OC16.01: Pain and ultrasonographic appearance of endometriomas may change with age

To assess ultrasonographic features of adnexal endometriomas in relation to patient age in premenopausal patients. Retrospective cross-sectional analysis of 5914 adnexal masses from the International Ovarian Tumor Analysis (IOTA) study. All patients were examined with transvaginal grey-scale and color Doppler ultrasound using the IOTA standardised study protocol. 1005 endometriomas were histologically confirmed in adult premenopausal women (mean age 35 years, standard deviation 7.8, range 18–54). The following variables were investigated: pain during ultrasound, maximal lesion diameter, locularity, echogenicity of cyst content, presence of papillations (with maximum size and vascularity if present), proportion of solid tissue (if present) and color score. We summarised changes per 10 years increase in age using odds ratios (OR) for categorical variables and median changes for continuous variables. In addition we visualised the relationship using a flexible approach based on restricted cubic splines. Maximal lesion diameter did not vary with age (median change was 1.3 mm per 10 years, 95% CI −1.4 to 4.0). Pain decreased with age (OR 0.75, 95% CI 0.63–0.89). Regarding locularity, we observed a decrease in unilocular cysts (OR 0.70 vs. multilocular cysts, 95% CI 0.57–0.85; OR 0.61 vs. lesions with solid components, 95% CI 0.48–0.77). Papillations appeared more frequently with age (OR 1.65, 95% CI 1.24–2.21), although their height and vascularisation did not change meaningfully. Lesions with ground glass appearance decreased with age (OR 0.74 vs. homogeneous low level, 95% CI 0.58-0.94; OR 0.64 vs. other types of cystic contents, 95% CI 0.50–0.81). We observed more solid components (including papillations), less unilocular cysts, ground glass appearance and pain in older premenopausal women with endometriomas. These findings can aid in the diagnosis and understanding of this disease.