Ovarian Ultrasound Can Reduce Need for Surgery

 LEXINGTON, Ky. (March 17, 2010) − A study led by researchers at the University of Kentucky Markey Cancer Center provides evidence that certain ovarian tumors can safely be monitored with ultrasound for years without raising the risk of ovarian cancer. The current evidence supports a reduction in the number of gynecologic surgeries.

The study, "Risk of Malignancy in Sonographically Confirmed Septated Cystic Ovarian Tumors," was presented at the annual meeting of the Society of Gynecologic Oncologists held March 14-17 in San Francisco by Dr. Brook A. Saunders, a fellow in the Markey Cancer Center's Division of Gynecologic Oncology. The principal investigator is Dr. John R. van Nagell, the division's director.

The study followed 29,829 women and covered a 22-year-period from 1987 to 2009. Among study participants, 1,319 had complex cystic ovarian tumors with septation. The study indicates that these tumors need not be removed surgically, provided that no solid areas or papillary projections are evident on transvaginal sonography (TVS).

Within the subgroup of 1,319 women, researchers found 2,870 complex septated cystic tumors. Ultrasound indicated the tumors had no solid areas or papillary projections, so patients began a course of follow-up TVS every four to six months. More than 38 percent (38.8) of the tumors resolved, while the rest persisted. As long as tumors persisted, follow-up ultrasounds continued, and participants had, on average, two or three ultrasounds per year for six years. TVS tracking went on for as long as 21 years in one case.

During this time, researchers removed 128 complex septated cystic tumors from the subgroup. None were malignant, although one showed borderline malignancy [stage IB]. Researchers did not remove the other 2,742 tumors but tracked them with ultrasound. All but one patient remained cancer-free after an aggregate total of 7,642 follow-up years. TVS showed that one patient developed a tumor with a papillary projection in the opposite ovary three years after detection of a septated ovarian cyst. Doctors removed the tumor and found epithelial cancer in the patient's ovary and omentum.

Study participants included asymptomatic women who were 50 or older. Women as young as 25 were also enrolled in the study, but only if primary or secondary relatives had ovarian cancer. Patients with known ovarian tumors or personal history of ovarian cancer were excluded from the study.

This study provides evidence that a complex ovarian cyst with septations in the absence of solid areas or papillary structures may be followed, thereby decreasing the number of unnecessary surgical interventions in women being screened for cancer.