title: Ultrasonographic diagnosis and longitudinal follow-up of recurrences after conservative surgery for borderline ovarian tumors.
abstract: BACKGROUND
  Borderline ovarian tumors are generally diagnosed in young women. Because of the young age of patients at first diagnosis and at recurrence, and given the good prognosis of borderline ovarian tumors, a conservative surgical approach in those women who wish to preserve their fertility is advised. In this scenario, transvaginal ultrasound examination plays a key role in the detection of borderline ovarian tumor recurrence, and in assessment of amount of normal functioning parenchyma remaining. To date, no data are available about the natural history of borderline ovarian tumor recurrence.
  
  
  OBJECTIVE
  The aim of the study was to determine growth rate of recurrent ovarian cysts by a scheduled follow-up by ultrasound examination, in women previously treated with fertility-sparing surgery due to borderline ovarian tumors.
  
  
  METHODS
  In this prospective observational study, we collected data from 34 patients previously treated with fertility-sparing surgery due to borderline ovarian tumors, who had a suspicious recurrent lesion. The patients underwent transvaginal ultrasonographic examination every 3 months, until the clinical setting recommended proceeding with surgery. According to cyst size at study entry, they were categorized into 3 groups: ≤10 mm, 10-20 mm, and >20 mm. Summary statistics for cyst size, growth rate, and the probability of remaining within the same dimension category at first ultrasound during the follow-up were also obtained. For each cyst the growth rate was calculated as the slope of the linear interpolation between 2 consecutive measurements.
  
  
  RESULTS
  Follow-up timing (P < .001), cyst size (P < .001), and micropapillary pattern (P < .001) were factors significantly affecting the cyst growth both in univariate and multivariate analysis. According to size category at first ultrasound, growth rate ranges from a minimum of 0.06 mm/mo for cysts <10 mm up to 1.92 mm/mo for cysts >20 mm. The final histology of all recurrent lesions confirmed the same histotype of primary borderline ovarian tumors.
  
  
  CONCLUSIONS
  This article represents the first observational study that describes the trend in the growth rate of borderline ovarian tumor recurrence in relation to their size detected at the first ultrasound examination. The findings of this study seem to confirm, in selected patients, that a thorough ultrasonographic follow-up of borderline ovarian tumor recurrence has proven to be safe and feasible. The final goal of such management is to maximize the impact on fertility potential of these young women without worsening their prognosis.
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy. Electronic address: dorella.franchi@ieo.it.
authors.forename: Dorella
authors.initials: D
authors.lastname: Franchi
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Boveri
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy; Division of Gynecology and Obstetrics, Università Campus Bio-Medico of Rome, Rome, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Portuesi
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy.
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Division of Gynecology, European Institute of Oncology, Milan, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
authors.affiliation: Division of Gynecology, University of Sacred Heart, Rome, Italy.
authors.forename: Antonia Carla
authors.initials: AC
authors.lastname: Testa
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000072700:Conservative Treatment; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000601:surgery; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000000981:diagnostic imaging* / Q000601:surgery; D059351:Organ Sparing Treatments; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D010052:Ovariectomy; D011446:Prospective Studies; D012086:Reoperation; D055815:Young Adult
keywords: conservative surgery; ovarian borderline tumor; recurrences; ultrasound