Clinically Suspected Adnexal Mass US Pelvis Transabdominal and US Pelvis Transvaginal Likely benign adnexal lesions that can be adequately assessed and characterized on US may be followed sonographically. A large body of evidence including several large recent screening studies has shown that unilocular simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer [35,47-49]. In a large series, approximately 13% to 14% of women over 50 to 55 years of age, respectively, had simple ovarian cysts, with 8% demonstrating new cysts and 32% with no cyst at 1-year follow-up, with a near nonexistent risk of malignancy [47]. A second recent study of 72,093 women, those with simple cysts, demonstrated an absolute 3- year risk of ovarian cancer, 0 to 0.5 cases per 10,000 women, not dissimilar to women with normal ovaries [47,49]. Invasive serous cystadenocarcinoma is now primarily thought to originate from solid precursors in the fallopian tube, serous tubal intraepithelial carcinoma, further supporting the benignity of simple ovarian cysts [50]. A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects these findings with higher threshold for follow-up of simple cysts [42]. For postmenopausal patients, the SRU endorses follow-up of simple cysts >3 cm (and 5 cm for those that are exceptionally well seen) rather than the previous 1-cm threshold [42,58]. The rationale of follow-up for simple cysts is based on a potential risk of mischaracterization of larger cysts and potential clinical value of size monitoring growth rates of larger cysts, which may reflect benign neoplasms and warrant clinical follow-up. Unilocular cysts, as a whole, in the postmenopausal population similarly have a very low risk of malignancy.
Clinically Suspected Adnexal Mass No Acute Symptoms. Clinically Suspected Adnexal Mass US Pelvis Transabdominal and US Pelvis Transvaginal Likely benign adnexal lesions that can be adequately assessed and characterized on US may be followed sonographically. A large body of evidence including several large recent screening studies has shown that unilocular simple cysts, regardless of size and menopausal status, are not associated with an increased risk of cancer [35,47-49]. In a large series, approximately 13% to 14% of women over 50 to 55 years of age, respectively, had simple ovarian cysts, with 8% demonstrating new cysts and 32% with no cyst at 1-year follow-up, with a near nonexistent risk of malignancy [47]. A second recent study of 72,093 women, those with simple cysts, demonstrated an absolute 3- year risk of ovarian cancer, 0 to 0.5 cases per 10,000 women, not dissimilar to women with normal ovaries [47,49]. Invasive serous cystadenocarcinoma is now primarily thought to originate from solid precursors in the fallopian tube, serous tubal intraepithelial carcinoma, further supporting the benignity of simple ovarian cysts [50]. A recent consensus update to the SRU in 2019 regarding management of simple cysts reflects these findings with higher threshold for follow-up of simple cysts [42]. For postmenopausal patients, the SRU endorses follow-up of simple cysts >3 cm (and 5 cm for those that are exceptionally well seen) rather than the previous 1-cm threshold [42,58]. The rationale of follow-up for simple cysts is based on a potential risk of mischaracterization of larger cysts and potential clinical value of size monitoring growth rates of larger cysts, which may reflect benign neoplasms and warrant clinical follow-up. Unilocular cysts, as a whole, in the postmenopausal population similarly have a very low risk of malignancy.