Ultrasound society issues consensus statement for ovarian cyst management

The Society of Radiologists in Ultrasound (SRU) has released a consensus statement regarding the management of ovarian and other adnexal cysts imaged sonographically in asymptomatic women, which appears in the September edition of Radiology.

The panel, moderated by Deborah Levine, MD, of the department of radiology of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, and Douglas L. Brown, MD, of the department of radiology at Mayo Clinic in Rochester, Minn., met in October 2009 to analyze current literature and common practice strategies to draft the statement.

The goal, according to Levine and colleagues, was to reach a consensus on which masses require no follow-up; which masses need imaging follow-up, as well as when evaluation should occur; and which masses warrant surgical intervention.

SRU panelists agreed on the following implications for patient care:

• Adnexal masses in the physiologic range in terms of size and appearance in a woman of menstrual age or a simple adnexal cyst smaller than 1 cm in a postmenopausal women are likely to be benign and can be safely ignored;
• Simple cysts larger than 3 cm in women of reproductive age or larger than 1 cm in postmenopausal women should be described in ultrasound reports (Simple cysts up to 10 cm in a woman of any age are highly likely to be benign with malignancy rates of less than 1 percent.); and
• It is reasonable to perform annual ultrasound follow-up of cysts larger than 5 cm in premenopausal women and 1 cm in postmenopausal women although such cysts are unlikely to be malignant.

The panel also identified several areas for future research, including:

• Long-term follow-up to clarify the natural history of adnexal masses that will be tracked with imaging rather than surgically removed;
• Investigation of suspected endometriomas that have a solid-appearing component to determine features that allow a confident endometrioma diagnosis and follow-up versus surgical removal;
• Refinement of the clinical importance of 3D and Doppler ultrasound;
• Investigation into structured reporting of adnexal cysts to improve communication of results and follow-up recommendations;
• Investigation into the role of contrast-enhanced ultrasound and other new techniques for the assessment of adnexal cysts; and
• Assessment of noninvasive methods for identification of early ovarian cancer.