Role of puncture and aspiration in expectant management of simple ovarian cysts: a randomised study

Objectives : To assess the potential of expectant management for simple ovarian cysts diagnosed by transabdominal or transvaginal ultrasonography. To compare the results of needle aspiration with those achieved with simple observation. Design : Randomised trial. Setting : Hospital department of obstetrics and gynaecology. Subjects : 278 women with simple cysts randomly allocated to simple observation (143) or ultrasound guided fine needle aspiration (135) between 1990 and 1994. Main outcome measures : Resolution of cyst or development of malignancy. Results : After six months 269 were available for follow up. The rate of resolution was 46% (59/128) with aspiration and 44.6% (63/141) with observation. Only the diameter of the cyst (P<0.0001) was a significant independent prognostic factor for resolution in a multivariate analysis. Age and treatment had no significant effect. One woman was subsequently found to have borderline malignant changes on histopathological examination. Her cyst was detected by transabdominal ultrasonography. Conclusions : Expectant management for up to six months does not cause risks for the patients and allows spontaneous resolution in over a third of cases, avoiding the costs and risks of unnecessary surgery. Aspiration does not provide better results than simple observation Key messages Most of these masses are benign After follow up of six months the rate of resolu- tion was similar in those who had had their cysts aspirated and those who had had them observed Only the diameter of the cyst was a significant independent prognostic factor for resolution A short expectant management is not risky for patients and allows resolution in more than a third of cases