Simple Asymptomatic Adnexal Cysts

Simple adnexal cysts up to 10 cm have malignancy rates < 1%. In the absence of hard evidence to guide which simple cysts need follow-up, the following guidelines have been adopted:

Premenopausal women:

• ≤5 cm: Do not need follow-up.
• 5 cm - 7 cm: Yearly follow-up with ultrasound is recommended.
• >7 cm: Difficult to assess completely with ultrasound (mural nodules may be obscured). MRI or surgery is recommended.

Postmenopausal women:

• ≤ 1 cm: Do not need follow-up.
• 1 cm - 7 cm: 1-year follow-up with ultrasound is recommended. Yearly or less frequent follow-up thereafter based on stability or decrease in size.
• >7 cm: Difficult to assess completely with ultrasound (mural nodules may be obscured). MRI or surgery is recommended.

References

Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R. Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2010 Sep;256(3):943-54.