title: Management of presumed benign ovarian tumors: updated French guidelines.
abstract: Transvaginal pelvic ultrasound is the first-line imaging examination for presumed benign ovarian tumors (PBOT) in adult women (Grade A). Ultrasound is sufficient for characterizing a unilocular anechoic cyst smaller than 7cm (Grade A). Magnetic resonance imaging is the recommended second-line investigation for indeterminate masses or masses larger than 7cm (Grade B). Serum CA-125 assay is not recommended for first-line diagnosis in adult women (Grade C). In women with a unilocular anechoic cyst, hormone therapy is ineffective and not recommended (Grade A). Ultrasound-guided aspiration is not recommended (Grade B). Abstention is an option in adult women with a unilocular asymptomatic anechoic cyst smaller than 10cm and no history of cancer (Grade B). If symptoms develop, laparoscopy is the gold standard for surgical treatment of PBOT (Grade A). Conservative surgical treatment (cystectomy) should be preferred to oophorectomy in pre-menopausal women without a previous history of cancer (Grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (Grade B). Conservative treatment or detorsion without oophorectomy is recommended for pre-menopausal women regardless of the estimated torsion duration and macroscopic appearance of the ovary (Grade B). During pregnancy, expectant management is recommended for unilocular asymptomatic anechoic cysts smaller than 6cm (Grade C).
authors.affiliation: Department of Gynaecology and Obstetrics, Pellegrin University Hospital, Bordeaux, France. Electronic address: Jean-luc.brun@chu-bordeaux.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Brun
authors.affiliation: Department of Gynaecology and Obstetrics, La Milétrie University Hospital, Poitiers, France.
authors.forename: X
authors.initials: X
authors.lastname: Fritel
authors.affiliation: Department of Gynaecology and Obstetrics, Dupuytren University Hospital, Limoges, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Aubard
authors.affiliation: Department of Gynaecology and Obstetrics, Cochin University Hospital, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Borghese
authors.affiliation: Department of Gynaecology and Obstetrics, Estaing University Hospital, Clermont Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Bourdel
authors.affiliation: Department of Gynaecology and Obstetrics, Tenon University Hospital, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Chabbert-Buffet
authors.affiliation: Department of Gynaecology and Obstetrics, Jeanne de Flandre University Hospital, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Collinet
authors.affiliation: Department of Gynaecology and Obstetrics, Antoine Béclère University Hospital, Clamart, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Department of Gynaecology and Obstetrics, La Croix-Rousse University Hospital, Lyon, France.
authors.forename: G
authors.initials: G
authors.lastname: Dubernard
authors.affiliation: Department of Gynaecology and Obstetrics, Poissy-St-Germain University Hospital, Poissy, France.
authors.forename: C
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Department of Paediatric Surgery, Lapeyronie University Hospital, Montpellier, France.
authors.forename: N
authors.initials: N
authors.lastname: Kalfa
authors.affiliation: Department of Hormonal Biology, Cochin University Hospital, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Lahlou
authors.affiliation: Department of Gynaecology and Obstetrics, Bretonneau University Hospital, Tours, France.
authors.forename: H
authors.initials: H
authors.lastname: Marret
authors.affiliation: Department of Paediatrics, Children's University Hospital, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Pienkowski
authors.affiliation: Department of Pathology, Jules Verne University Hospital, Amiens, France.
authors.forename: H
authors.initials: H
authors.lastname: Sevestre
authors.affiliation: Department of Radiology, Tenon University Hospital, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Thomassin-Naggara
authors.affiliation: Department of Gynaecology and Obstetrics, Anne de Bretagne University Hospital, Rennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Levêque
mesh_terms: D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D019468:Disease Management; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D006801:Humans; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D009369:Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010052:Ovariectomy; D011372:Progestins / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D003278:Contraceptives, Oral, Hormonal; D011372:Progestins; D003613:Danazol
keywords: Biomarkers; Imaging; Ovarian cyst; Pregnancy; Treatment