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
