How best to follow up if U visualize a cyst in vary ? The approach
varies according to her age. The Society
of Radiologists in Ultrasound made in 2019 the following recommendations
regarding reporting of simple adnexal cysts of suspected ovarian origin based
on size and menopausal status :
·
A) premenopausal
women
o
1) ≤3 cm: no need to report; if described, consider calling a
"follicle" rather than a "cyst" to reduce patient anxiety
§ impression: normal ovaries/adnexa
§ recommendation:
no follow-up
o 2) >3
to ≤5 cm: report presence of simple cyst(s) and largest cyst diameter
§ impression:
benign finding in the physiologic size range
§ recommendation:
no follow-up
o 3) >5 cm: report with all
cyst diameters
§ impression:
benign simple cyst
§ recommendation:
§ 4) >5 to ≤7 cm:
follow-up either in 2-6 months for resolution/re-characterization or in 6-12
months for growth rate assessment, but no follow up is needed if the cyst is
exceptionally well-visualized/characterized and documented with confidence by
the imager
§ 5) >7 cm:
follow-up either in 2-6 months for resolution/re-characterization or in 6-12
months for growth rate assessment
o follow-up
of cyst (previously >5 cm): describe in report with all cyst diameters if
not resolved
§ Follow up report possibilities :-1:-decreased
in size
§ impression:
benign inconsequential finding; decrease in size excludes neoplasm
§ recommendation:
no further follow-up needed
§ Follow up report possibilities :-2 -similar
in size
§ impression:
benign simple cyst with stability over ≥12 months, most likely nonneoplastic or
very slow growing benign neoplasm
§ recommendation:
follow-up at 2 years from initial study to document stability and understand
growth rate
§ Follow up report possibilities :-3 -increased
in size
§ impression:
enlarging simple cyst, most likely a benign neoplasm
§ recommendation:
follow-up in 1 year to evaluate any further changes in size
·
Follow up report possibilities :-in postmeno Type one behaviour
1:-postmenopausal women
o ≤1 cm:
no need to report
§ impression:
normal ovaries/adnexa
§ recommendation:
no follow-up
·
Follow up report possibilities :-in postmeno Type one behaviour
2:-postmenopausal women
o >1
to ≤3 cm: report presence of simple cyst(s) and largest cyst diameter
§ impression:
benign inconsequential finding
§ recommendation:
no follow-up
·
Follow up report possibilities :-in postmeno Type one behaviour
3-postmenopausal women
o >3
cm: report with all cyst diameters
§ impression:
benign simple cyst
§ recommendation:
·
Follow up report possibilities :-in postmeno Type one behaviour
4-postmenopausal women
§ >3
to ≤5 cm: follow-up either in 3-6 months for resolution/re-characterization or
in 6-12 months for growth rate assessment, but no follow up is needed if the
cyst is exceptionally well-visualized/characterized and documented with
confidence by the imager
·
Follow up report possibilities :-in postmeno Type one behaviour
5-postmenopausal women
§ >5
cm: follow-up either in 3-6 months for resolution/re-characterization or in
6-12 months for growth rate assessment
·
Follow up report possibilities :-in postmeno Type one behaviour
6 ;postmenopausal women
o follow-up
of cyst (previously >3 cm): describe in report with all largest cyst
diameters if not resolved
§ decreased
in size
§ impression:
benign simple cyst; decrease in size excludes neoplasm
§ recommendation:
no further follow-up needed
·
Follow up report possibilities :-in postmeno Type one behaviour
7postmenopausal women
§ similar
in size
§ impression:
benign simple cyst
§ recommendation:
follow-up at 2 years from initial study to document stability
§ increased
in size
§ impression:
enlarging simple cyst, most likely a benign neoplasm
§ recommendation:
follow-up in 1 year to evaluate any further changes in size
Treatment
and prognosis
·
large (>3 cm) or symptomatic cysts may undergo surgical
resection
·
smaller asymptomatic cysts are treated conservatively
·
risk of malignancy in septated
ovarian cysts with no papillary projections or solid components are also
considered low and are usually followed up on ultrasound
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