From the Guidelines
For a patient with a stable left adnexal cystic lesion measuring 2.8 x 2.7 cm, the recommended management is conservative follow-up with a repeat ultrasound in 8-12 weeks, as this lesion falls into the "Almost Certainly Benign" category according to the O-RADS US risk stratification and management system 1. This approach is based on the most recent and highest quality evidence available, which suggests that most adnexal cysts under 5 cm are functional (physiologic) and resolve spontaneously within 1-2 menstrual cycles. The patient should be advised to report any new symptoms such as severe pelvic pain, fever, or changes in menstrual patterns. If the patient is premenopausal and experiencing pain, oral contraceptives (such as a combination pill containing ethinyl estradiol 20-35 mcg with a progestin) may be prescribed for 2-3 months to suppress ovulation and potentially reduce cyst size. For pain management, NSAIDs like ibuprofen 400-600 mg every 6 hours as needed can be used. Surgical intervention would only be considered if the cyst increases in size, develops concerning features on imaging, or causes significant symptoms that don't respond to conservative management, as per the guidelines outlined in the O-RADS US risk stratification and management system 1 and supported by recent updates in the management of adnexal masses 1. It's also important to consider the patient's overall clinical presentation and risk factors for malignancy, as outlined in the O-RADS US risk stratification and management system 1.
From the Research
Management Plan for a Stable Left Adnexal Cystic Lesion
The patient has a left adnexal cystic lesion measuring 2.8 x 2.7 cm, which has not significantly changed compared to prior assessments.
- The initial step in managing this patient is to assess for symptoms that may suggest malignancy, such as abdominal pain, abdominal bloating, and early satiety 2.
- A family history of ovarian, breast, or certain heritable syndromes should be considered, as it increases the risk of malignancy 2.
- Transvaginal ultrasonography is the imaging test of choice for evaluating adnexal masses for size and complexity 3, 2.
- The patient's adnexal cyst is less than 10 cm and does not contain solid components, which suggests a lower risk for malignancy 3, 2.
- Asymptomatic masses that are determined to be benign may be observed and managed expectantly 2.
- Specialist ultrasound examination is superior to CA 125 for preoperative discrimination between benign and malignant adnexal masses 4.
- The use of MRI in cases of indeterminate adnexal masses is widely accepted 5, 6.
- Risk prediction models, such as the 'International Ovarian Tumor Analysis simple rules' and the 'Risk of Malignancy Index', can be used to assess the risk of malignancy 6.