Radiology 2019 11 24;293(2):359-371. Epub 2019 Sep 24.
From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Mass GU, US02215 (D.L.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (M.D.P.); 1425 S. Main St, Walnut Creek, Calif 94596 (E.J.S.B.); 2115 Sharondale Dr, Nashville, Tenn 37215 (R.F.A.); One Brookline Place, Brookline, Mass 02445 (B.R.B.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.B.B.); UNC Chapel Hill Medical Center, Chapel Hill, NC (W.B.); Children's Hospital of Philadelphia, Philadelphia, Pa (B.G.C.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (P.M.D.); 530 First Avenue, Suite 10N, New York, NY 10016 (S.R.G.); Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Md (U.M.H.); Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Mass (J.L.H.); Einstein Medical Center, Philadelphia, Pa (M.M.H.); Columbia University Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery, New York, NY (H.C.H.); 1848 Century Valley Road NE, Rochester, Minn 55906 (M.L.M.); OB/GYN UKMC, 800 Rose St, Lexington, Ky 40536 (E. Pavlik); 6310 San Vicente, Suite 520, Los Angeles, Calif 90048 (L.D.P.); Wayne State University, C.S. Mott Center for Human Growth and Development, Department of Obstetrics and Gynecology, Detroit, Mich and InVia Fertility, Hoffman Estates, Ill (E. Puscheck); 350 Parnassus Ave, Suite 307C, San Francisco, Calif 94143 (R.S.B.); and Department of Radiology, Mayo Clinic, Rochester, Minn (D.L.B.).
This multidisciplinary consensus update aligns prior Society of Radiologists in Ultrasound (SRU) guidelines on simple adnexal cysts with recent large studies showing exceptionally low risk of cancer associated with simple adnexal cysts. Most small simple cysts do not require follow-up. For larger simple cysts or less well-characterized cysts, follow-up or second opinion US help to ensure that solid elements are not missed and are also useful for assessing growth of benign tumors. In postmenopausal women, reporting of simple cysts greater than 1 cm should be done to document their presence in the medical record, but such findings are common and follow-up is recommended only for simple cysts greater than 3-5 cm, with the higher 5-cm threshold reserved for simple cysts with excellent imaging characterization and documentation. For simple cysts in premenopausal women, these thresholds are 3 cm for reporting and greater than 5-7 cm for follow-up imaging. If a cyst is at least 10%-15% smaller at any time, then further follow-up is unnecessary. Stable simple cysts at initial follow-up may benefit from a follow-up at 2 years due to measurement variability that could mask growth. Simple cysts that grow are likely cystadenomas. If a previously suspected simple cyst demonstrates papillary projections or solid areas at follow-up, then the cyst should be described by using standardized terminology. These updated SRU consensus recommendations apply to asymptomatic patients and to those whose symptoms are not clearly attributable to the cyst. These recommendations can reassure physicians and patients regarding the benign nature of simple adnexal cysts after a diagnostic-quality US examination that allows for confident diagnosis of a simple cyst. Patients will benefit from less costly follow-up, less anxiety related to these simple cysts, and less surgery for benign lesions.