Careful Observation of Ovarian Cysts Safe Alternative to Surgery

Once identified, ovarian tumors are usually surgically removed due to the presumed risk of complications associated with the diagnosis. Researchers recently looked to evaluate the incidence of cyst complications and malignancy during the first 2 years of follow-up after the tumors were classified as benign.

Study authors enrolled patients identified through the international prospective cohort International Ovarian Tumor Analysis Phase 5 (IOTA5) study who were older than 18 years with at least 1 ovarian tumor who had been selected for conservative management after an ultrasound assessment. Follow-up for patients was still ongoing at the time the study results were published.

In total, the study enrolled 1919 women from 10 different countries who had been diagnosed with noncancerous ovarian cysts. Researchers found that the cumulative incidence of spontaneous resolution of the cysts within 2 years of follow-up was 20.2% (95% CI, 18.4%-22.1%). Only 12 women were subsequently diagnosed with ovarian cancer, making the risk of malignancy 0.4% (95% CI, 0.1%-0.6%), although the authors cautioned that this could be due to a misdiagnosis of the tumors on the initial ultrasound scan. The rates of other complications, such as a torsion and a cyst rupturing, were 0.4% and 0.2%, respectively.

The study authors noted that these potential risks must be weighed against the risks of surgery, such as bowel perforation, which for women aged 50 to 74 years is between 3% to 5%.

Overall, the authors found that the “results suggest that the risk of malignancy and acute complications is low if [ovarian tumors] with benign ultrasound morphology are managed conservatively, which could be of value when counselling patients, and supports conservative management of [ovarian tumors] classified as benign by use of ultrasound.”

References

Froyman W, Landolfo C, deCock B, et al. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicenter, prospective, cohort study [published February 5, 2019]. Lancet Oncol. doi: 10.1016/S1470-2045(18)30837-4.