[Skip to Content]
[Skip to Content Landing]
Views 897
Citations 0
Original Investigation
November 12, 2018

Risk of Malignant Ovarian Cancer Based on Ultrasonography Findings in a Large Unselected Population

Author Affiliations
  • 1Department of Radiology and Biomedical Imaging, University of California, San Francisco
  • 2Department of Epidemiology and Biostatistics, University of California, San Francisco
  • 3Philip Lee Institute for Health Policy Studies, University of California, San Francisco
  • 4Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
  • 5Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
  • 6Department of Public Health Sciences, University of California, Davis
JAMA Intern Med. Published online November 12, 2018. doi:10.1001/jamainternmed.2018.5113
Key Points

Question  What is the risk of malignant ovarian cancer associated with simple cysts?

Findings  Among 72 093 women in this nested case-control study of patients enrolled in Kaiser Permanente Washington, simple cysts were common in both premenopausal and postmenopausal women undergoing pelvic ultrasonography, but they were not associated with an elevated risk of being diagnosed as having malignant ovarian cancer. In contrast, complex cysts or solid masses are far less common but are associated with a significantly increased risk of developing malignant cancer.

Meaning  Simple cysts should be considered normal findings and do not need surveillance.

Abstract

Importance  The risk of malignant ovarian cancer associated with simple cysts is unknown.

Objective  To quantify the risk of ovarian cancer based on ultrasonographic characteristics of ovarian masses, including simple cysts, in a large unselected population.

Design, Setting, and Participants  This was a nested case-control study of patients enrolled in Kaiser Permanente Washington, a large integrated health care system in Washington State. Participants were 72 093 women who underwent pelvic ultrasonography between January 1, 1997, and December 31, 2008. Analysis was completed in April 2017.

Exposures  Ultrasonographic characteristics of ovarian masses measured in 1043 women, and also, using weights derived from the sampling strategy, estimated frequencies for the entire cohort.

Main Outcomes and Measures  Malignant ovarian cancer, identified through December 31, 2011, by cancer registry linkage.

Results  Among 210 women who were diagnosed as having ovarian cancer, 49 were younger than 50 years, and 161 were 50 years or older. Ultrasonography findings were predictive of cancer (C statistic, 0.89). The risk of cancer was significantly elevated in women with complex cysts or solid masses, with likelihood ratios relative to women with normal ovaries ranging from 8 to 74 and the 3-year risk of cancer ranging from 9 to 430 cases per 1000 women based on patient age and ultrasonography findings. In contrast, the 23.8% of women younger than 50 years and the 13.4% of women 50 years or older with simple cysts were not at a significantly increased risk of ovarian cancer compared with women with normal ovaries. Likelihood ratios associated with the detection of a simple cyst were 0.00 in women younger than 50 years (no cancers were identified) and 0.10 (95% CI, 0.01-0.48) in women 50 years or older, and the absolute 3-year risk of cancer ranged from 0 to 0.5 cases per 1000 women.

Conclusions and Relevance  According to this study, the ultrasonographic appearance of ovarian masses is strongly associated with a woman’s risk of ovarian cancer. Simple cysts are not associated with an increased risk of ovarian cancer, whereas complex cysts or solid masses are associated with a significantly increased risk of ovarian cancer.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×