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Adnexal lesions detected on CT in postmenopausal females with non-ovarian malignancy: do simple cysts need follow-up?

  • Akshay D. BahetiEmail author
  • Cory E. Lewis
  • Daniel S. Hippe
  • Ryan B. O’Malley
  • Carolyn L. Wang
Article
Part of the following topical collections:
  1. CME articles

Abstract

Purpose

To assess whether CT morphology of adnexal lesions in postmenopausal women with history of non-ovarian cancer could be used to discriminate benign and malignant lesions, particularly focusing on applicability of the ACR criteria.

Materials and methods

This was an IRB-approved HIPAA-compliant retrospective review of contrast-enhanced CTs of 199 women, 55 years and older. Lesions were classified as simple cystic, complex cystic, solid-cystic, or solid based on CT morphology, and were diagnosed as benign, indeterminate, or malignant on follow-up imaging or pathology. Associated metastatic disease was noted, if present. Findings were analyzed to correlate CT morphology, primary tumor pathology, and metastatic disease pattern with eventual lesion diagnosis.

Results

There were 223 adnexal lesions, including 123 (55%) simple cystic, 48 (22%) complex cystic, 40 (18%) solid-cystic, and 12 (5%) solid lesions. 186/223 (83%) lesions were benign, and 37/223 (17%) were malignant. Primary colorectal cancer was significantly associated with an increased likelihood of malignant adnexal lesions (OR 10.2, p < 0.001) compared to patients with other cancers. Adnexal malignancy was significantly associated with the presence of non-ovarian peritoneal metastases (p < 0.001). None of the simple cysts (including 85 cysts between 1–3 cm and 38 cysts > 3 cm) were found to be malignant (malignancy rate: 0.0%, 95% CI 0.0–3.0%). Complex cysts were more likely to be malignant than simple cysts (p = 0.002) and solid-cystic lesions were more likely to be malignant than complex cysts (p < 0.001).

Conclusion

Simple adnexal lesions on CT in this cohort were unlikely to be malignant, supporting the ACR guidelines. A higher size threshold of 3 cm (vs. 1 cm) may be preferred in all cases of simple cysts for recommending further follow-up. However, more complex-appearing cysts need further evaluation as the risk of malignancy is increased. Peritoneal metastases have a significant correlation with malignant adnexal involvement.

Keywords

Ovarian cyst Adnexal cyst Ovarian lesion Adnexal lesion CT 

Notes

Compliance with ethical standards

Disclosure

Daniel S Hippe wishes to disclose grants from GE Healthcare, Philips Healthcare, Toshiba America Medical Systems, and Siemens Medical Solutions USA, outside of the submitted work. The rest of the authors have nothing to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This was a retrospective review with waiver of informed consent.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Akshay D. Baheti
    • 1
    • 2
    Email author
  • Cory E. Lewis
    • 1
  • Daniel S. Hippe
    • 1
  • Ryan B. O’Malley
    • 1
  • Carolyn L. Wang
    • 1
  1. 1.Department of RadiologyUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of RadiologyTata Memorial Center, Homi Bhabha National InstituteMumbaiIndia

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