Diagnosis and management of simple ovarian cysts: an audit

Simple ovarian cysts are common. The aim of clinical management is to optimize the treatment of malignant and premalignant cysts while minimizing intervention for cysts likely to resolve spontaneously. In this retrospective study, ovarian cysts over 30 mm in diameter were detected in 90 women. Of this population, 75 were premenopausal, 13 postmenopausal, and two had undergone a hysterectomy. Thirteen women presented acutely. Family history of breast, ovary or colon cancer was not ascertained in any of the women. None had CA125 levels performed. In 22 cases, the cyst was aspirated; only 10 of these had follow-up ultrasound. Laparotomy was performed in 25 premenopausal women, the two perimenopausal women and eight postmenopausal women. Average cyst size was 71 mm (range 40-80 mm) in the laparoscopy group, and 72 mm (range 36-180 mm) in the laparotomy group. After initial diagnosis at ultrasound, a follow-up scan was performed 4-16 weeks later. The final diagnosis was ovarian neoplasm in 13 and hydrosalpinx in two. None had a malignancy. Documentation at ultrasound was often inadequate, and management of the women with an ovarian cyst was haphazard. Guidelines on management of simple ovarian cysts are likely to improve clinical practice.