Risk of malignancy in sonographically confirmed septated cystic ovarian tumors

doi:10.1016/j.ygyno.2010.05.013

Gynecologic Oncology

Volume 118, Issue 3, September 2010, Pages 278-282

https://doi.org/10.1016/j.ygyno.2010.05.013 Get rights and content

Abstract

Objective

To determine the risk of malignancy in septated cystic ovarian tumors.

Materials

1319 (4.4%) of 29,829 women were identified by transvaginal sonography (TVS) as having a complex cystic ovarian tumor with septations without solid areas or papillary projections and were placed on long-term ultrasound surveillance for ovarian malignancy.

Results

These 1319 patients had a total of 2870 septated cystic ovarian tumors. 2288 tumors (79.7%) had a septal width < 2 mm and 582 (20.3%) had a septal width ≥ 2 mm. 2286 tumors (79.6%) were < 5 cm in diameter and 584 (20.4%) were ≥ 5 cm in diameter. 1114 septated cystic tumors (38.8%) resolved spontaneously (mean duration to resolution—12 months) and 1756 (61.2%) tumors persisted. 128 patients underwent surgical tumor removal within 3 months of ultrasound. Most common histopathology was: serous cystadenoma (75), mucinous cystadenoma (13), and endometrioma (10). One patient had an ovarian tumor of borderline malignancy (Stage IB). There were no cases of ovarian cancer. Patients were followed from 4 to 252 months (mean—77 months). One patient developed papillary morphology in the contralateral ovary 3.2 years after detection of a septated ovarian cyst and had epithelial ovarian cancer in that ovary and in the omentum (Stage IIIC disease). The remaining patients are all free of ovarian neoplasia after a total of 7642 follow-up years.

Conclusions

Septated cystic ovarian tumors without solid areas or papillary projections have a low risk of malignancy and can be followed sonographically without surgery.

Introduction

Ovarian cancer remains the leading cause of gynecologic oncology mortality in the United States. This year, it is estimated that there will be 21,554 new cases of ovarian cancer, and that 14,600 women will die of disease [1]. Most women diagnosed with ovarian cancer continue to present with advanced stage disease where the prognosis is poor. As a result, there has been increasing interest in screening asymptomatic high risk women in an attempt to detect ovarian cancer at an earlier and more curable stage. Recent reports have indicated that annual biomarker and sonographic screening causes a decrease in stage at detection of ovarian cancer and increased patient survival [2], [3]. However, sonography has not been accurate in differentiating benign from malignant ovarian tumors, and TVS screening has been associated with a low positive predictive value (PPV) [4], [5]. Further analysis of ovarian tumor morphology generated by sonographic images has indicated that certain anatomic patterns are not indicative of ovarian neoplasia, and that patients with these lesions can be followed without surgery. Specifically, unilocular cystic ovarian tumors have been associated with an extremely low risk of malignancy [6], [7], [8].

The following investigation was undertaken to determine the risk of malignancy in complex cystic ovarian tumors with septations confirmed in transvaginal sonography (TVS), and to document their natural history.

Section snippets

Materials and methods

From January 1987 to July 2009, 29,828 women enrolled in the University of Kentucky Ovarian Cancer Screening Project. Eligibility criteria for this trial included (1) all asymptomatic women at least 50 years of age, and (2) asymptomatic women at least 25 years of age with a documented family history of ovarian cancer in at least one primary or secondary relative. All study participants completed a questionnaire regarding past medical history, menopausal status, hormonal use, and family history of

Statistical methods

Proportions were compared using chi-square statistics or Fisher exact tests. Means were compared using 2-sample ± statistics with t-testing. Statistical significance was determined at the 0.05 level.

Results

From January 1987 to July 2009, 1,319 (4.4%) of the 29,829 women screened had a sonographically confirmed complex cystic ovarian tumor with septations but without solid areas or papillary projections from the cyst wall. Demographic variables in these patients compared to those in the entire screened population are illustrated in Table 1. The mean age of the patients with complex septated ovarian tumors was 57.0 years (range 25–95 years) and the mean gravidity was 2.3 (0–10). There were no

Discussion

Although advances in chemotherapy and drug delivery systems have improved response rates and survival of women with advanced epithelial ovarian cancer, the cost of treatment is high and few patients are actually cured of disease [11], [12], [13], [14]. Screening asymptomatic high risk women is predicated on the belief that detection of ovarian cancer at an earlier stage will result in a significant improvement in patient survival. The results from two large screening trials [2], [3] have

Conflict of interest statement

None of the authors have a financial interest in the consequences of the findings reported here and none of the authors have a conflict of interest represented by their involvement in the work reported.

Acknowledgments

Supported by research grants from the Kentucky Department of Health and Human Services and the Telford Foundation.

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^☆: Presented as an Oral Plenary Session at SGO's 41st Annual Meeting on Women's Cancer, March 14-17, 2010, San Francisco, California.

¹: American Cancer Society Professor of Clinical Oncology.

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Risk of malignancy in sonographically confirmed septated cystic ovarian tumors☆

Abstract

Objective

Materials

Results

Conclusions

Introduction

Section snippets

Materials and methods

Statistical methods

Results

Discussion

Conflict of interest statement

Acknowledgments

Lancet Oncol

Am J Obstet Gynecol

Gynecol Oncol

Gynecol Oncol

Obstet Gynecol

Gynecol Oncol

Gynecol Oncol