Persistent unilocular ovarian cysts in a general population of postmenopausal women: is there a place for expectant management?

Abstract Objective At present it is not well known whether some persistent unilocular ovarian cysts can develop into malignancy. The aim of this observational study was to define the management of postmenopausal women with persistent unilocular ovarian cysts less than 50 mm in diameter and with normal serum CA 125 levels. Methods Retrospective data were obtained from 226 postmenopausal women (mean age 56.2 years, range 45–87) with unilocular ovarian cysts who were followed up for a 5-year period. Women were referred because of postmenopausal symptoms, abdominal discomfort, and postmenopausal bleeding. All women underwent pelvic examination, transvaginal ultrasonography, and serum CA 125 measurement. Tumor-associated antigen CA 125 and ovarian cyst diameter were assessed routinely. Surgery was offered according to clinical indications and women's wishes. Results Ovarian cyst diameter and serum CA 125 levels did not change in 172 of 226 women (76.1%). Conversely, the remaining 54 women had an increase in cyst diameter, and six of those (11.1%) also had raised serum CA 125 levels. All women with suspicious ovarian pathology ( n = 54) and 84 without ovarian pathology underwent surgical management. International Federation of Gynecology and Obstetrics stage IB well-differentiated serous cystoadenocarcinomas were diagnosed in two of 54 women (3.7%). Serum CA 125 levels were elevated in both cases. Conclusion These findings suggest that the majority of unilocular ovarian cysts with diameter less than 50 mm are benign and remain unchanged. These lesions can be managed expectantly when there is no increase in the ovarian cyst diameter and the serum CA 125 concentration is normal.