Recommendations for Adnexal Cysts

Abstract

PURPOSE: In 2009, the Society of Radiologists in Ultrasound (SRU) convened a consensus conference to discuss the management of adnexal cysts in asymptomatic women and reach consensus on when follow-up imaging was required. The purpose of this quality assurance project was to assess the impact of using the resulting guidelines in our institution during 1-month periods before and after publication of the guidelines. METHODS: We retrospectively reviewed all pelvic ultrasound reports for a 1-month period before the conference (February 2009) and 2 years later (February 2011) after publication of the SRU guidelines. Incidence of recommendations for simple cysts and classic hemorrhagic cysts 5 cm or less in premenopausal women and simple cysts less than 1 cm in postmenopausal women was compared. Fisher exact test was used to compare proportions. RESULTS: Over the time period evaluated, the number of pelvic sonograms performed in our department decreased by 27%. The overall number of cysts with recommendations for follow-up decreased from February 2009 (132 studies with recommendations for follow-up in 870 pelvic ultrasound examinations, 15%) to February 2011 (71 recommendations for follow-up in 639 examinations, 11%; P = 0.02). The percentage of premenopausal simple cysts and classic hemorrhagic cysts described as less than 5 cm where follow-up was recommended decreased from 39/48 (89%) to 2/29 (7%, P < 0.0001). CONCLUSIONS: Use of the SRU guidelines on the management of adnexal cysts has, in our practice, dramatically decreased radiologist recommendations for follow-up of benign appearing cysts.