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Invited Commentary
November 12, 2018

Evaluating an Asymptomatic Adnexal Cyst Found on Pelvic Ultrasonography

Author Affiliations
  • 1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Intern Med. Published online November 12, 2018. doi:10.1001/jamainternmed.2018.5133

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.

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