From the Guidelines
Complex cysts should be managed with either aspiration or short-term follow-up with physical examination and ultrasonography with or without mammography every 6 to 12 months for 1 to 2 years to assess stability, as they are associated with a low risk of malignancy (<2%) 1.
Key Considerations
- The management of complex cysts depends on their characteristics and the level of suspicion for malignancy.
- Aspiration is a viable option for managing complicated cysts, which may have low-level echoes or intracystic debris 1.
- Short-term follow-up with imaging and physical examination is also appropriate for assessing stability and determining the need for further intervention 1.
- The follow-up interval may vary based on the level of suspicion, with more frequent evaluations for cysts that increase in size or suspicion 1.
- Biopsy should be considered for complicated cysts that increase in size or suspicion 1.
Treatment Approach
- For complex cysts with discrete solid components, such as thick walls, thick septa, and/or intracystic mass, a more careful evaluation and management approach is necessary 2.
- The treatment approach may vary depending on the location, size, and symptoms of the complex cyst, as well as the patient's overall health status and preferences.
- Regular imaging follow-up, such as ultrasound, CT, or MRI, may be appropriate for smaller, less concerning cysts 2.
- Surgical removal may be recommended for symptomatic complex cysts, particularly if there is concern for malignancy 2.
From the Research
Complex Cyst Treatment Options
- Surgical management is often required for complex cysts, with options including laparoscopic surgery, open surgery, and percutaneous aspiration with sclerotherapy 3
- For complex ovarian cysts in newborns, a conservative approach may be appropriate, with surgical intervention reserved for larger or more complex cysts 4, 5
- Spontaneous regression of complex ovarian cysts can occur, with one study showing that 56% of cysts regressed by 6-8 months 5
Treatment Considerations
- The management of complex cysts depends on the location, size, and characteristics of the cyst, as well as the patient's symptoms and overall health 3, 6
- For renal cysts, the Bosniak classification system is used to characterize the cyst and determine the risk of malignancy 3
- For ovarian cysts, histologic analysis can help determine the origin and nature of the cyst, with some studies suggesting that gonad maldevelopment may be a cause of complex neonatal ovarian cysts 4
Minimally Invasive Treatment Options
- Laparoscopic surgery is a highly efficacious and minimally invasive option for treating complex cysts, with high satisfaction rates and minimal morbidity 3, 5
- Robot-assisted surgical management may also be an option for complex cysts, although it may not offer significant benefits over traditional laparoscopic surgery 3