Pediatric Ganglion Cyst Recurrence: Location Isn’t the Only Risk Factor

Abstract

Introduction: Ganglion cysts represent the most common benign soft-tissue masses of the hand and wrist, most are treated nonoperatively, with relatively few local recurrences. Few studies have identified risk factors for recurrence in the pediatric population. The aim of this study is to identify risks of cyst recurrence and to establish if ultrasonographic imaging aids in the prediction of recurrence. Methods: A single-center retrospective chart review was performed, identifying patients diagnosed with a ganglion cyst of the hand or wrist. Demographic information, cyst characteristics, and ultrasound examination reports were documented. Standard statistical and logistic regression analyses were performed. Results: A total of 132 cysts were identified in 126 patients and the average age was 8.5 years old. The most common location was the dorsal wrist (57/132, 43.2%). There were 14 recurrences [11/14, (79%) dorsal wrist, 3/14 (21%) volar wrist, 0/14 (0%) in nonwrist locations]. The risk of recurrence was significantly greater for dorsal wrist cysts than nonwrist locations (odds ratio=18.1; 95% confidence interval: 1.02, 316.65; P=0.048); there was no statistical difference in recurrence rates between dorsal and volar cysts (P=0.15). Recurrence was noted in older patients (12.2 vs. 8.1 y, P<0.001) and those patients with painful masses (P=0.02). Patients undergoing surgical excision had a higher risk of recurrence than those who did not undergo surgical excision (P<0.001). Cyst volume as measured by ultrasound was performed in 37 cysts, with repeat ultrasounds in 12 cases demonstrating a decreased volume of 0.85 cm3 at baseline to 0.35 cm3 with repeat examination (P=0.40). In patients that received at least 1 ultrasound, there were no differences in cyst volume between those that recurred and those that did not (P=0.40). Conclusions: Risk factors for recurrence in pediatric patients with a ganglion cyst include older age, symptomatic masses, cysts located around the wrist, and those requiring surgical excision. Ultrasound examination of cyst volume did not predict recurrence. Level of Evidence: Level III—therapeutic.

Common Ultrasound Applications for Pediatric Musculoskeletal Conditions

“…Synovial cysts are fluid-filled structures with synovial cell lining, which arise from herniations from synovial membrane through the joint capsule. They usually present as round, firm, compressible and movable superficial lesions that may be painful or pain-free, without skin color changes [39,40]. They may occur at any site, but are most commonly found on the dorsum of the wrist, and are considered the most common benign soft tissue of the hand or wrist [1,40].…”

“…They usually present as round, firm, compressible and movable superficial lesions that may be painful or pain-free, without skin color changes [39,40]. They may occur at any site, but are most commonly found on the dorsum of the wrist, and are considered the most common benign soft tissue of the hand or wrist [1,40]. Amongst the different soft tissue masses, ultrasound has highest accuracy in diagnosing cystic masses [2] (Fig.…”

“…An ultrasound evaluation may reveal a simple anechoic lesion, or a lesion with septations or loculations, without any solid components or vascularity. Ultrasound may also visualize the synovial cyst's extension into the tendon sheath or joint [1,5,40]. Symptomatic cysts may be aspirated or surgically excised [1,40].…”

“…Ultrasound may also visualize the synovial cyst's extension into the tendon sheath or joint [1,5,40]. Symptomatic cysts may be aspirated or surgically excised [1,40]. Recurrence rates in children following surgical excision range from 2.8 to 50%, which are higher than those seen in the adult population [39].…”

“…Recurrence rates in children following surgical excision range from 2.8 to 50%, which are higher than those seen in the adult population [39]. Factors that have been found to predict recurrence include cyst location (with those located on the dorsal wrist having higher recurrence than non-wrist locations), older age, and symptomatic cysts [40]. Ultrasound guidance may be used for cyst aspiration.…”