are diagnosed at an advanced stage, making it the most fatal gynecological cancer. The aim of the current study was to determine whether there are differences in immunohistochemical tissue staining of cytokine tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) between benign tumors and malignant primary ovarian cancer. In total, 28 patients undergoing surgery for ovarian cysts were evaluated, and a diagnosis of benign neoplasm (n=14) or malignant neoplasm (n=14) was determined. An immunohistochemical study of histological sections of ovarian tumors was conducted. The results were analyzed using Fisher's exact test, with P<0.05 indicating a statistically significant difference. Immunohistochemical staining of IL-10 was increased in malignant tumors compared with benign tumors (P=0.0128). For TNF-α, the immunohistochemical staining was more intense in malignant neoplasms, however, a statistically significant difference was not observed. These results indicate that the analysis of cytokines may be useful as a potential tissue marker of ovarian malignancy.
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Affiliation(s)
- MILLENA PRATA JAMMAL
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ALLISON ARAÚJO DA SILVA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - AGRIMALDO MARTINS FILHO
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ELIÂNGELA DE CASTRO CÔBO
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - SHEILA JORGE ADAD
- Department of Special Pathology, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - EDDIE FERNANDO CANDIDO MURTA
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
| | - ROSEKEILA SIMÕES NOMELINI
- Research Institute of Oncology (IPON)/Discipline of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), 38025-440 Uberaba, MG, Brazil
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Bourdel N, Canis M. Stratégies thérapeutiques des tumeurs ovariennes présumées bénignes. ACTA ACUST UNITED AC 2013; 42:802-15. [DOI: 10.1016/j.jgyn.2013.09.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Valentin L, Ameye L, Franchi D, Guerriero S, Jurkovic D, Savelli L, Fischerova D, Lissoni A, Van Holsbeke C, Fruscio R, Van Huffel S, Testa A, Timmerman D. Risk of malignancy in unilocular cysts: a study of 1148 adnexal masses classified as unilocular cysts at transvaginal ultrasound and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:80-89. [PMID: 23001924 DOI: 10.1002/uog.12308] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the rate of malignancy in adnexal lesions described as unilocular cysts at transvaginal ultrasound examination and to investigate if there are differences in clinical and ultrasound characteristics between benign and malignant unilocular cysts. METHODS A total of 3511 patients with an adnexal mass underwent transvaginal ultrasound examination between 1999 and 2007. Sonologists used the International Ovarian Tumor Analysis terms and definitions to describe their ultrasound findings. Only masses operated on within 120 days after the ultrasound examination were included in the analysis and the histopathological diagnosis of the mass was used as the gold standard. RESULTS Of the 3511 masses, 1148 (33%) were classified as unilocular cysts on ultrasound. Of these, 11 (0.96% (95% CI, 0.48-1.71)) were malignant. The malignancy rate was lower in premenopausal than in postmenopausal women: 0.54% (5/931; 95% CI, 0.17-1.25) vs. 2.76% (6/217; 95% CI, 1.02-5.92); P = 0.009. More patients with malignant unilocular cysts had a personal history of breast cancer (18% vs. 2%; P = 0.02) or ovarian cancer (18% vs 0.6%; P = 0.003). Hemorrhagic cyst contents on ultrasound were more common in malignant than in benign unilocular cysts (18% vs. 2%; P = 0.03). In seven of the 11 malignancies judged to be unilocular cysts at scan, papillary projections or other solid components were seen at macroscopic inspection of the surgical specimen. CONCLUSIONS The malignancy rate in surgically removed adnexal lesions judged to be unilocular cysts at transvaginal scan is c 1%. Postmenopausal status, personal history of breast or ovarian cancer and hemorrhagic cyst contents on ultrasound increase the risk of malignancy. To avoid misclassifying adnexal lesions as unilocular cysts at scan, it is important to scrutinize unilocular cysts for the presence of solid components.
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Affiliation(s)
- L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmo, Sweden.
