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Simple cysts not linked to ovarian cancer

The presence of simple cysts on ultrasonography is not associated with a higher risk for ovarian cancer, according to findings published in JAMA Internal Medicine.

“The risk of malignant ovarian cancer associated with simple cysts is unknown,” Rebecca Smith-Bindman, MD, professor in residence of radiology, epidemiology and biostatistics, and obstetrics, gynecology and reproductive medicine at the University of California, San Francisco, and colleagues wrote.

Therefore, Smith-Bindman and colleagues conducted a nested case-control study to determine the risk for malignant ovarian cancer based on ultrasonographic characteristics of masses in the ovaries, including simple cysts. The researchers enrolled 72,093 women who underwent pelvic ultrasonography and identified 210 who were subsequently diagnosed with ovarian cancer.

About three-quarters of participants were younger than 50 years, but women who developed cancer were more likely to be 50 years or older (76.7%). Normal ovaries were observed in most women. A simple cyst was the second most common ovarian finding among participants after a normal ovary. Nearly 25% of participants younger than 50 years had a simple cyst, as did 13% of women aged 50 years and older.

Women with complex cysts or solid masses were significantly more likely to develop cancer. The likelihood ratios of cancer among women with complex cysts or solid masses ranged from eight to 74 compared with those with normal ovaries, whereas the 3-year risk of cancer ranged from nine to 430 cases per 1,000 women.

There was no significantly elevated risk for ovarian cancer among women with simple cysts both older and younger than 50 years compared with those with normal ovaries. No ovarian cancer was identified in women younger than 50 years with a simple cyst. Women aged 50 years or older with a simple cyst had a likelihood ratio of 0.1 (95% CI, 0.01-0.48) of developing cancer.

“According to the results of this study, increased ultrasonography use, with concomitant improved technical quality, has led to the identification of imaging findings without clear criteria about what images require further evaluation,” Smith-Bindman and colleagues concluded. “The result has been tissue sampling and surgery when little value comes from this assessment. Simple cysts are frequently encountered incidental and normal findings on pelvic imaging, and additional evaluation of these findings is not warranted.”

In an accompanying editorial, Deborah Levine, MD, director of obstetric and gynecologic ultrasound in the department of radiology at Beth Israel Deaconess Medical Center, wrote that the findings by Smith-Bindman and colleagues build upon past evidence suggesting that “asymptomatic simple cysts may be safely ignored, regardless of size and regardless of patient age.”

“The quality of the sonographic examination is key for confident diagnosis of a simple cyst,” she wrote. “With confident diagnosis of simple cysts, clinicians can be reassured that the likelihood of cancer is similar to that of patients without cysts, and management can be based on patient symptoms rather than on a benign incidental pelvic ultrasonographic finding.” – by Alaina Tedesco

Disclosures: The authors report no relevant financial disclosures.