DIAGNOSTIC AND TREATMENT OF BENIGN OVARIAN CYSTS BY TRANSVAGINAL ULTRASOUND-GUIDED NEEDLE ASPIRATION

Purpose: The classic therapy for persistent symptomatic ovarian cysts has been surgical extirpation by means of laparoscopy or open laparotomy. Both of these procedures have the risks associated with anesthesia and the risks of infection, bleeding, bowel perforation, and adhesion formation with possible compromise of fertility. The aim of this study was to evaluate the feasibility, safety, diagnostic importance and efficiency of transvaginal ultrasound-guided aspiration benign ovarian cysts.

Methods and Materials: Ninety-six patients with probably benign ovarian and peritoneal cysts were submitted to transvaginal ultrasound-guided needle aspiration for diagnostic and therapeutic purpose. These benign lesions included 33 follicle cysts, 33 corpus luteum cysts, nine endometriomas, seven peritoneal cysts, two serous cystadenomas and two mature cystic teratomas. 90 aspirations were attempted in 86 patients, using a transvaginal approach.

The mean age of the patients was 39 years (range, 19–55). 57 patients (66, 3%) did benefit from contralateral ovarian dissection either by cystectomy or oophorectomy because of contralateral benign, borderline or inflammatory disease. The size of ovarian masses and cyst-wall thickness ranged from 3.5 to 11cm and 1 to 5mm, respectively.

An 18-gauge needle was inserted into the lesion under transvaginally guided sonography. The fluid collection was completely aspirated. The dark-chocolate colored cyst contents of endometriomas were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear. Ethanol (70%) was then instilled into the cyst for sclerotherapy of endometriomas. The fluid was then removed. The procedure was performed without a local anesthesia. All aspirates were examined cytologically. All patients had serum concentrations of CA 125 below 35 UI/ml. After aspiration, hormonal suppression therapy was recommended for all patients who had endometriomas. All patients were followed for 1 to 7 years (mean, 4.2 years) by transvaginal ultrasonography with color Doppler after cyst puncture.

Results: The volume of aspirated fluid in every case varied between 13 and 600ml. None of the patients had evidence of malignant cells on cytological examination after the procedure. No procedure-related complications were recorded. The recurrence rate for benign-appearing cysts was 9.1%. The recurrence rate for endometriomas was 44.4%; however, only two of these nine patients complied with hormonal suppression therapy. The recurrence rate for peritoneal cysts was 28.6%. The overall recurrence rate was 14.6%. The recurrence risk and the conception rate were not affected by the cyst size or aspirated volume. Two serous cystadenomas, two mature cystic teratomas and all recurrent ovarian cysts were treated with surgical extirpation. During a follow-up 1–7 years fourteen patients conceived and twelve have already delivered at term.

Conclusions: US-guided aspiration of simple ovarian cysts is a safe and effective alternative to surgery when strict selection criteria are used. Therapeutic results of aspiration and sclerotherapy of endometriomas have been disappointing, with relatively high recurrence rates.