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Annaiah TK, Reynolds SF, Lopez C. Histology and prevalence of ovarian tumours in postmenopausal women: is follow-up required in all cases? J OBSTET GYNAECOL 2012; 32:267-70. [PMID: 22369402 DOI: 10.3109/01443615.2011.626089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to determine if follow-up is required for all ovarian tumours incidentally diagnosed in postmenopausal women, by studying the prevalence and histology of ovarian tumours in postmenopausal women undergoing hysterectomy. The histopathology of adnexa in 100 consecutive postmenopausal women who underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy for various indications, was reviewed. A total of 200 adnexa were examined. Ovarian pathology was found in 62/200 (31%). Of these 34/62 (53%) were unilocular cystic tumours, 9/62 (15%) were multilocular tumours, 11/62 (18%) were solid tumours and 8/62 (11%) were uni or multilocular with solid elements. The prevalence of borderline tumours was 4% and that of malignant tumours was 5%. All tumours < 2 cm were found to be benign. All unilocular cysts < 5 cm were benign. In conclusion, a vast majority of ovarian tumours in this group of women were benign. It may be reasonable not to follow-up women with unilocular ovarian tumours < 5 cm who have a normal CA125.
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Affiliation(s)
- T K Annaiah
- Department of Obstetrics and Gynaecology, Bedford Hospital NHS Trust, Bedford, UK.
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Abstract
In the past few years the contribution of operative laparoscopy in all fields of gynecological surgery has been revolutionary. Nowadays laparoscopic management of adnexal masses is the most frequently performed laparoscopic intervention. Laparoscopy in comparison to laparotomy has the advantages of lower morbidity, shorter length of hospital stay, decreased postoperative pain, lesser de novo adhesion formation, better cosmetic results, faster recovery, and reduced overall cost of care. However, careful preoperative evaluation is important for the appropriate and successful use of laparoscopy for removal of adnexal masses and the advantages of the laparoscopic approach should, in no way, compromise the clinical outcome in women with malignancy. Patient's age, history, findings of physical examination, and the results of serum markers in combination with the imaging assessment, such as Doppler sonography, CT, or MRI, should be considered to reach the diagnosis preoperatively. However, only pathology of the adnexal mass can provide the definitive diagnosis. The specific characteristics of the adnexal masses in childhood, adolescent, reproductive, and postmenopausal age represent the essential parameters that will determine the therapeutic strategy to be followed. Furthermore, the clinician has to determine whether an adnexal mass requires surgery or expectant management as well as to estimate the possibility of malignancy.
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Affiliation(s)
- George Pados
- First Department of OB-GYN, Aristotle University of Thessaloniki and Diavalkaniko Hospital, Thessaloniki, Greece.
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Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate Ovarian Mass at US: Incremental Value of Second Imaging Test for Characterization—Meta-Analysis and Bayesian Analysis. Radiology 2005; 236:85-94. [PMID: 15955864 DOI: 10.1148/radiol.2361041618] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare value of current diagnostic strategies in assessment of changes in posttest probability of ovarian cancer when menopausal status and combination and sequence of diagnostic imaging tests are considered. MATERIALS AND METHODS Prevalence of ovarian cancer according to menopausal status in women with an ovarian mass and performance of combined gray-scale and Doppler ultrasonography (US), computed tomography (CT), and non-enhanced magnetic resonance (MR) imaging and contrast material-enhanced MR imaging after indeterminate results at gray-scale US were derived from meta-analysis by using MEDLINE database and institutional data. Study was approved by the institutional review board of University Hospital Geneva, Geneva, Switzerland; informed consent was waived. Posttest probability values were computed through Bayesian analysis and Monte Carlo simulation after initial gray-scale US and secondary combined gray-scale and Doppler US, CT, or MR imaging, while dependence of test results among imaging modalities was considered. Changes in posttest probability were compared among imaging modalities with summary receiver operating characteristic curves. RESULTS Prevalence of ovarian cancer was 8.75% in premenopausal women and 32.40% in postmenopausal women with an ovarian mass. After characterization with initial gray-scale US, posttest probability in pre- and postmenopausal women changed, respectively, to 25% and 63% for indeterminate results and to 2% and 7% for benign results. Subsequent use of combined gray-scale and Doppler US, CT, or MR imaging had significant higher positive and lower negative posttest probability than did use of gray-scale US alone. In women with an indeterminate initial US result, posttest probability decreased after secondary testing with benign results for all imaging modalities to 2% in premenopausal women and to 8%-10% in postmenopausal women. After secondary testing for suspicious lesions, posttest probability increased more after non-enhanced (premenopausal women, 70%; postmenopausal women, 92%) or contrast-enhanced MR imaging (premenopausal women, 80%; postmenopausal women, 95%) than it did after combined gray-scale and Doppler US (premenopausal women, 30%; postmenopausal women, 69%) or CT (premenopausal women, 38%; postmenopausal women, 76%) (P < .001). CONCLUSION In women with an indeterminate ovarian mass at gray-scale US, MR imaging results contributed to change in probability of ovarian cancer in both pre- and postmenopausal women more than did CT or combined gray-scale and Doppler US results.
