Ultrasound-Guided Conservative Management May Be Feasible For Benign Ovarian Masses

Women with adnexal masses diagnosed as benign using ultrasonography may not require surgery

  • Date: 08 Feb 2019
  • Author: By Lynda Williams, Senior medwireNews Reporter
  • Topic: Ovarian Cancer / Imaging

medwireNews: Women diagnosed by ultrasound with benign ovarian tumours may be able to safely avoid surgery, suggest 2-year interim trial findings published in The Lancet Oncology

“Our results could lead to a paradigm shift in recommended management of benign adnexal masses resulting in less surgery”, say Dirk Timmerman, from KU Leuven in Belgium, and fellow IOTA5 trial investigators.

“The benefit thereof would be fewer severe surgical complications and associated patient discomfort and lower health costs than are associated with current practices.”

The team recruited 8519 patients with at least one adnexal mass from 36 centres in 14 countries, 37% of whom were chosen to undergo conservative management consisting of ultrasound and clinical follow-up after 3 and 6 months, and then annual check-ups thereafter.

This included 1919 patients who had a new mass at time of recruitment and were followed up for a median of 27 months, explain the researchers.

At the 2-year interim assessment, 20.2% of these patients had experienced a spontaneous resolution of their tumour. Of the 16.6% of patients who underwent surgery during follow-up, 2.0% of cases were suspected to have an invasive malignancy, and this was confirmed in 0.4% of the patients, including three stage I, two stage III and two secondary metastatic tumours.

A further 0.3% had a borderline tumour, 0.4% torsion and 0.2% a ruptured cyst, the investigators say.

The 2-year cumulative incidence of events in all patients at all the centres was similar, at 18.9% for spontaneous resolution, 15.1% for surgery and 0.3% for invasive malignancy. 

However, the researchers note that a retrospective review showed that signs of malignancy had been missed on the ultrasound images of many of the patients who were subsequently diagnosed with cancer.

“We find it unlikely that the prognosis of the borderline tumours and stage I tumours was made worse by the delay in diagnosis”, they write. “If, and to what extent, the prognosis of the two stage III ovarian cancers and two secondary cancers was affected is difficult to determine.”

“Longer follow-up than in this study is needed to estimate the incidence of a change from benign to malignant ultrasound morphology in an adnexal mass”, the team says.

And they conclude: “Before management recommendations can be made, results from the extended follow-up of our participants who were conservatively managed are needed.

“Future research should also investigate whether the application of objective criteria or prediction models could improve safe selection of patients for follow-up.” 



Froyman W, Landolfo C, De Cock B, et al. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre , prospective, cohort study . Lancet Oncol; Advance online publication 5 February 2019. http://dx.doi.org/10.1016/S1470-2045(18)30837-4

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