abstract
2017 Jan 23
OBJECTIVE:
To assess the natural history of benign appearing purely solid ovarian lesions in asymptomatic postmenopausal women.
METHODS:
Retrospective
observational cohort study comprising 99 women (mean age, 58.2 years,
ranging from 50 to 77 years) diagnosed as having a purely solid ovarian
lesion at transvaginal ultrasound between April 2001 and October 2015.
Inclusion criteria were as follows: asymptomatic postmenopausal women
with a well-defined purely solid ovarian lesion with International
Ovarian Tumor Analysis color score 1 or 2, without ascites and/or signs
of carcinomatosis. Clinical, sonographic, biochemical (CA-125), and
histologic data (in case of surgery) were retrieved for analysis.
Patients who were managed conservatively were assessed by transvaginal
sonography every 6 months for a minimum of a year. In case of bilateral
lesions we used the largest one for analysis.
RESULTS:
Five
women (5.1%) had bilateral lesions. Mean size of the lesion was 2.9 cm
(range, 1.0-7.8 cm). Most lesions were homogeneous (96.0%). Acoustic
shadowing was present in 59.6% of cases. International Ovarian Tumor
Analysis color score was 1 in 77.8% and 2 in 22.2% of the cases,
respectively. Median CA-125 was 10.8 IU/mL (range, 3.0-403.0 IU/mL).
Forty-two women underwent surgery after diagnosis (histologic diagnoses
were as follows: fibroma (n = 26), fibrothecoma (n = 5), dermoid
(n = 3), Brenner tumor (n = 3), endometrioma (n = 2), thecoma (n = 1),
primary invasive cancer (n = 2). One case of invasive cancer CA-125 was
403.0 IU/mL and in the other case CA-125 was 6.0 IU/mL. They both were
stage 1. Fifty-seven women were managed with serial follow-up. With a
median follow-up time of 36 months (range, 12-142 months) all these
lesions had no change and women remain asymptomatic. Considering all 99
cases the risk of malignancy is 2% (95% CI, 0.1-7.5).
CONCLUSIONS:
The
risk of malignancy of benign appearing purely solid adnexal masses in
asymptomatic postmenopausal women is low. Conservative management of
these lesions might be an option.
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