Management of Cysts by Medical Specialty
The type of doctor who manages a cyst depends entirely on the cyst's anatomical location, with gynecologists managing ovarian and vaginal cysts, interventional radiologists performing percutaneous drainage of symptomatic abdominal/pelvic cysts, and hepatologists or surgeons managing liver cysts.
Ovarian and Adnexal Cysts
General Gynecologist Management
- Simple ovarian cysts and low-risk lesions (O-RADS 2-3) should be managed by a general gynecologist, including hemorrhagic cysts, dermoid cysts, endometriomas, peritoneal inclusion cysts, and hydrosalpinges 1.
- For O-RADS 3 lesions (1% to <10% malignancy risk), the vast majority (>90%) are benign and do not require gynecologic oncology consultation 1.
- Premenopausal women with nonsimple unilocular smooth cysts >3 cm and all postmenopausal women with nonsimple unilocular smooth cysts should be referred to a gynecologist 1.
Gynecologic Oncologist Referral
- O-RADS 4 lesions (10% to <50% malignancy risk) warrant either consultation with gynecologic oncology prior to removal or direct referral for management 1.
- O-RADS 5 lesions (≥50% malignancy risk) should be directly referred to a gynecologic oncologist 1.
- Menopausal status, ultrasound specialist evaluation, MRI characterization, and CA-125 levels help determine which intermediate-risk lesions require gynecologic oncology management 1.
Ultrasound Specialist Role
- Referral to an ultrasound specialist or performance of MRI is recommended when premenopausal cysts persist or enlarge on follow-up, or for postmenopausal nonsimple cysts requiring additional characterization 1.
- Ultrasound specialists help minimize the risk of overlooking suspicious features in O-RADS 3 lesions 1.
Vaginal Cysts
- The American College of Radiology recommends observation for asymptomatic small vaginal cysts (<5 cm), with referral to a specialist if the cyst persists or enlarges 2.
- Postmenopausal women with vaginal cysts require more thorough evaluation due to increased malignancy risk, warranting ultrasound or MRI before management decisions 2.
Abdominal and Pelvic Cysts (Non-Gynecologic)
- Interventional radiologists manage symptomatic abdominal and pelvic cysts through percutaneous catheter drainage techniques, providing symptom relief without surgery 3.
- Percutaneous aspiration is appropriate for selected patients after proper imaging characterization differentiates true cysts from cystic-appearing masses 3.
Hepatic Cysts
- Hepatologists or surgeons manage liver cysts, with treatment indicated for symptomatic cysts or those suspicious for malignant/premalignant features 4.
- Treatment modalities include fenestration, aspiration sclerotherapy, or surgical resection depending on cyst characteristics 4.
Common Pitfalls to Avoid
- Do not refer simple ovarian cysts or O-RADS 2 lesions to gynecologic oncology—these can be safely managed by general gynecologists or observed 1, 5.
- Do not assume all postmenopausal cysts require surgery—simple unilocular cysts can be followed conservatively with appropriate imaging surveillance 5.
- Ensure proper risk stratification using O-RADS classification before determining the appropriate specialist, as this directly impacts whether general gynecology versus gynecologic oncology management is needed 1.