The Clinical Relevance of Distinguishing Between Simple and Complex Adnexal Cystic Structures by Ultrasound in the Peri- and Postmenopause

Background/Objectives: To determine the reliability of simple ultrasound (US) markers and CA-125 measurement in diagnosing peri- and postmenopausal ovarian masses. Methods: The study was conducted in a retrospective setting. Preoperative imaging properties of peri- (PEM) and postmenopausal (POM) ovarian cysts were examined. According to US findings, two groups were made: (1) simple cysts: unilocular, anechoic cysts without any solid part, (2) complex cysts: cystic structures with different parameters from the simple cysts. Imaging characteristics, size of the mass, and demographic data were matched with histology and CA125 levels. Results: 379 cystic structures (PEM: N=195, average age: 45.6yrs; range: 40-54yrs, POM: N=184, average age 61.2yrs; range: 41-88yrs) were analyzed. In the PEM group 75 simple (Ø<5cm N=32, Ø≥5cm N=43) and 122 complex cysts (Ø<5cm N=29, Ø≥5cm, N=93), while in the POM group 49 simple (Ø<5cm N=9, Ø≥5cm N=40) and 135 complex cysts (Ø<5cm N=15, Ø≥5cm N=120) were found. In the PEM group, malignancy was detected in complex cysts larger than 5cm (N=16, 17.58%). In the POM group malignancy was present in 40 cases, three of them proved to be smaller than 5cm. Majority of cysts were functional (54.36 %) in the PEM group. In the POM group, serous cysts were the most frequent (38.04%), followed by malignant (21.74%) and mucinous cysts (13.04%). CA125 was elevated in 66 of 217 cases (30.41%); only 23 were malignant (NPV: 0.95, PPV: 0.35). Conclusions: Functional cysts are frequently found among perimenopausal ovarian cysts, but malignancy was detected only in cysts with complex morphology larger than 5 cm. However, complex cysts of any size carry a significant risk of malignancy in menopause, thus, surgery is recommended. Simple cysts can be followed by serial scans in both groups. CA-125 did not give added value to the detection of malignancy.