Skip to main content
SpringerLink
Log in

Performance of laparoscopy in identifying malignant ovarian cysts

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to evaluate the performance of laparoscopy in identifying malignant ovarian cysts.

Methods

Patients undergoing laparoscopy for ovarian cysts from 1998 to 2001 were enrolled prospectively. Physical findings, Doppler ultrasonography, and serum CA 125 served to compute two risk-of-malignancy indexes (RMI-1 and RMI-2), and laparoscopy findings served to categorize lesions as benign, possibly malignant, or malignant. Frozen sections were examined as needed. Final histology was the reference.

Results

Of 313 patients, 294 had benign cysts, six borderline lesions, and 13 malignancies. Sensitivity and specificity were respectively 84 and 93% for RMI-1, 92 and 80% for RMI-2, 100 and 99% for laparoscopy, 91 and 100% for frozen sections, and 100 and 100% for laparoscopy plus frozen sections, which had 100% negative predictive value. Six (1.8%) adverse events occurred.

Conclusions

Laparoscopy reliably identifies ovarian cancer and borderline disease. Morbidity is low compared to oncologic surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Reference

  1. Blanc B, Boubli L, D’Ercole L, Nicoloso E (1994) Laparoscopic management of malignant ovarian cysts: a 78 cases national survey. Part 1: pre-operative and laparoscopic evaluation. Eur J Obstet Gynecol Biol Reprod 56: 177–180

    Article  CAS  Google Scholar 

  2. Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL, Bruhat MA (2000) Management of adnexal masses: role and risk of laparoscopy. Semin Surg Oncol 19: 28–35

    Article  PubMed  CAS  Google Scholar 

  3. Canis M, Mage G, Pouly JL, Wattiez A, Manhes H, Bruhat MA (1994) Laparoscopic diagnosis of adnexal cystic masses: a 12 year experience with long-term follow-up. Obstet Gynecol 83: 707–712

    PubMed  CAS  Google Scholar 

  4. Canis M, Rabischong B, Houlle C, Botschorishvilli R, Jardon K, Safi A, Wattiez A, Mage G, Pouly JL, Bruhat MA (2002) Laparoscopic management of adrenal masses: a gold standard? Curr Opin Obstet Gynecol 14: 423–428

    Article  PubMed  Google Scholar 

  5. Childers J, Nasseri A, Surwitt E (1996) Laparoscopic management of suspicious adnexal masses. Am J Obstet Gynecol 175: 1451–1459

    Article  PubMed  CAS  Google Scholar 

  6. Dobronte Z, Wittmann T, Karacsony G (1978) Rapid development of malignant metastases in the abdominal wall after laparoscopy. Endoscopy 10: 127–130

    Article  PubMed  CAS  Google Scholar 

  7. Granberg S, Wikland M, Jansson I (1989) Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: criteria to be used for ultrasound evaluation. Gynecol Oncol 35: 139–144

    Article  PubMed  CAS  Google Scholar 

  8. Jacobs IJ, Skates S, Davies AP, Woolas RP, Jeyerajah A, Weidemann P, Sibley K, Oram DH (1996) Risk of diagnosis of ovarian cancer after raised serum CA 125 concentration: a prospective cohort study. Br Med J 313: 1355–1358

    CAS  Google Scholar 

  9. Krissi H, Dekel A, Hava I, Orvieto R, Dicker D, Shalev J, Ben Rafa R (1999) Laparoscopic management of suspicious ovarian cysts in elderly post-menopausal women. Eur J Obstet Gynecol Biol Reprod 83: 53–56

    Article  CAS  Google Scholar 

  10. Lécuru F, Desfeux P, Camatte S, Bissery A, Robin F, Blanc B, Querleu D (2004) Stage I ovarian cancer: comparison of laparoscopy and laparotomy on staging and survival. Eur J Gynecol Oncol 5: 5771–5776

    Google Scholar 

  11. Lehner R, Wenzl R, Heinzl H, Husslein P, Sevelda P (1998) Influence of delayed staging laparotomy after laparoscopic removal of ovarian masses later found malignant. Obstet Gynecol 92: 967–971

    Article  PubMed  CAS  Google Scholar 

  12. Lok I, Sahota D, Rogers M, Yuen P (2000) Complications of laparoscopic surgery for benign ovarian cysts. J Am Assoc Gynaecol Laparosc 7: 529–534

    Article  CAS  Google Scholar 

  13. Mahdavi A, Berker B, Nehzat C, Nezhat F, Nehzat C (2004) Laparoscopic management of ovarian cysts. Obstet Gynecol Clin North Am 31: 581–592

