Recurrence Rate and Morbidity after Ultrasound-guided Transvaginal Aspiration of Ultrasound Benign-appearing Adnexal Cystic Masses with and without Sclerotherapy: A Systematic Review and Meta-analysis

Irene García-García, Juan Luis Alcázar, Ignacio Rodríguez, M. Pascual, Amparo García‐Tejedor, S. Guerriero
In: Journal of Minimally Invasive Gynecology · 2021 · vol. 29(2) , pp. 204–212 · doi:10.1016/j.jmig.2021.09.708 · PMID:34571216 · W3204663454
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This systematic review and meta-analysis compared recurrence rates and morbidities between ultrasound-guided transvaginal aspiration with and without sclerotherapy for benign-appearing adnexal cystic masses.

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Abstract

ObjectiveTo determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal ultrasound-guided aspiration, with or without sclerotherapy.Data sourcesSearch of studies published in PubMed and Web of Science databases between January 1990 and December 2020.Methods of study selectionA systematic search strategy was done using Medical Subject Heading terms. Only randomized trials and prospective studies published in English language were included.Tabulation, integration, and resultsA total of 395 articles were screened. After applying inclusion and exclusion criteria, 20 studies were included in this review comprising data from 1386 patients with a mean follow-up of 11.4 months (range 0.5-26.5 months). The overall pooled rate of recurrence of adnexal masses was 27%, (95% confidence interval [CI], 18%-39%). Recurrence rate was significantly higher after only aspiration than after sclerotherapy (53%; 95% CI, 46%-60% vs 14%; 95% CI, 8%-22%; p <.001). However, a high heterogeneity across the studies was found. A total of 10 major complications were recorded in the different publications.ConclusionIn a selected population, aspiration with sclerotherapy had a lower recurrence rate than aspiration without sclerotherapy. However, these results should be interpreted with caution given the heterogeneity of the studies and the paucity of randomized controlled trials. Regarding the adoption of this procedure in routine clinical practice, we believe that aspiration should be considered an experimental procedure as there are few studies addressing long-term recurrence rate, and data comparing this technique with surgical cystectomy are lacking.

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