From the Guidelines
Most ovarian cysts are benign and can be managed conservatively with watchful waiting and follow-up ultrasound. For premenopausal women, simple cysts less than 5 cm in diameter do not require follow-up, while those between 5-10 cm may require follow-up in 8-12 weeks to confirm their functional nature or to reassess for cyst wall abnormalities 1. In postmenopausal women, simple cysts up to 10 cm in diameter are likely to be benign and may be safely monitored using repeat imaging without surgical intervention 1. The American College of Radiology's Ovarian-Adnexal Reporting and Data System (O-RADS) provides a framework for risk stratification and management of adnexal lesions, including ovarian cysts 1. Key factors in determining the risk of malignancy include the size and characteristics of the cyst, as well as the patient's menopausal status and symptoms. Recent studies have shown that the risk of malignancy in simple cysts is very low, regardless of size or menopausal status 1. Therefore, a conservative approach with watchful waiting and follow-up ultrasound is often the most appropriate management strategy for ovarian cysts, reserving surgical intervention for cases where there is a high suspicion of malignancy or significant symptoms. It is essential to individualize management based on patient-specific factors, including symptoms, medical history, and imaging characteristics. In cases where surgery is necessary, a multidisciplinary approach involving gynecologists, radiologists, and other specialists can help ensure optimal outcomes. Ultimately, the goal of management is to minimize morbidity and mortality while maintaining quality of life, and a thoughtful, evidence-based approach can help achieve this goal.
From the Research
Ovary Cyst Diagnosis and Management
- Ovarian cysts are detected in female patients of all ages, and the patient's age, the size of the cyst, and the ultrasound appearance are helpful in determining which ovarian cysts necessitate observation and which necessitate surgical excision 2
- The cancer antigen 125 level alone does not help to distinguish between benign and malignant ovarian cysts, but the combination of benign findings on pelvic examination, a benign ultrasound appearance, and a cancer antigen 125 level within normal limits indicates a benign origin in practically all cases 2
- Simple cysts found on ultrasound may be safely followed without intervention, even in postmenopausal women, as they are not likely cancer precursors, nor markers of increased risk, and can be managed conservatively 3
Ovary Cyst Treatment
- Laparoscopic surgery for ovarian cysts is one of the most frequent laparoscopic surgical procedures performed presently, and the routine use of the 'closed technique' and of an impermeable bag for removal should limit the risk of spillage of the cyst contents 4
- The adnexal torsion can be properly managed by laparoscopic surgery, and suspected adnexal torsion should always be managed with early laparoscopy and de-torsion of the twisted tube or ovary 4, 5
- A new approach to ovarian cystectomy combining the advantages of laparoscopy with the benefits of microsurgical principles can simplify the surgical laparoscopic procedure and reduce postoperative adhesion formation 6
Ovary Cyst Complications
- Ovarian cyst accidents include cyst rupture, haemorrhage, and torsion, and torsion commonly occurs to the whole adnexa and is not necessarily associated with an ovarian cyst 5
- Ovarian cyst rupture and haemorrhage usually occur in association with physiological (functional) cysts and are generally self-limiting, but laparoscopy may be necessary in cases where the diagnosis is in doubt or for haemodynamic compromise 5
- Recurrent cyst rupture or haemorrhage should be prevented by suppression of ovulation, usually with the combined oral contraceptive, and fixation of the ovary by a variety of techniques should be considered to prevent recurrent torsion 5