What is the next step for an asymptomatic 45-year-old female with a 5.8 cm simple ovarian cyst?

From the Guidelines

The most appropriate next step for this 45-year-old premenopausal woman with an incidentally discovered 5.8 cm simple ovarian cyst would be to perform a follow-up in a year, as the cyst is considered almost certainly benign according to the O-RADS guidelines 1.

Key Considerations

• The patient's age, regular menstrual cycles, and absence of concerning symptoms (such as pelvic pain, bloating, weight loss, or night sweats) are all important factors in determining the appropriate course of action.
• The O-RADS guidelines provide a framework for risk stratification and management of ovarian cysts, and in this case, the cyst is classified as almost certainly benign with a risk of malignancy < 1% 1.
• According to the O-RADS guidelines, a simple cyst > 5 cm but < 10 cm in a premenopausal woman should be followed up in a year, which is the recommended approach for this patient 1.

Management Approach

• The patient should be scheduled for a follow-up appointment in a year to reassess the cyst and determine if it has changed in size or characteristics.
• If the cyst grows, develops complex features, or becomes symptomatic, referral to gynecology for possible surgical intervention would be warranted.
• It is essential to continue monitoring the patient's symptoms and adjust the management plan as needed to ensure the best possible outcome.

Rationale

• The O-RADS guidelines are based on the latest evidence and provide a standardized approach to the management of ovarian cysts, reducing the risk of overtreatment or undertreatment 1.
• By following the O-RADS guidelines, healthcare providers can ensure that patients receive appropriate care and minimize the risk of adverse outcomes.
• In this case, the patient's cyst is considered low-risk, and a follow-up in a year is the most appropriate course of action, as it allows for continued monitoring while minimizing the risk of unnecessary interventions 1.

From the Research

Ovarian Cyst Management

The patient presents with a simple appearing 5.8 cm ovarian cyst, which was incidentally found on a CT scan of the abdomen and pelvis. The patient is asymptomatic, with no pelvic pain, bloating, fevers, night sweats, or unintentional weight loss.

Key Considerations

• The patient's age and lack of symptoms are important factors in determining the management of the ovarian cyst.
• The size of the cyst (5.8 cm) is relatively large, but still within the range that can be managed conservatively or with laparoscopic surgery.
• The absence of any solid components, abnormal Doppler flow, or elevated CA-125 levels suggests that the cyst is likely benign.

Management Options

• Conservative management with regular follow-up sonography is a reasonable approach, as most simple ovarian cysts are benign and may resolve spontaneously 2.
• Laparoscopic surgery is a feasible and safe option for women with large ovarian cysts with benign features, resulting in a short hospital stay 3, 4.
• The incidence of unplanned oophorectomy during laparoscopic ovarian cystectomy for clinically benign cysts is low, suggesting that conservative surgery can be successful in preserving the affected ovary 5.

Next Steps

• Given the patient's asymptomatic status and the benign appearance of the cyst, conservative management with regular follow-up sonography may be the most appropriate approach.
• If the patient's symptoms change or the cyst grows in size, laparoscopic surgery may be considered as a treatment option.
• It is essential to continue monitoring the patient's condition and adjust the management plan as needed, taking into account the patient's preferences and any changes in her symptoms or the cyst's characteristics.