Ultrasound Can Prevent Surgery for Some Ovarian Tumors

A study presented by Brook A. Saunders, MD, and John R. van Nagell, University of Kentucky Markey Medical Center, at the Society of Gynecologic Oncologists 41st Meeting on Women’s Cancer provides evidence that certain tumors can safely be monitored with ultrasound for years without raising the risk of ovarian cancer. In the study, surgery proved unnecessary in all but one of the tumors, and the current evidence supports a reduction in the number of gynecologic surgeries.

The study followed 29,829 women and covered a 22-year-period, from 1987 to 2009. Among study participants, 1319 had complex cystic ovarian tumors with septation. The study indicates that these tumors need not be removed through surgery, provided that no solid areas or papillary projections are evident on transvaginal sonography (TVS).

Heretofore, doctors have often recommended surgery, because ultrasound data were lacking concerning the risk of malignancy in complex septated ovarian tumors without mural nodularity. Within the subgroup of 1319 women, researchers found 2870 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 4 to 6 months. More than 38% 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 6 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 2742 tumors but tracked them with ultrasound. All but one 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-years of age 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.

Source: Society of Gynecologic Oncologists