Long-term Results for Expectant Management of Ultrasonographically Diagnosed Benign Ovarian Teratomas

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 130; no. 6; pp. 1244 - 1250
• Main Authors: Pascual, M. Angela, Graupera, Betlem, Pedrero, Cristina, Rodriguez, Ignacio, Ajossa, Silvia, Guerriero, Stefano, Alcázar, Juan Luis
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2017; by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Adult; Age Factors; Disease Management; Female; Humans; Long Term Adverse Effects - diagnosis; Long Term Adverse Effects - epidemiology; Middle Aged; Outcome and Process Assessment, Health Care; Ovarian Cysts - diagnostic imaging; Ovarian Cysts - pathology; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - pathology; Ovariectomy - methods; Ovariectomy - statistics & numerical data; Ovary - diagnostic imaging; Ovary - pathology; Retrospective Studies; Spain; Teratoma - diagnosis; Teratoma - pathology; Tumor Burden; Ultrasonography - methods; Ultrasonography - statistics & numerical data; Spain
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000002327

OBJECTIVE:To assess the natural history of ultrasonographically diagnosed benign ovarian teratomas in asymptomatic women.
METHODS:We conducted a retrospective observational cohort study of 408 women (mean age 36.6 years, range 14–81 years) diagnosed as having an ovarian teratoma by transvaginal ultrasonography (except eight who only had a transabdominal study done) between January 2003 and December 2013 at a single tertiary care institution. Six hundred thirteen women were diagnosed with ovarian teratoma of whom 205 were promptly treated surgically, leaving 408 patients followed conservatively with follow-up scans at 3 and 6 months from diagnosis and then yearly. The ultrasonographic diagnosis of a benign ovarian teratoma required at least one of the following featuresa cystic mass with mixed echogenicity, thick band-like echoes, a fat–fluid level, or echogenic tubercle with posterior shadowing. Clinical, ultrasonographic, and histologic data (in case of surgery) were retrieved for analysis.
RESULTS:During follow-up, 130 of 408 (31.8%) women underwent surgery. The main reason for surgery was the physicianʼs recommendation according to our protocol (n=115). One patient had adnexal torsion. Most surgeries (112/130 [86.2%]) were performed within the first 5 years after diagnosis. The remainder (278/408) is still being followed (median time 45.6 months, range 6–147 months). The vast majority of these lesions had no change and women remain asymptomatic. Histologic diagnosis of tumors removed surgically revealed a benign ovarian teratoma in 103 of 130 (79.2%) of the women. There were two borderline tumors, four endometriomas, three fibromas, seven serous cysts, two mucinous cysts, two stroma ovarii, seven other benign, and no case of malignant tumor.
CONCLUSION:Our results demonstrate that expectant management might be a reasonable option for managing asymptomatic women who receive a ultrasonographic diagnosis of a benign ovarian teratoma. The risk of undergoing surgery for this lesion decreases significantly after 5 years to follow-up. With careful observation, the risk of missing a diagnosis of malignancy is low.