Observation in lieu of surgery OK for simple ovarian cysts after menopause
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For postmenopausal women, simple ovarian cysts were likely to remain unchanged or disappear during follow-up, according to a systematic review and meta-analysis published in Menopause.
“Postmenopausal ovarian masses are not uncommon; most of them are found by chance during physical examination or pelvic imaging,” Ya-Na Liu, MS, from the department of obstetrics and gynecology at West China Second University Hospital at Sichuan University, Chengdu, and the Key Laboratory of Birth Defects and Related Diseases of Women and Children at Sichuan University Ministry of Education, Sichuan, China, and colleagues wrote. “The probability of an ovarian mass within 15 years after menopause in American women is 18%.”
To investigate whether these masses are likely to become malignant, researchers conducted a systematic review and meta-analysis searching through PubMed, MEDLINE, Embase, CENTRAL, ClinicalTrials.gov and ISRCTN from inception to January 2022. Researchers identified 12 studies of 1,672 total participants and 1,513 ovarian cysts. All studies enrolled postmenopausal women with simple ovarian cysts and women without ascites and/or other signs of carcinomatosis.
For cysts managed with conservative observation, first evaluation was usually within 3 to 6 months after diagnosis with follow-up every 6 to 12 months for an average of 29 to 64 months, according to the researchers.
During conservative observation, researchers noted that most simple cysts remained unchanged (38.9%; P < .01) or disappeared (34.17%; P < .01) at follow-up. For simple cysts, the surgery rate was 19.04% (P < .01). Shrinkage at follow up was observed for 5.5% of cysts vs. 1.59% that grew.
The malignancy rate among ovarian cysts was “very low,” according to the researchers, with approximately one occurrence in 10,000 patients (P = .79). Researchers also noted a low rate of simple cysts that upgraded to complex cysts (1.18%).
Patient choice accounted for 44.02% of surgeries, and an upgrade from a simple to a complex cyst or cyst enlargement accounted for 27.75%.
“For most participants with benign simple ovarian cysts, avoiding unnecessary surgery should be an important goal because the benefits of conservative treatment greatly outweigh the risk of malignant transformation of the cysts,” the researchers wrote.