{"paper_id":"f530e6b2-3788-485a-a965-116b3f678806","body_text":"Abstract\nBackground and purpose\nTransvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy.\nMethods\nTwenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G × 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness.\nResults\nLong-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy.\nConclusion\nTransvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.\nSimilar content being viewed by others\nReferences\nCampbell S, Bhan V, Royston P, et al. (1989) Transabdominal ultrasound screening for early ovarian cancer. Br Med J 299:1363–1367\nGrimes DA, Hughes JM (1989) Use of multiphasic oral contraceptives and hospitalizations of women with functional ovarian cysts in the United States. Obstet Gynecol 35:139–144\nBhan V, Anso N, Whitehead MI, et al. (1989) Characteristics of persistent ovarian masses in asymptomatic women. Br J Obstet Gynaecol 96:384–391\nSchwartz PE (1993) The role of tumor markers in the preoperative diagnosis of ovarian cysts. Clin Obstet Gynecol 36:384–394\nHerrmann U, Locher GW, Goldhirsch A (1987) Sonographic patterns of ovarian tumors: Prediction of malignancy. Obstet Gynecol 69:777\nGranberg S, et al. (1989) Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women. J Clin Ultrasound 17:107\nFox H (1990) Malignant potential of benign ovarian cysts: The case “against.” In: Sharp F, Mason WP, Leake RE (eds) Ovarian cancer: Biological and therapeutic challenges. WW Norton, New York, pp 185–186\nLee CL, Lai YM, Chang SY, et al. (1993) The management of ovarian cysts by sono-guided transvaginal cyst aspiration. J Clin Ultrasound 21:551–554\nTroiano RN, Taylor KJ (1998) Sonographically guided therapeutic aspiration of benign appearing ovarian cysts and endometriomas. AJR Am J Roentgenol 171:1601–1605\nKoonings PP, Campbell K, Mishell DR, et al. (1989) Relative frequency of primary ovarian neoplasms: A ten year review. Obstet Gynecol 74:921–926\nEriksson L, Kjellgren O, von Schoultz B (1985) Functional cysts or ovarian cancer? Histopathological findings during 1 year of surgery. Gynecol Obstet Invest 19:155–159\nZanetta G, Lissoni A, Torri V, et al. (1996) Role of puncture and aspiration in expectant management of simple ovarian cysts: A randomised study. Br Med J 313:1110–1113\nGoldstein S, Subramanyam B, Snyder J, et al. (1989) The postmenopausal cystic adnexal mass: The potential role of ultrasound in conservative management. Obstet Gynecol 73:8–10\nEriksson L, Kjellgren O, von Schoultz B (1985) Functional cysts or ovarian cancer? Histopathological findings during 1 year of surgery. Gynecol Obstet Invest 19:155–159\nHermann U, Locher GW, Goldhirsch A (1987) Sonographic patterns of ovarian tumors: Prediction of malignancy. Obstet Gynecol 69:777\nDe la Cuesta RS, Goff BA, Fuller AF, et al. (1994) Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 84:1–7\nEinhorn N, Nilsson B, Sjovall K (1985) Factors influencing survival in carcinoma of the ovary. Cancer 55:2019–2025\nWebb JM, Decuer DG, Mussey E, et al. (1973) Factors influencing survival in stage I ovarian cancer. Am J Obstet Gynecol 116:222–228\nMalkasian GD, Melton LJ III, O’Brien PC, et al. (1984) Prognostic significance of histologic classification and grading of epithelial malignancies of the ovary. Am J Obstet Gynecol 149:274–284\nWadi RV, Smythe AR, Watt GW, et al. (1985) Reliability of gynaecologic sonographic diagnosis, 1978–1984. Am J Obstet Gynecol 153:186\nMoyle JW, Rochester D, Sider L, et al. (1983) Sonography of ovarian tumors: Predictability of tumor type. Am J Radiol 141:985\nSanders RC, McNeil BJ, Finberg HJ, et al. (1983) A prospective study of computed tomography and ultrasound in the detection of staging of pelvic masses. Radiology 146:439\nGranberg S, Wikland M, Jansson I (1989) Macroscopic characterization of ovarian cancer and relation to the histological diagnosis: Criteria to be used for ultrasound evaluation. Gynecol Oncol 35:139–144\nTroiano RN, Quedens-Case C, Taylor KJW (1997) Correlation of findings on transvaginal sonography with serum CA125 levels. AJR Am J Roentgenol 168:1587–1590\nMoran O, Menczer J, Ben-Baruch G, et al. (1993) Cytological examination of ovarian cyst fluid for the distinction between benign and malignant tumors. Obstet Gynecol 82:444―446\nBonilla-Musoles F, Ballester MJ, Simon C, et al. (1993) Is the avoidance of surgery possible in patients with perimenopausal ovarian tumours using transvaginal ultrasound and duplex color Doppler sonography? J Ultrasound Med 12:33–39\nWeinraub Z, Avrech O, Fuchs C, et al. (1994) Transvaginal aspiration of ovarian cysts: Prognosis based on outcome over a 12-month period. Journal Ultrasound Med 13:275–279\nBret PM, Guibaud L, Atri M, et al. (1992) Transvaginal US-guided aspiration of ovarian cysts and solid pelvic masses. Radiology 185:377–380\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nDuke, D., Colville, J., Keeling, A. et al. Transvaginal Aspiration of Ovarian Cysts: Long-Term Follow-up. Cardiovasc Intervent Radiol 29, 401–405 (2006). https://doi.org/10.1007/s00270-005-0167-0\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00270-005-0167-0","source_license":"CC0","license_restricted":false}