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Affiliation(s)
- Karen Kinkel
- Department of Radiology, University Hospital Geneva, Geneva, Switzerland.
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Exacoustos C, Romanini ME, Rinaldo D, Amoroso C, Szabolcs B, Zupi E, Arduini D. Preoperative sonographic features of borderline ovarian tumors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:50-59. [PMID: 15619309 DOI: 10.1002/uog.1823] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To determine the sonographic findings that distinguish borderline ovarian tumors (BOT) from both benign and invasive malignant tumors, thus allowing conservative treatment and laparoscopic management of these tumors. METHODS We reviewed retrospectively transvaginal sonograms of 33 women who, when evaluated further by surgery and histology, were found to have BOT. Twenty-three were premenopausal and 10 were postmenopausal (mean age +/- SD, 45.8 +/- 15.7 years). For each mass, size and morphological features and power Doppler characteristics were evaluated. We compared these findings with those of 337 patients with benign ovarian tumors and those of 82 patients with invasive malignant ovarian tumors. Patients with dermoid cysts were not included in the study. RESULTS Of the 33 BOT, 15 were mucinous and 18 were serous cystadenomas. The presence of papillae, defined as a small number of solid tissue projections, 1-15 mm in height and 1-10 mm in width (base) and length (base), into the cyst cavity from the cyst wall, was significantly more frequent in BOT (48%) than it was in benign (4%) and invasive (4%) malignant tumors. Intracystic solid tissue (> 15 mm in height or > 10 mm in width or length) was observed in 48% of invasive malignant masses but in only 18% of BOT and in 7% of benign tumors (P < 0.001). No sonographically unilocular, hypoechoic, smooth-walled adnexal cysts were invasively malignant but three unilocular cysts with a diameter of > 6 cm were serous BOT. Although close attention was paid to the cyst wall at ultrasound examination we did not observe in these three cysts the very small papillae which were found at histological analysis. CONCLUSIONS The most frequent diagnostic feature on imaging BOT is the presence of papillae within the cyst. However, neither papillae nor other sonographic features constituted highly sensitive sonographic markers of BOT.
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Affiliation(s)
- C Exacoustos
- Department of Obstetrics and Gynecology, Università degli Studi di Roma Tor Vergata, Ospedale Generale S. Giovanni Calibita Fatebenefratelli, Isola Tiberina, Rome, Italy.
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Dørum A, Blom GP, Ekerhovd E, Granberg S. Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study. Am J Obstet Gynecol 2005; 192:48-54. [PMID: 15672002 DOI: 10.1016/j.ajog.2004.07.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this autopsy study was to examine the prevalence and histologic condition of adnexal cysts in postmenopausal women. STUDY DESIGN Adnexa of 234 postmenopausal women who had died from nongynecologic diseases were examined by the team pathologist. RESULTS Ovarian cysts were found in 36 of the women (15.4%). Nine women (3.8%) had ovarian cysts with a diameter between 20 and < or =50 mm; 4 women (1.7%) had cysts that were >50 mm in diameter. Four women had bilateral ovarian cysts. Paraovarian cysts were found in 11 women (4.7%). All cysts were benign, except for 1 woman, who had bilateral serous cystadenoma of borderline type. Macroscopically, the borderline cysts were multilocular with mean diameters of 60 mm and 15 mm, respectively. CONCLUSION Because of the high prevalence of benign adnexal cysts, the identification of small unilocular cysts in postmenopausal women should be regarded as a normal finding.
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Affiliation(s)
- Anne Dørum
- Department of Gynecological Oncology, The Norwegian Radium Hospital, Oslo, Norway.
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Knudsen UB, Tabor A, Mosgaard B, Andersen ES, Kjer JJ, Hahn-Pedersen S, Toftager-Larsen K, Mogensen O. Management of ovarian cysts. Acta Obstet Gynecol Scand 2004; 83:1012-21. [PMID: 15488114 DOI: 10.1111/j.0001-6349.2004.00607.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts. METHODS Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications. RESULTS Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings. CONCLUSIONS The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.
