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Ovarian Cyst – Incidental Finding

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Ovarian Cyst – Incidental Finding Ovarian Cyst – Incidental Finding Page 1 of 10 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. 2 CLINICAL Pre-menopausal Less than or equal to 5 cm INITIAL (includes perimenopausal) Greater than 5 cm Transvaginal ultrasound follow-up at 6-12 weeks PRESENTATION EVALUATION ● Age less than 50 years Less than or equal to 3 cm Early post-menopausal Greater than 3 cm ● Within 5 years of LMP or but less than or Transvaginal ultrasound follow-up at 6-12 weeks Benign-appearing ● Age 50-55 years, when LMP is 1 equal to 5 cm cyst unknown Transvaginal ultrasound promptly, see cysts Incidental Greater than 5 cm with benign characteristics on Pages 3-5 for Adnexal Cystic Late post-menopausal cyst management Benign, no follow-up Mass on CT, MRI ● Greater than 5 years from LMP or Less than or equal to 3 cm (See normal (greater than or ● Age greater than 55 years, if LMP Transvaginal ultrasound promptly, see cysts equal to 1 cm) is unknown Greater than 3 cm with benign characteristics on Pages 3-5 for appearance Post-Menarchal, cyst management physiologic descriptors on Non-Pregnant 2 Less than or equal to 3 cm Pre-menopausal Pages 2-3) (includes perimenopausal) Greater than 3 cm LMP = last menstrual but less than or Transvaginal ultrasound follow-up at 6-12 weeks ● Age less than 50 years period equal to 5 cm Transvaginal ultrasound promptly, see cysts with 1 Probably benign Should have all of the indeterminate, but probably benign, characteristics 3 Early post-menopausal Greater than 5 cm following features on cyst on Pages 5-6 for cyst management CT, MRI: (a) oval or ● Within 5 years of LMP or Less than or round; (b) unilocular, ● Age 50-55 years, when LMP is equal to 3 cm with uniform fluid unknown Transvaginal ultrasound promptly, see cysts with attenuation or signal Greater than 3 cm indeterminate, but probably benign, characteristics (layering hemorrhage Late post-menopausal on Pages 5-6 for cyst management acceptable if ● Greater than 5 years from LMP or Less than or premenopausal); ● Age greater than 55 years, if LMP equal to 1 cm (c) regular or imperceptible wall; (d) no is unknown Greater than 1 cm Transvaginal ultrasound promptly, solid area, mural nodule; Other imaging Features not specific see Pages 3-7 for cyst management and (e) 10 cm in maximum features4 diameter Probable diagnostic features Manage as appropriate for diagnosis 2 For simple ovarian cyst for pre-menopausal women, CA-125 is not recommended 3 Refers to an adnexal cyst that would otherwise meet the criteria for a benign-appearing cyst except for one or more of the following specific observations: (a) angulated margins, (b) not round or oval in shape, (c) a portion of the cyst is poorly imaged (e.g., a portion of the cyst may be obscured by metal streak artifact on CT pelvis), and (d) the image has reduced signal-to-noise ratio, usually because of technical parameters or in some cases the study was performed without intravenous contrast 4 Features of masses in this category include: (a) solid component, (b) mural nodule, (c) septations, (d) higher than fluid attenuation, and (e) layering hemorrhage if postmenopausal Department of Clinical Effectiveness V3 Approved by the Executive Committee of the Medical Staff on 10/20/2020 Ovarian Cyst – Incidental Finding Page 2 of 10 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. APPENDIX A: Recommendations for Management of Asymptomatic Ovarian and Other Adnexal Cysts Normal appearance Follow-up Comments Normal ovary appearance: Not needed Developing follicles and dominant follicle less Reproductive age than or equal to 3 cm are normal findings Follicles ● Thin and smooth walls ● Round or oval ● Anechoic ● Size less than or equal to 3 cm ● No blood flow Normal ovary appearance: Not needed Corpus luteum less than or equal to 3 cm Reproductive age is a normal finding Corpus luteum ● Diffusely thick wall ● Peripheral blood flow ● Size less than or equal to 3 cm ● With or without internal echoes ● With or without crenulated appearance Normal ovary appearance: Not needed Normal postmenopausal ovary is atrophic Postmenopausal without follicles ● Small ● Homogenous From “Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement,” by D. Levine, D. L. Continued on Next Page Brown, R. F. Andreotti, B. Benacerraf, C. B. Benson, W. R. Brewster, . U. M. Hamper, 2010. Radiology, 256, p. 949-951. Copyright 2010 by The Radiological Society of North America. Reprinted with permission. Department of Clinical Effectiveness V3 Approved by the Executive Committee of the Medical Staff on 10/20/2020 Ovarian Cyst – Incidental Finding Page 3 of 10 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. APPENDIX A: Recommendations for Management of Asymptomatic Ovarian and Other Adnexal Cysts - continued Normal appearance Follow-up Comments Clinically inconsequential: Not needed Small simple cysts are common; cyst less than or equal Postmenopausal to 1 cm are considered clinically unimportant Simple cyst less than or equal to 1 cm ● Thin wall ● Anechoic ● No flow Cysts with benign characteristics Follow-up Comments Simple cysts (includes ovarian and Reproductive age: Simple cysts, regardless of age of patient, are almost extraovarian cysts) ● Less than or equal to 5 cm: Not needed certainly benign ● Round or oval ● Greater than 5 cm and less than or equal to For cysts less than or equal to 3 cm in women of ● Anechoic 7 cm: Yearly reproductive age, it is at the discretion of the ● Smooth, thin walls Postmenopausal (PM): interpreting physician whether to describe them ● No solid component or septation ● Greater than 1 cm and less than or equal to in imaging report ● Posterior acoustic enhancement 7cm: Yearly ● No internal flow Any age: ● Greater than 7 cm: Further imaging (e.g.,MRI) or surgical evaluation Continued on Next Page Department of Clinical Effectiveness V3 Approved by the Executive Committee of the Medical Staff on 10/20/2020 Ovarian Cyst – Incidental Finding Page 4 of 10 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient's care. This algorithm should not be used to treat pregnant women. APPENDIX A: Recommendations for Management of Asymptomatic Ovarian and Other Adnexal Cysts - continued Cysts with benign characteristics Follow-up Comments Hemorrhagic cyst Reproductive age: Use Doppler to ensure no solid elements ● Reticular pattern of internal echoes ● Less than or equal to 5 cm: Not needed For cysts less than or equal to 3 cm in women ● With or without solid appearing area with ● Greater than 5 cm: 6-12 weeks of reproductive age, it is at the discretion of concave margins follow-up to ensure resolution the interpreting physician whether to describe ● No internal flow Early PM: them in imaging report Any size: Follow-up to ensure resolution Late PM: Consider surgical evaluation Endometrioma Any age: ● Homogenous low level internal echoes Initial follow-up at 6-12 weeks, then if not ● No solid component surgically removed, follow-up yearly ● With or without tiny echogenic foci in wall Dermoid Any age: ● Focal or diffuse hyperechoic component If not surgically removed, follow-up yearly ● Hyperechoic lines and dots to ensure stability ● Area of acoustic shadowing ● No internal flow Continued on Next Page Department of Clinical Effectiveness V3 Approved by the Executive Committee of the Medical Staff on 10/20/2020 Ovarian Cyst – Incidental Finding Page 5 of 10 Disclaimer: This algorithm has been developed for MD Anderson using a multidisciplinary approach considering circumstances particular to MD Anderson’s specific patient population, services and structure, and clinical information. This is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine
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