Sonographic Follow-up of Ovarian Masses

Medscape

Hello. I'm Andrew Kaunitz, Professor and Associate Chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Today I would like to discuss sonographic follow-up of ovarian masses.

Although transvaginal ultrasound's role in detecting ovarian masses is well recognized, screening programs based on ultrasound have led to high numbers of surgeries for each malignancy encountered.^[1] Investigators analyzed data from 1987 to 2012 that involved more than 39,000 asymptomatic participants in a long-standing annual ovarian cancer screening program at the University of Kentucky.^[2] After an abnormal screening sonogram, repeat imaging was scheduled at intervals ranging from 6 weeks to 6 months. Women underwent surgery if the sonographic appearance of the mass progressed, if its volume increased substantially, or if the mass began to cause symptoms.

Overall, abnormal ovarian findings were noted at some point in almost 20% of women screened. Two thirds of the masses were low-risk, including simple cysts and cysts with septations. One third of the masses were considered to be high-risk, a designation that included cysts with solid areas and mostly solid masses. Within 1 year of follow-up, more than one third of low-risk masses and more than three quarters of high-risk masses resolved.

As screening algorithms evolved during the 25-year study period, the investigators increasingly used serial sonography for follow-up of ovarian masses. Initially, no masses were followed in this way, then simple cysts were followed, and then all masses were followed. Overall, 557 women, representing 1.4% of all women screened, underwent surgery.

As the investigators became more experienced during this long-term screening program, the proportion of women found to have malignancy at the time of surgery increased from 8% to 25% by the end of the study.

This report's finding that many ovarian masses (including those with complex features) eventually resolve points to a strategy that can minimize the use of surgery in managing asymptomatic women who have abnormal ovarian findings with vaginal ultrasound. The authors suggested that the frequency of sonographic follow-up should vary according to the initial morphology of the mass as well as its stability over time. Complex masses that increase in size or complexity should be surgically removed.

Thank you. I am Andrew Kaunitz.

References

1. Buys SS, Partridge E, Black A, et al; PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305:2295-2303. Abstract
2. Pavlik EJ, Ueland FR, Miller RW, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol. 2013;122:210-217. Abstract