Ovarian cysts: observation a safe alternative to surgery in IOTA5

  • Froyman W & al.
  • Lancet Oncol
  • 5 Feb 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Women with benign adnexal masses on ultrasonography managed conservatively showed a low risk for malignancy and acute complications at 2 years.
  • 20% of masses resolve spontaneously within 2 years.

Why this matters

  • Conservative management will reduce surgical complications, patient discomfort, and health costs associated with current practices.

Study design

  • Multicenter International Ovarian Tumor Analysis Phase 5 (IOTA5) study: 1919 patients with benign adnexal mass on ultrasonography (ovarian, tubal, and paratubal) received surgery or conservative management.
  • Funding: Research Foundation Flanders, KU Leuven; others.

Key results

  • Median follow-up was 27 months.
  • The 2-year cumulative incidence of:
    • Spontaneous resolution: 20.2% (95% CI, 18.4%-22.1%).
    • Invasive malignancy at surgery: 0.4% (95% CI, 0.1%-0.6%).
    • Borderline tumor: 0.3% (95% CI,
    • Torsion: 0.4% (95% CI, 0.1%-0.7%).
    • Cyst rupture: 0.2% (95% CI,
  • 2-year cumulative incidence in pre- and postmenopausal women:
    • Spontaneous resolution: 29.8% (95% CI, 27.0%-32.6%) and 7.5% (95% CI, 5.6%-9.3%).
    • Surgery: 18.7% (95% CI, 16.3%-21.1%) and 12.6% (95% CI, 10.2%-14.9%).
    • Invasive malignancy at surgery: 0.1% (95% CI,

Limitations

  • Nonrandomized trial.
  • Longer follow-up is needed.

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