Evaluation of Ovarian Cysts

Initial evaluation of an ovarian cyst is largely determined by its characteristics on ultrasonography, in addition to the presence of symptoms, laboratory evaluation, and patient history. Women with an ovarian cyst, but with no symptoms, family or personal history of cancer (e.g., ovarian, breast, colorectal), physical or laboratory evidence suggestive of infection, pregnancy, or systemic illness, are considered at low risk of ovarian cancer and may be followed with serial ultrasonography. (Strength of Recommendation [SOR]: B, based on a prospective cohort study.) A cyst identified on transvaginal ultrasonography is usually benign if it is thin-walled, unilocular, smooth-bordered, and less than 10 cm in diameter. Cyst aspiration and treatment with combined oral contraceptives do not hasten cyst resolution. (SOR: A, based on good-quality randomized controlled trials.) A complex cyst without benign features should be aggressively evaluated for ovarian cancer. (SOR: C, based on expert opinion.