Adnexal lesions detected on CT in postmenopausal females with non-ovarian malignancy: do simple cysts need follow-up?

  • Akshay D. BahetiEmail author
  • Cory E. Lewis
  • Daniel S. Hippe
  • Ryan B. O’Malley
  • Carolyn L. Wang
Part of the following topical collections:
  1. CME articles



To assess whether CT morphology of adnexal lesions in postmenopausal women with history of non-ovarian cancer could be used to discriminate benign and malignant lesions, particularly focusing on applicability of the ACR criteria.

Materials and methods

This was an IRB-approved HIPAA-compliant retrospective review of contrast-enhanced CTs of 199 women, 55 years and older. Lesions were classified as simple cystic, complex cystic, solid-cystic, or solid based on CT morphology, and were diagnosed as benign, indeterminate, or malignant on follow-up imaging or pathology. Associated metastatic disease was noted, if present. Findings were analyzed to correlate CT morphology, primary tumor pathology, and metastatic disease pattern with eventual lesion diagnosis.


There were 223 adnexal lesions, including 123 (55%) simple cystic, 48 (22%) complex cystic, 40 (18%) solid-cystic, and 12 (5%) solid lesions. 186/223 (83%) lesions were benign, and 37/223 (17%) were malignant. Primary colorectal cancer was significantly associated with an increased likelihood of malignant adnexal lesions (OR 10.2, p < 0.001) compared to patients with other cancers. Adnexal malignancy was significantly associated with the presence of non-ovarian peritoneal metastases (p < 0.001). None of the simple cysts (including 85 cysts between 1–3 cm and 38 cysts > 3 cm) were found to be malignant (malignancy rate: 0.0%, 95% CI 0.0–3.0%). Complex cysts were more likely to be malignant than simple cysts (p = 0.002) and solid-cystic lesions were more likely to be malignant than complex cysts (p < 0.001).


Simple adnexal lesions on CT in this cohort were unlikely to be malignant, supporting the ACR guidelines. A higher size threshold of 3 cm (vs. 1 cm) may be preferred in all cases of simple cysts for recommending further follow-up. However, more complex-appearing cysts need further evaluation as the risk of malignancy is increased. Peritoneal metastases have a significant correlation with malignant adnexal involvement.


Ovarian cyst Adnexal cyst Ovarian lesion Adnexal lesion CT 


Compliance with ethical standards


Daniel S Hippe wishes to disclose grants from GE Healthcare, Philips Healthcare, Toshiba America Medical Systems, and Siemens Medical Solutions USA, outside of the submitted work. The rest of the authors have nothing to disclose.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This was a retrospective review with waiver of informed consent.


  1. 1.
    Castillo G, Alcazar JL, Jurado M (2004) Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol 92:965–969CrossRefGoogle Scholar
  2. 2.
    Modesitt SC, Pavlik EJ, Ueland FR, et al. (2003) Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol 102:594–599Google Scholar
  3. 3.
    Dorum A, Blom GP, Ekerhovd E, Granberg S (2005) Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: an autopsy study. Am J Obstet Gynecol 192:48–54CrossRefGoogle Scholar
  4. 4.
    Slanetz PJ, Hahn PF, Hall DA, Mueller PR (1997) The frequency and significance of adnexal lesions incidentally revealed by CT. AJR Am J Roentgenol 168:647–650CrossRefGoogle Scholar
  5. 5.
    Levine D, Brown DL, Andreotti RF, et al. (2010) Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology 256:943–954CrossRefGoogle Scholar
  6. 6.
    Patel MD, Ascher SM, Paspulati RM, et al. (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol 10:675–681CrossRefGoogle Scholar
  7. 7.
    Muto MG. Management of an adnexal mass. In: UpToDate SH, Goff B (Eds), UpToDate, Waltham, MA. (Accessed on May 24, 2016.), editorGoogle Scholar
  8. 8.
    Davison AC, Hinkley DV (1997) Bootstrap methods and their applications. Cambridge: Cambridge University PressCrossRefGoogle Scholar
  9. 9.
    Diggle PJ, Heagerty PJ, Liang KY, Zeger SL (2002) Analysis of longitudinal data, 2nd edn. New York: Oxford University PressGoogle Scholar
  10. 10.
    Stany MP, Maxwell GL, Rose GS (2010) Clinical decision making using ovarian cancer risk assessment. AJR Am J Roentgenol 194:337–342CrossRefGoogle Scholar
  11. 11.
    Sadowski EA, Robbins JB, Rockall AG, Thomassin-Naggara I (2018) A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system. Abdom Radiol (NY) 43:679–695CrossRefGoogle Scholar
  12. 12.
    Pickhardt PJ, Hanson ME (2010) Incidental adnexal masses detected at low-dose unenhanced CT in asymptomatic women age 50 and older: implications for clinical management and ovarian cancer screening. Radiology 257:144–150CrossRefGoogle Scholar
  13. 13.
    Boos J, Brook OR, Fang J, Brook A, Levine D (2018) Ovarian cancer: prevalence in incidental simple adnexal cysts initially identified in CT examinations of the abdomen and pelvis. Radiology 286:196–204CrossRefGoogle Scholar
  14. 14.
    Kelly ME, Heeney A, Redmond CE, et al. (2015) Incidental findings detected on emergency abdominal CT scans: a 1-year review. Abdom Imaging 40:1853–1857CrossRefGoogle Scholar
  15. 15.
    Alcazar JL, Olartecoechea B, Guerriero S, Jurado M (2013) Expectant management of adnexal masses in selected premenopausal women: a prospective observational study. Ultrasound Obstet Gynecol 41:582–588CrossRefGoogle Scholar
  16. 16.
    Guraslan H, Dogan K (2016) Management of unilocular or multilocular cysts more than 5 centimeters in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 203:40–43CrossRefGoogle Scholar
  17. 17.
    Maturen KE, Blaty AD, Wasnik AP, et al. (2017) Risk stratification of adnexal cysts and cystic masses: clinical performance of society of radiologists in ultrasound guidelines. Radiology 285(2):650–659CrossRefGoogle Scholar
  18. 18.
    Suh-Burgmann E, Hung YY, Kinney W (2014) Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol 211(623):e1–e7Google Scholar
  19. 19.
    Suh-Burgmann E, Kinney W (2015) Potential harms outweigh benefits of indefinite monitoring of stable adnexal masses. Am J Obstet Gynecol 213(816):e1–e4Google Scholar
  20. 20.
    Omranipour R, Abasahl A (2009) Ovarian metastases in colorectal cancer. Int J Gynecol Cancer 19:1524–1528CrossRefGoogle Scholar
  21. 21.
    Young RH (2007) From Krukenberg to today: the ever present problems posed by metastatic tumors in the ovary. Part II. Adv Anat Pathol 14:149–177CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Akshay D. Baheti
    • 1
    • 2
    Email author
  • Cory E. Lewis
    • 1
  • Daniel S. Hippe
    • 1
  • Ryan B. O’Malley
    • 1
  • Carolyn L. Wang
    • 1
  1. 1.Department of RadiologyUniversity of Washington Medical CenterSeattleUSA
  2. 2.Department of RadiologyTata Memorial Center, Homi Bhabha National InstituteMumbaiIndia

Personalised recommendations