Evaluating an asymptomatic adnexal cyst found on pelvic ultrasonography
Menée aux Etats-Unis auprès de 72 093 femmes ayant subi une échographie pelvienne entre 1997 et 2008, cette étude évalue l'association entre la détection de différents types de masses ovariennes (kystes, kystes complexes ou masses solides) et le risque de cancer de l'ovaire
Pelvic ultrasonography is a wonderful tool for assessing women presenting with pelvic pain, reporting abnormal bleeding, or having a suspected pelvic mass. However, as a screening tool for ovarian cancer, pelvic ultrasonography is limited for the following reasons: (1) the low incidence of ovarian cancer (a 1 in 80 lifetime risk); (2) the normal physiologic activity of the ovaries, where cysts are often seen, and due to size or appearance lead to more follow-up imaging; and (3) the likelihood of finding benign but nonphysiologic adnexal cysts, which lead to further imaging or surgery, without necessarily leading to improved patient outcomes. Therefore, guidelines recommend follow-up for only certain types of adnexal cysts.1-4 It is well recognized that simple adnexal cysts (thin-walled round or oval cysts with anechoic fluid and through transmission) are almost always benign, but there is hesitancy to ignore these common cysts and not recommend follow-up, particularly when cysts are large or when the patient is postmenopausal. It is with this background that the article by Smith-Bindman et al5 advances our knowledge.
JAMA Internal Medicine , commentaire, 2017