Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study

BMJ 1996;313:1110-1113 (2 November)

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Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study

Gerardo Zanetta, consultant,^a Andrea Lissoni, consultant,^a Valter Torri, medical statistician,^b Cristina Dalla Valle, senior registrar,^a Diego Trio, consultant,^a Giovanni Rangoni, consultant,^a Costantino Mangioni, chief ^a

^a Department of Obstetrics and Gynaecology, Ospedale San Gerardo di Monza, III Branch of the University of Milan, Milan, Italy, ^b Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

Correspondence to: Dr G Zanetta, Gynecologic Surgery, Eisenberg 5A, Mayo Clinic, Rochester 55905 MN, USA.

Abstract

Objectives: To assess the potential of expectant managementfor simple ovarian cysts diagnosed by transabdominal or transvaginalultrasonography. To compare the results of needle aspirationwith those achieved with simple observation.
Design: Randomised trial.
Setting: Hospital department of obstetrics and gynaecology.
Subjects: 278 women with simple cysts randomly allocated tosimple observation (143) or ultrasound guided fine needle aspiration(135) between 1990 and 1994.
Main outcome measures: Resolution of cyst or development ofmalignancy.
Results: After six months 269 were available for follow up.The rate of resolution was 46% (59/128) with aspiration and44.6% (63/141) with observation. Only the diameter of the cyst(P<0.0001) was a significant independent prognostic factorfor resolution in a multivariate analysis. Age and treatmenthad no significant effect. One woman was subsequently foundto have borderline malignant changes on histopathological examination.Her cyst was detected by transabdominal ultrasonography.
Conclusions: Expectant management for up to six months doesnot cause risks for the patients and allows spontaneous resolutionin over a third of cases, avoiding the costs and risks of unnecessarysurgery. Aspiration does not provide better results than simpleobservation

Key messages

Most of these masses are benign
After follow up of six months the rate of resolu- tion was similar in those who had had their cysts aspirated and those who had had them observed
Only the diameter of the cyst was a significant independent prognostic factor for resolution
A short expectant management is not risky for patients and allows resolution in more than a third of cases

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