Treatment Dilemma of Simple Cyst in Menopausal Women
Shaikh Zinnat Ara Nasreen, Safinaz Shahreen, Saleheen Huq, Sabereen Huq
Citation Information :
Nasreen SZ, Shahreen S, Huq S, Huq S. Treatment Dilemma of Simple Cyst in Menopausal Women. J South Asian Feder Menopause Soc 2017; 5 (2):75-80.
Can we offer conservative treatment for the menopausal women who are having simple cysts?
Study design
It is a prospective cross sectional study carried out in ZHSikder medical college & hospital, Medinova and Popular hospital. The study period was from january 2011 to January 2016.
Materials and methods
500 menopausal women with simple cysts were enrolled after counseling and taking written consent. Inclusion criteria was cysts size should not be more than 5 cm, they should be unilocular, without having any solid component or any debris. Exclusion criteria was women with family history of cancer of ovary, breast, or colon or women with HRT therapy. Thorough history taking, clinical examination, and some investigation like CA125, TVS with Color Doppler was carried out for all the women. CT Scan.MRI, and PET Scan were reserved for selected cases. All the patients were followed up every 3 monthly for 3 to 5 years. Surgery was done if the patient developed any symptoms, or increment of sizes of cysts or there was any sonographic changes were evident. MRI1 (malignancy risk index ) was calculated for each patient. Data were analyzed by SPSS where all calculation rate of less than 0.05 was considered significant.
Results
Among 500 cysts, 285 (57%) cysts resolved spontaneously which is highly significant( p = < 0.05), 165 (33%) cysts needed surgery and only 50(10%) cysts remained without significant changes. Histopathology of surgical specimen revealed all were benign except 4 cysts, i.e., < 1% became malignant or malignant potential.
Conclusion
Menopausal women with simple cysts not more than 5cm,which are unilocular, unilateral, without having any solid component and with normal Doppler study are rarely malignant. So if MRI1 is below 200 we may avoid unnecessary surgery and assure the menopausal women for the conservative treatment with regular follow up.
How to cite this article
Nasreen SZA, Shahreen S, Huq S, Huq S. Treatment Dilemma of Simple Cyst in Menopausal Women. J South Asian Feder Menopause Soc 2017;5(2):75-80.
Ovarian status in healthy postmenopausal women. Menopause 2008 Nov-Dec;15(6):1109-1114.
Predictors of clinical outcomes in the laparoscopic management of adnexal masses. Obstet Gynecol 2003 Aug;102:243-251.
A risk of malignancy index incorporating CA125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990 Oct;97(10):922-929.
The efficacy of a sonographic morphology index in identifying ovarian cancer: a multi-institutional investigation. Gynecol Oncol 1994 Nov;55(2):174-178.
Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis: report of the Radiology Diagnostic Oncology Group. Radiology 1999 Jul;212(1):19-27.
Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography. Gynecol Oncol 2000 Jun;77(3):454-459.
Pelvic examination, tumor marker level, and gray-scale and Doppler sonography in the prediction of pelvic cancer. Obstet Gynecol 1997 Apr;89(4):493-500.
Evaluation of a risk of malignancy index based on serum CA125,ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. Br J Obstet Gynaecol 1996 Aug;103(8):826-831.
The risk-of-malignancy index to evaluate potential ovarian cancer in local hospitals. Obstet Gynecol 1999 Mar;93(3):448-452.
Specialist gynaecologists and survival outcome in ovarian cancer: a Scottish national study of 1866 patients. Br J Obstet Gynaecol 1999 Nov;106(11):1130-1136.
Simple adnexal cysts: the natural history in postmenopausal women. Radiology 1992 Sep;184(3):653-659.
Simple cyst in postmenopausal patient: Detection and management. J Ultrasound Med 1998 Jun; 17(6);369-372; quiz 373-374.
Simple cyst in Postmenopausal women. US Pharm 2010 Jul;35(7):HS-5-HS-8.
Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings. Am J Obstet Gynecol 1999 Mar;180(3 Pt 1):550-553.
Cytologic examination of ovarian cyst fluid for the distinction between benign and malignant tumors. Obstet Gynecol 1993 Sep;82(3):444-446.
Laparoscopic preliminary surgery of ovarian malignancies. Experiences from 127 German women gynecologic clinics. Geburtshilfe Frauenheilkd 1995 Dec;55(12):687-694.
Ovarian cysts in Postmenopausal Women voices for change. Ovarian Cancer 2011 Jan.
Ovarian cysts and masses in menopause. Paoli (PA): Main line health; 2009.
Ovarian incidentaloma. Best Pract Res Clin Endocrinol Metab 2012 Feb;26(1):105-116.
Multicentre external validation of IOTA prediction models and RMI by operators with varied training. Br J Cancer 2013 Jun;108(12):2448-2454.
Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 2014 May-Jun;20(3):449-462.
Clinical performance of a multivariate index assay for detecting early-stage ovarian cancer. Am J Obstet Gynecol 2014 Jan;210(1):78.e1-78.e9.
The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstet Gynecol 2009 Feb;113(2 Pt 1):384-394.
Ovarian cysts in postmenopausal women (Green-top guideline No. 34). London: RCOG; 2016.
