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The study founded that an analysis of ultrasound data from nearly 30,000 women suggests that many ovarian tumours can be monitored rather than removed without increasing the risk of ovarian cancer.

The key observation in the study was presented on March 16 at the Society of Gynecologic Oncologists (SGO) 41st Annual Meeting on Women's Cancer, was the absence of solid or papillary projections seen on transvaginal ultrasound.

These new data support a dramatic reduction in the number of gynaecologic surgeries performed, according to lead author Brook Saunders, MD, University of Kentucky Markey Medical Center, Lexington, Kentucky.

Researchers reviewed sonograms from 29,829 women undergoing transvaginal ultrasound between January 1987 and July 2009 to identify complex cystic ovarian tumours with septations. Researchers recorded septal width, tumour diameter, and patient demographics; any tumours with solid areas or papillary projections were excluded from the study.

Women with eligible tumours were followed every 4 to 6 months with additional transvaginal ultrasound. Some patients with persistent septated ovarian tumours were given surgery, and the tumours were removed for pathological investigation. These patients were given long-term surveillance to document any future ovarian malignancies.

Of the original screening group, 1,319 (4.4%) women were found to have complex cystic ovarian tumours with septations but without solid areas or papillary projections from the cyst wall. The mean age of patients with tumours was 56.9 years and 71% were postmenopausal.

Over the years of observation, these 1,319 women had a total of 2,870 septated cystic ovarian tumours. From this group of tumours, 2,288 (79.7%) had a septal width of <2 mm and 582 (20.3%) had a septal width of >=2 mm. Tumour diameter was <5 cm in 2,286 (79.6%) tumours and >=5 cm in 584 (20.4%) tumours.

The median follow-up was 65 months, with the actual duration of follow-up ranging from 4 months to 252 months (21 years).

Of the 2,870 septated cystic tumours, 1,114 (38.8%) resolved spontaneously in a median of 13 months from initial detection and 1,756 (61.2%) tumours persisted. Within the persistent-tumour group, 128 patients underwent surgical tumour removal, all within 3 months of ultrasound detection. The most common histopathology in the tumours removed was serous cystadenoma (75; 58.6%), mucinous cystadenoma (13; 19.2%), and endometrioma (10; 7.8%).

Two patients were found to have tumours of borderline malignancy, 1 stage IA and 1 stage IB, but there were no cases of ovarian cancer within the group. One patient developed papillary morphology on continued transvaginal ultrasound follow-up and epithelial ovarian cancer in the contralateral ovary 3.2 years after initial detection of a septated ovarian cyst. All of the other patients in the study remain free of ovarian neoplasia.

Dr. Saunders concluded that the risk of malignancy in septated cystic ovarian tumours without solid areas or papillary projections is extremely low. Patients found to have these low-risk tumours can be followed sonographically without surgery.

Source: SGO

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