    Article  PubMed  Google Scholar 

  14. Maiman M, Seltzer V, Boyce J (1991) Laparoscopic excision of ovarian neoplasms subsequently found to be malignant. Obstet Gynecol 77: 565–565

    Google Scholar 

  15. Mendilcioglu I, Zorlu C, Trak B, Ciftci C, Akinci Z (2002) Laparoscopic management of adnexal masses. Safety and effectiveness. J Reprod Med 47: 36–40

    PubMed  Google Scholar 

  16. Ou C, Liu Y, Zabriskie V, Rowbotham R (2001) Alternate methods for laparoscopic management of adnexal masses greater than 10 cm in diameter. Laparoscoendosc Adv Surg Tech A 11: 125–132

    Article  CAS  Google Scholar 

  17. Pinto P, Andrade L, Derchain S (2001) Accuracy of intraoperative frozen section diagnosis of ovarian tumors. Gynecol Oncol 81: 230–232

    Article  PubMed  CAS  Google Scholar 

  18. Pomel C, Provencher D, Dauplat J, Gauthiere P, Le Bouedec G, Drouin P, Audet-Lapointre P, Dubuc-Lissoir R (1995) Laparoscopic staging of early ovarian cancer. Gynecol Oncol 58: 301–306

    Article  PubMed  CAS  Google Scholar 

  19. Rafii A, Camatte S, Lelievre L, Darai E, Lecuru F (2005) Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study. BJOG 112: 100–102

    PubMed  Google Scholar 

  20. Sadik S, Onoglu A, Gokdeniz R, Turan E, Taskin O, Wheeler J (1999) Laparoscopic management of selected adnexal masses. J Am Assoc Gynaecol Laparosc 6: 313–316

    Article  CAS  Google Scholar 

  21. Salem H (2002) Laparoscopic excision of large ovarian cysts. J Obstet Gynaecol Res 28: 290–294

    Article  PubMed  Google Scholar 

  22. Seidman JD, Kurman RJ (2000) Ovarian serous borderline tumours: a critical review of literature with emphasis on prognostic indicators. Hum Pathol 31: 539–557

    Article  PubMed  CAS  Google Scholar 

  23. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis Group (2000) Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol 16: 500–505

    Article  PubMed  CAS  Google Scholar 

  24. Tingulstad S, Hagen B, Skjeldestad FE, Halvorsen T, Nustad K, Onsrud M (1999) The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol 93: 448–452

    Article  PubMed  CAS  Google Scholar 

  25. Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, Nustad K (1996) Evaluation of a risk of malignancy index based on serum CA 125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. Br J Obstet Gynaecol 103: 826–831

    PubMed  CAS  Google Scholar 

  26. Trimbos J, Vergote I, Bolis G, Vermorken J, Mangioni C, Madronal C, Franchi M, Tateo S, Zanetta G, Scarfone G, et al (2003) Impact of adjuvant chemotherapy and surgical staging in early stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer—Adjuvant Chemotherapy in Ovarian Neoplasm Trial. J Natl Cancer Inst 95: 113–125

    Article  PubMed  CAS  Google Scholar 

  27. Ulrich U, Paulus W, Schneider A, Keckstein J (2000) Laparoscopic surgery for complex ovarian masses. J Am Assoc Gynecol Laparosc 7: 373–380

    Article  PubMed  CAS  Google Scholar 

  28. Vergote I, De Brabanter J, Fyles A, Beterlsen K, Einhorn N, Sevelda P, Gore M, Kaern J, Verrelst H, Sjövall K, et al (2001) Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 357: 176–182

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gynecological and Oncological Surgery Department, European Georges Pompidou Teaching Hospital, and René Descartes School of Medicine, AP-HP, Paris V, 75015, Paris, France

    C. Bensaid, U. Metzger, F. Larousserie, D. Clément & F. Lécuru

  2. Pathology Department, European Georges Pompidou Teaching Hospital, and René Descartes School of Medicine, AP-HP, Paris V, 75015, Paris, France

    M. A. Le Frère Belda

  3. Clinical Epidemiology Department, Hôpital Européen Georges Pompidou, and René Descartes School of Medicine, AP-HP, Paris V, 75015, Paris, France

    G. Chatellier

Authors
  1. C. Bensaid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. A. Le Frère Belda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Metzger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Larousserie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Clément
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Chatellier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Lécuru
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Lécuru.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bensaid, C., Belda, M.A.L.F., Metzger, U. et al. Performance of laparoscopy in identifying malignant ovarian cysts. Surg Endosc 20, 1410–1414 (2006). https://doi.org/10.1007/s00464-005-0350-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0350-z

Keywords

Search

Navigation