Prevalence, incidence, and natural history of simple ovarian cysts among women >55 years old in a large cancer screening trial

Abstract

Objective-To measure the occurrence and natural history of simple ovarian cysts in a cohort of older women.Study Design-Simple cysts were ascertained among a cohort of 15,735 women from the intervention arm of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, through 4 years of transvaginal ultrasound screening.Results-Simple cysts were seen in 14% of women the first time their ovaries were visualized. The one-year incidence of new simple cysts was 8%. Among ovaries with one simple cyst at the first © 2009 Mosby, Inc. All rights reserved.*Author for manuscript correspondence. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript screen, 54% retained one simple cyst, and 32% had no cyst one year later. Simple cysts did not increase risk of subsequent invasive ovarian cancer.Conclusions-Simple ovarian cysts are fairly common among post-menopausal women, and most appear stable or resolve by the next annual exam. These findings support recent recommendations to follow unilocular simple cysts in post-menopausal women without intervention.

Management of the Adnexal Mass

“…65 Although 12% of women had morphologic change develop, there were no invasive ovarian cancers identified that were attributable to the identified index unilocular cyst. Moreover, an 8 -12% annual incidence of new simple cysts was documented among postmenopausal women, and this is consistent with other published data.…”

“…9,10,66 -68 Further lending support to this theory are cohort and large prospective observational studies that indicate the removal of persistent simple ovarian cysts is not associated with a decrease in the proportion of expected deaths from ovarian cancer relative to other cancers, 69 and that monitoring of patients with unilocular ovarian cysts smaller than 10 cm without intervention is not associated with evidence of malignant transformation over the course of prolonged observation. [61][62][63][64][65] Thus, the present literature indicates that it may not always be necessary to surgically remove asymptomatic unilocular ovarian cysts thought to represent benign entities. Further, it implies that the purpose of a follow-up protocol in this setting is to capture prevalent ovarian cancer that may have been missed by imperfectly sensitive index diagnostic imaging studies, rather than that of monitoring for benign processes that may transform into malignant.…”

“…Although studies may vary in length of follow-up, method of follow-up, and threshold for intervention, most studies reporting follow-up in women with unilocular ovarian cysts use interval ultrasonography at 3-to 6-month intervals, often in conjunction with repeat CA 125 testing. [61][62][63][64][65] Protocols using repetitive ultrasound examinations at intervals of 3-to 6-month examinations appear quite safe 2 and cancers identified during follow-up are rare (less than 1%).…”

Evaluation and Management of Ultrasonographically Detected Ovarian Tumors in Asymptomatic Women

“…Ovarian cancer screening trials [3][4][5][6][7] have provided valuable information concerning the relationship between tumor morphology and risk of malignancy. Likewise, serum biomarker patterns 8,9 and analysis of tumor blood flow 10,11 have been shown to be useful in selected cases.…”

Imaging of the Female Pelvis through the Life Cycle

“…Simple ovarian cysts as large as 3 cm have been reported in as many as 15% of postmenopausal patients; most such cysts spontaneously regress, as verified at serial US examinations (35,70,71). The simple cyst seen at imaging in early menopause probably represents an occasional ovulatory event or an atretic follicle.…”