GTG 62 premenopausal ovarian cyst management Flashcards
What is the incidence of a malignancy for symptomatic ovarian cysts in premenopausal women?
1 in 1000
What is incidence of malignancy for symptomatic ovarian cysts in premenopausal women aged 50?
3 in 1000
How should a woman with an incidental finding of a 3cm, asymptomatic, simple ovarian cyst be managed?
Do not perform ca-125 or other tumour markers
Does not require follow up
Offer reassurance that the cyst will resolve within 3 menstrual cycles
What proportion of suspected of ovarian masses are non-ovarian in origin?
10%
What proportion of borderline ovarian tumours will have suspicious features on ultrasound?
80%
Which ovarian cancer is ca-125 primarily a marker for?
Epithelial ovarian carcinoma
In a pre-menopausal woman, how should a ca-125 <200 be managed?
Exclude other causes of raised ca-125
Consider serial measurements of ca-125 because rapidly rising levels are more suggestive of ovarian cancer than static high levels
In a pre-menopausal woman, how should a ca-125 of >200 units/ml be managed?
Refer to gynaeoncology
Which risk of malignancy index is most effective in predicting risk of ovarian cancer?
RMI 1
How is RMI calculated?
Ca125 x menopausal status (0= premenopausal, 1 = postmenopausal) x ultrasound findings
Which ultrasound findings contribute to the RMI score?
Ultrasound findings (1 point for each)
1) Multilocal cysts
2) Solid areas
3) Bilateral lesions
4) Metastases
5) Ascites
Score = 0 = no features
Score =1 = 1 feature
Score = 3= 2-5 features
What is the sensitivity and specificity of an RMI score of 200?
Sensitivity 78%
Specificity 87%
What is the sensitivity and specificity of the IOTA ultrasound rules?
Sensitivity 95%
Specificity 91%
Describe how cyst loculation on ultrasound is classified by B and M rules ?
Unilocular cyst = B rule
Multilocular, smooth, <100mm = B rule
Multilocular, irregular, >100mm = M rule
Describe how blood flow in an ovarian cyst is classified in B and M rules?
No blood flow = B rule
Very strong blood flow = M rule
Describe how solid components of an ovarian cyst are classified in B and M rules?
Acoustic shadowing = B rule
Solid components <7mm = B rule
Irregular solid tumour = M rule
> /= 4 papillary projections = M rule
Is ascites classified as B or M rule?
M rule – refer to gynaeoncology
Which ovarian cysts in premenopausal women do NOT require follow up?
<50mm, unilocular, simple ovarian cyst
What feature of a simple ovarian cyst in a premenopausal woman should prompt follow up with ultrasound?
50-70mm require yearly ultrasound
What feature of a simple ovarian cyst in a premenopausal woman would indicate the need for MRI?
The cyst is >70mm (MRI or surgical intervention is indicated)
What are the two different ways of risk assessing premenopausal ovarian cysts?
RMI 1 (score >200 warrants referral to gynaeonc)
IOTA ultrasound rules – any positive M rules warrant referral to gynaeonc
How should asymptomatic, persistent ovarian cysts be managed in premenopausal women?
Risk assess with wither RMI 1 or IOTA ultrasound rules
If increasing in size or persisting after several cycles – consider surgical management
Asymptomatic cysts 5-6cm are arbitarily managed conservatively
Does COCP help resolve functional cysts?
No
Which operative technique is preferred for ovarian cysts which a suspected to be benign?
Laparoscopy. Laparotomy may be considered for very large ovarian cysts but the cut off is unclear
Aspiration is not recommended due to high risk of recurrence
What is the incidence of chemical peritonitis due to spillage of dermoid cyst contents?
0.2%
How should ovarian cysts be removed at laparoscopy?
Tissue retrieval bag, via the umbilical port
Which biochemical tests should be performed in a woman under the age of 40 presenting with a complex ovarian mass?
LDH AFP HCG, Ca-125