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Affiliation(s)
- Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
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Ekerhovd E, Wienerroith H, Staudach A, Granberg S. Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: a comparison between ultrasonographic morphologic imaging and histopathologic diagnosis. Am J Obstet Gynecol 2001; 184:48-54. [PMID: 11174478 DOI: 10.1067/mob.2001.108330] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to evaluate the risk of malignancy in surgically removed ovarian cysts that were characterized before the operation as unilocular according to transvaginal ultrasonography. STUDY DESIGN This prospective analysis included 927 premenopausal women and 377 postmenopausal women operated on at 2 European university hospitals between January 1992 and December 1997. On the basis of ultrasonographic findings the cysts were characterized either as echo-free, without solid parts or papillary formations (group 1), or as having echogenic cyst content, with solid parts or papillary formations (group 2). Ultrasonographic and macroscopic appearances of the cysts were compared with histopathologic diagnosis. RESULTS In group 1, in premenopausal women 3 of 413 cysts (0.73%) proved to be borderline or malignant, and in postmenopausal women 4 of 247 cysts (1.6%) proved to be borderline or malignant. The figures for cysts in group 2 were 11 of 514 cysts (2.1%) and 13 of 130 cysts (10.0%), respectively. It was not possible to differentiate by transvaginal ultrasonography between benign, borderline, and malignant cysts when solid parts or papillary formations were visualized. CONCLUSIONS This study confirmed that the risk of malignancy associated with unilocular echo-free cysts (group 1) was low. Serial ultrasonographic follow-up should therefore be the standard procedure with unilocular echo-free cysts <50 mm in diameter. In cysts with a mean diameter of >50 mm, papillary formations or solid parts may be missed by transvaginal ultrasonography. The risk for malignancy in cysts containing papillary formations or solid parts (group 2) was 3 to 6 times higher than that in unilocular echo-free cysts.
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Affiliation(s)
- E Ekerhovd
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden
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Reimer T, Gerber B, Müller H, Jeschke U, Krause A, Friese K. Differential diagnosis of peri- and postmenopausal ovarian cysts. Maturitas 1999; 31:123-32. [PMID: 10227005 DOI: 10.1016/s0378-5122(98)00102-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To test the value of preoperative and intracystic parameters in the differential diagnosis of ovarian cysts. METHODS Criteria for admission of 58 patients were age > 47 years, complete history, detection of CA 125 serum level, and ultrasound findings. Tumor markers (CA 125, cancer-associated serum antigen (CASA), CA 72-4), hormones (estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH)), epidermal growth factor (EGF) receptor and c-erb B-2 amplification rate were detected in cyst fluid. RESULTS Of the 58 subjects, 9 (15.4%) had functional cysts, 37 (63.8%) had benign tumors and 12 (20.8%) had malignant tumors. No functional ovarian cyst presented as echoic or multilocular cyst sonographically. The serum CA 125 values demonstrated significant differences between the non-malignant and malignant patient groups (P < 0.0005). The majority (63.8%, n = 37) of ovarian cysts were obtained at laparotomy, whereas only 36.2% (n = 21) were laparoscopically operated. The cyst fluid levels of FSH (P < 0.005) and LH (P < 0.05) were significantly lower in the functional group than in the benign or malignant group. Malignant cysts were significantly different from non-malignant cysts regarding low E2 (P < 0.01), high FSH (P < 0.05) and CASA (P < 0.02) values. There were no significant correlations between EGF receptor (P = 0.14) and c-erb B-2 (P = 0.06) gene amplification rates and malignant histology. CONCLUSIONS Simple ovarian cysts combined with normal serum CA 125 levels are candidates for conservative follow-up or laparoscopy. The serum CA 125 is a powerful marker for prediction of histology in postmenopausal ovarian cyst. Laparoscopic surgery may be considered in patients with multilocular sonographic findings and normal CA 125 serum level. Combining serum CA 125 levels with cyst fluid parameters (E2, FSH, CASA) improves the sensitivity and specificity in predicting malignancy.
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Affiliation(s)
- T Reimer
- Department of Obstetrics and Gynecology, University of Rostock, Germany.
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Women's Health LiteratureWatch & Commentary. J Womens Health (Larchmt) 1998. [DOI: 10.1089/jwh.1998.7.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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