Some ovarian tumors can be safely followed on US

Certain complex ovarian tumors may be safely monitored using ultrasound without raising the risk of ovarian cancer, according to a new study. In the past, radiologists deemed septated ovarian cystic tumors complex and sent the patient immediately to surgery. A study from the University of Kentucky (UK) changes the standard of care for those patients.

Dr. Brook Saunders, currently a gynecologic oncologist at Knoxville Gynecologic Cancer Specialists in Knoxville, TN, and his former UK colleagues followed 29,829 women from 1987 to 2009 as part of the university’s ovarian cancer screening program. Among the screened women, 1319 had complex cystic ovarian tumors with septation.

Provided there are no solid areas or papillary projections evident on transvaginal sonography, these women do not require surgery, Saunders said.

“For septated cysts physicians used their clinical judgment, but they could not guarantee they were benign,” he said. “This study shows you still have to use your clinical judgment, but you have a much better idea [whether] these cysts are benign.”

Asymptomatic women older than 50 and women 25 and older with a family history of ovarian cancer came in for transvaginal ultrasound ovarian cancer screening once a year. If the findings were abnormal, the women came back for a follow-up ultrasound in four to six weeks. If the cyst was considered simple, follow-up was conducted every three to six months. If the cyst was not considered simple-if it was septated, for instance-follow-up transvaginal ultrasound was conducted every four to six weeks.

In the 1319 subjects with septated cystic ovarian tumors, 38.8% of those tumors resolved on their own. The researchers removed 128 septated tumors from the women but none were found to be malignant.

The only differences between the group of women who had tumors removed and the group who did not were tumors larger than approximately 5 cm and tumors with multiple septations in the removal group, according to Saunders. The differences were not statistically significant.

“If the radiologist is seeing a septated cyst, it is more than likely a benign septated cyst, as long as there are no papillary areas or solid areas,” Saunders said. “If you have a good ultrasound where you can see that, you can reliably relay that information to the clinician who ordered the test.”

The UK study provides strong evidence due to the large cohort and extended follow-up, said Dr. Susan Modesitt, division director of gynecologic oncology at the University of Virginia in Charlottesville.

“I remember when I was a medical student, if any postmenopausal mass was detected, it was felt it needed to be removed because of the risk of malignancy,” she said. “However, in the intervening years we’ve discovered, largely through screening programs at the University of Kentucky, many of these can be observed, they have a very low risk of malignancy.”

The current study by Saunders and colleagues reinforces that finding, she said.

The UK study was presented at the Society of Gynecologic Oncologists annual meeting on March 17 in San Francisco.