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Gaby’s Green Top Guidelines > 2016 34 Postmenopausal Ovarian Cysts > Flashcards

2016 34 Postmenopausal Ovarian Cysts Flashcards

1
Q
  • What is important in the history of postmenopausal ovarian cysts? *
A
  1. Risk factors
  2. Symptoms suggestive of malignancy
  3. Family history of ovarian, bowel or breast cancer
  4. IBS symptoms within last 12 months
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2
Q
  • What should examination include for postmenopausal ovarian cysts? *
A
  1. BMI
  2. Abdo for ascites & features of palpable mass
  3. VE
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3
Q
  • What is the role of Ca-125 in postmenopausal ovarian cysts? *
A
  1. Only serum tumour marker
  2. Don’t use in isolation, normal value does not exclude cancer
  3. Not enough evidence for other tumour markers
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4
Q
  • What imaging should be used to characterise postmenopausal ovarian cysts? *
A
  1. TVUS
  2. TAUS supplementary if too large for TVUS
  3. Clearly document morphological findings & subjective assessment
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5
Q
  • What imaging should not be used to characterise postmenopausal ovarian cysts? *
A
  1. Colour flow Doppler
  2. Spectral & pulse Doppler indices
  3. 3D ultrasound
  4. CT (until diagnosis indicated)
  5. MRI (2nd line if US inconclusive)
  6. PET-CT
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6
Q
  • Which postmenopausal cysts can be managed conservatively? *
A

Must meet all conditions:
1. RMI < 200
2. Asymptomatic
3. Simple cyst
4. < 5cm
5. Unilocular
6. Unilateral

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7
Q
  • What does conservative management of postmenopausal ovarian cysts involve? *
A
  1. Repeat Ax in 4-6 months
  2. Discharge if resolved
  3. Repeat again if unchanged
  4. Consider discharge at 1 year
  5. Consider intervention if features change
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8
Q
  • In which postmenopausal ovarian cysts is BSO considered? *
A
  1. RMI < 200
    ANY of the following features:
  2. Symptomatic
  3. Non-simple features
  4. > 5cm
  5. Multilocular
  6. Bilateral
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9
Q
  • How are postmenopausal ovarian cysts with an RMI > 200 managed? *
A
  1. CTAP
  2. Referral to gynae-onc MDT
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10
Q
  • How are postmenopausal ovarian cysts with an RMI > 200 managed? *
A
  1. CTAP
  2. Referral to gynae-onc MDT
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11
Q
  • How are postmenopausal cysts with high suspicion of malignancy following MDT managed? *
A
  1. Laparotomy
  2. Full staging procedure
  3. By gynae-oncologist
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12
Q
  • How are postmenopausal ovarian cysts with a low suspicion of malignancy following MDT managed? *
A
  1. Laparotomy
  2. Pelvic clearance: TAH + BSO + omentectomy + peritoneal cytology
  3. By a gynaecologist
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13
Q
  • How is RMI-I calculated? *
A
  1. U x M x Ca-125
  2. U scored 0 (no features) 1 (1) or 3 (2-5)
  3. M scores 1 for premenopausal, 3 for postmenopausal
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14
Q
  • What are the ultrasound features that score on RMI-I? *
A
  1. Multilocular
  2. Solid areas
  3. Metastases
  4. Ascites
  5. Bilateral lesions
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15
Q
  • What are the ultrasound features that score on RMI-I? *
A
  1. Multilocular
  2. Solid areas
  3. Metastases
  4. Ascites
  5. Bilateral lesions
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16
Q

What is the incidence of ovarian cysts in postmenopausal women?

17
Q

What is the incidence of ovarian cysts in postmenopausal women?

18
Q

What postmenopausal ovarian cysts are insignificant & don’t need following up?

19
Q

What examination findings of a postmenopausal custard associated with malignancy?

A
  1. Irregularity
  2. Solid consistency
  3. Fixed, immobile
  4. Nodularity
  5. Bilaterality
  6. Ascites
20
Q

What non-malignant conditions can increase Ca-125 level?

A
  1. PID
  2. Fibroids
  3. Acute benign cyst accidents
  4. Endometriosis
  5. Non-gynae causes of peritoneal irritation
21
Q

What are the ultrasound features of a simple cyst?

A
  1. round or oval shape
  2. thin or imperceptible wall
  3. posterior acoustic enhancement
  4. anechoic fluid
  5. absence of septations or nodules
22
Q

What are the ultrasound features of a complex ovarian cyst?

A
  1. Complete separation/multilocular
  2. Solid nodules
  3. Papillary projections
23
Q

What are the sensitivity & specificity of RMI-I score > 200?

A

Sensitivity: 78%
Specificity: 87%

24
Q

What are the IOTA B-rules for ovarian cysts?

A
  1. Unilocular
  2. Solid components, largest <7mm
  3. Acoustic shadowing
  4. Smooth multilocular with largest diameter < 100mm
  5. No blood flow on colour Doppler
25
Q

What are the M-rules for ovarian cysts?

A
  1. Irregular solid tumour
  2. Ascites
  3. At least 4 papillary structures
  4. Irregular multilocular with largest diameter > 100mm
  5. Prominent blood flow on colour Doppler
26
Q

Why is aspiration of cysts not recommended in postmenopausal women?

A
  1. Poor at distinguishing benign vs malignant
  2. Often not therapeutic
  3. May índice spillage & seeding

Gaby’s Green Top Guidelines (51 decks)

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