Thursday , November 26 2020

Less follow-up for simple ovarian cysts

Simple ovarian cysts are very common in women and do not require further ultrasound or surgical removal, according to a new study of more than 72,000 women and close to 119,000 pelvic ultrasound tests for a dozen years.

The study, a collaboration between UC San Francisco and Kaiser Permanente Washington, found that simple cysts are common, most common in women before and after menopause, and are not associated with a higher risk of ovarian cancer. As a result, unless they are symptomatic, one can clearly ignore the simple cysts.

In contrast, complex cysts or solid ovarian masses are less common, but are associated with a significantly higher risk of malignant cancer. These masses should be followed or surgically removed.

The newspaper, published on 12 November 2018 JAMA Internal Medicine, Suggests a change in the way that simple cysts are usually checked and sometimes treated.

"There is a lot of unnecessary medical follow-up going on for simple cysts," said corresponding author Rebecca Smith Bendman, MD, UCSF professor in the Department of Radiology and Biomedical Imaging. She is also a professor in the Departments of Epidemiology and Biostatistics, Obstetrics, Gynecology and Reproductive Medicine, and a member of the Philip R. Smith Institute of Health Policy. to me.

"Simple cysts are almost universal fruit, but because they are feared to serve as precursors to cancer, they have led to frequent observations and referrals to gynecologists and oncologists," he said. "Our study found that asymptomatic simple cysts of any size should be considered normal findings in women of any age and ignored."

Ovarian cancer is the fifth leading cause of cancer death among women in the United States, with 22,000 new cases being diagnosed and 14,000 deaths each year.

Over the past two decades, increased use of ultrasound in the breast pelvis has led to a common detection of ovarian masses. While most of these masses are benign, researchers and professional guidelines have recommended continuous follow-up of simple cysts, due to the poor prognosis of malignant ovarian cancer, as well as the fear of a small risk of cancer in the masses that appear benign.

This is the first study to quantify the risk of ovarian cancer in a large untreated population, based on ultrasound properties of ovarian mass, including simple cysts. The authors sought to identify traits that would indicate with high certainty whether ovarian mass was benign and would not require follow-up.

The study involved 72,093 women who underwent ultrasound in the pelvis via Kaiser Permanente Washington between January 1997 and December 2008. About 75% were under the age of 50.

During the study period, women underwent 118,778 ultrasound examinations in the pelvis. Among 54,452 women under the age of 50, 24% (12,957 women) were diagnosed with a simple cyst, and none developed cancer during follow-up. Of the 17,641 women aged 50 and older, about 13% (2,349 women) had a simple cyst and only one had cancer.

In the statistical analysis, the risk of developing cancer was zero in women with a simple cyst, regardless of the size of the cyst. The study identified 210 cases of ovarian cancer, most of which were seen in women with complex cystic fibrosis.

Ultrasound accurately predicted the probability of cancer, for which the odds increased significantly in women with complex fibrosis or solid ovarian mass. They estimated that 6.5% of postmenopausal women with these masses would be diagnosed with ovarian cancer within three years. In contrast, women with simple ovarian cysts were not associated with a higher cancer risk than those with normal ovaries. The authors recognized the limitations, including women who had no early history of cancer, excluded from the study.

"One justification for tracking simple cysts is that the images may be inaccurate and may miss complex features," said Smith-Bindman, a member of the UCSF Comprehensive Cancer Center Helen Diller. "Our data have not been supported, and explicit cysts, as simple as they are even large, are not linked to cancer.

"I understand why women and doctors do not want to misdiagnose ovarian cancer," she said. "Ovarian cancer is a devastating disease, but ovarian cancer does not occur in simple cysts, and following simple cysts with imaging will not lead to early detection of ovarian cancer."

Authors:Authors are Podder Accommodation, MD, of UCSF's Department of Radiology and Biomedical Imaging; And Eric Johnson, MS, and Diana L. Miglioretti, PhD of the Kaiser Permanente Washington Institute for Health Research. Dr. Miglioretti is also a professor at the University of California, Davis.

Funding: The study was supported by the National Cancer Institute grant R21CA131698 and K24CA125036.

Disclosures: nobody.

The University of San Francisco (UCSF) is a leading university dedicated to promoting global health through advanced biomedical research, post-secondary education in the life sciences and health professions, and excellence in patient care. It includes first-degree undergraduate schools in dentistry, medicine, nursing and pharmacies; A graduate division with world-renowned programs in basic sciences, biomedicine, translation and populations; And an important biomedical research institute. It also includes UCSF Healthcare, which consists of three top rated hospitals – UCSF Medical Center and UCSF Hospital and Benioff Children in San Francisco and Oakland – as well as Langley Porter psychiatric hospital and clinics, UCSF Benioff children and doctors and the UCSF practice faculty. UCSF Health has relationships with hospitals and health organizations throughout the Bay Area. The UCSF faculty also provide all medical care at the Zuckerberg General Public Hospital of the San Francisco Trauma Center, and the SF VA Medical Center. UCSF Fresno Medical Education Program is a major branch of the University of California, San Francisco School of Medicine.

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