Management of ovarian cysts.
BACKGROUND
The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts.


METHODS
Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications.


RESULTS
Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings.


CONCLUSIONS
The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.
Knudsen
Ulla Breth
UB
Department of Obstetrics and Gynecology, Odense University Hospital, Denmark. ubk@dadlnet.dk
Tabor
Ann
A
Mosgaard
Berit
B
Andersen
Erik Soegaard
ES
Kjer
Jens Joergen
JJ
Hahn-Pedersen
Suzanne
S
Toftager-Larsen
Kim
K
Mogensen
Ole
O
D018394:CA-125 Antigen; D005260:Female; D006801:Humans; D010048:Ovarian Cysts / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms; D017410:Practice Guidelines as Topic; D014463:Ultrasonography
D018394:CA-125 Antigen