The value of aspiration in the management of large adnexal cysts

• Published in: Journal of pediatric & adolescent gynecology 2023-04, Vol.36 (2), p.233-234
• Main Authors: Vukadin, Miroslav, Panova, Daniela Ivanova, Niznanska, Zuzana, Beder, Igor, Djuricic, Slavisa, Stankovic, Zoran
• Format: Article
• Language: English
• Subjects: aspiration; CA 125; cyst; estradiol; ovary
• ISSN: 1083-3188; 1873-4332
• DOI: 10.1016/j.jpag.2023.01.165

To assess the role of fluid aspiration in ovarian preservation from a great anechoic cystic adnexal mass. In addition, the diagnostic value of fluid levels of estradiol and CA 125 were examined. A prospective longitudinal study using clinical and ultrasound data collected for all patients under 19 years of age with clear cystic adnexal masses and ultrasonographic presence of the ipsilateral normal ovarian tissue, or the ovarian crescent sign (OCS) as a predictor of benign origin, with volume ≥200 ml, managed between January 2006 and November 2022. Aspiration was performed before surgery with the aim of strengthening the normal ovarian tissue to be whole preserved during laparoscopic stripping. In patients with suspicious for torsion samples was taken during laparoscopy. Pediatric and Adolescent Gynecology Departments in hospitals in three European countries. Surgical treated 92 patients with anechoic cystic adnexal masses. Ovarian volume, the presence of OCS and anechoic content were reported. From first syringe, fluid level of estradiol in pg/l and CA 125 in IU/ml were measured and correlated with postoperative histologic findings. The median cyst volume was 570 ml (range between 200 and 7600 ml). The normal ovarian tissue was reported, and no malignancy was found in all of 92 patients laparoscopically treated. Paraovarian cysts was considered on ultrasonography in 39 patients, but in four of them intrafilamentary ovarian cystadenomas was confirmed during laparoscopy. With laparoscopic stripping, the whole ovaries were preserved in nine patients with cystic mature teratomas and in 42 patients with serous cystadenomas including largest of 7600 ml. Torsion was reported in three of previous mentioned paraovarian cysts and in six ovarian cystic masses. Fluid levels of estradiol and CA 125 were successfully measured in all cystic masses except two ovarian torsions. CA 125 was significantly elevated in all serous cystadenomas and paraovarian cysts, Table 1, but estradiol was elevated only in four of functional ovarian cysts. In all large cystic mature teratomas both fluid markers remained low. Ovarian volume recovered to normal value within three months, as previous reported. ▪ Aspiration of cyst fluid before surgery in clearly defined patients may be very helpful to insuring ovarian tissue preservation in large cystic masses. Fluid levels of estradiol and CA 125 correlate with histology diagnosis and can be useful in distinguishing functional cysts from serous