The Risk of Infertility After Surgery for Benign Ovarian Cysts

Shandley, Lisa M.; Spencer, Jessica B.; Kipling, Lauren M.; Hussain, Banna; Mertens, Ann C.; Howards, Penelope P.

doi:10.1089/jwh.2022.0385

Journal of Women's Health

2023

DOI: 10.1089/jwh.2022.0385

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The Risk of Infertility After Surgery for Benign Ovarian Cysts

Lisa M. Shandley

Jessica B. Spencer

Lauren M. Kipling

et al.

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Cited by 6 publications

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“…3 The prevalence of malignancy in women undergoing ovarian surgery is quite low, especially if surgery is based purely on ultrasonography (US) results, 4 and the risk of infertility after surgery for benign ovarian cysts has been largely demonstrated. 5 In this setting, the first-line technique remains transvaginal US, which correctly classifies between 70% and 80% of all adnexal masses depending on the experience of ultrasonographer. 6,7 Many scores have been developed to standardize the management of adnexal masses.…”

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confidence: 99%

O‐RADS MRI SCORE: An Essential First‐Step Tool for the Characterization of Adnexal Masses

Thomassin‐Naggara

Dabi

Florin

et al. 2023

Magnetic Resonance Imaging

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The ovarian‐adnexal reporting and data system on magnetic resonance imaging (O‐RADS MRI) score is now a well‐established tool to characterize pelvic gynecological masses based on their likelihood of malignancy. The main added value of O‐RADS MRI over O‐RADS US is to correctly reclassify lesions that were considered suspicious on US as benign on MRI. The crucial issue when characterizing an adnexal mass is to determine the presence/absence of solid tissue and thus need to perform gadolinium injection. O‐RADS MR score was built on a multivariate analysis and must be applied as a step‐by‐step analysis: 1) Is the mass an adnexal mass? 2) Is there an associated peritoneal carcinomatosis? 3) Is there any significant amount of fatty content? 4) Is there any wall enhancement? 5) Is there any internal enhancement? 6) When an internal enhancement is detected, does the internal enhancement correspond to solid tissue or not? 7) Is the solid tissue malignant? With its high value to distinguish benign from malignant adnexal masses and its high reproducibility, the O‐RADS MRI score could be a valuable tool for timely referral of a patient to an expert center for the treatment of ovarian cancers. Finally, to make a precise diagnosis allowing optimal personalized treatment, the radiologist in gynecological imaging will combine the O‐RADS MRI score with many other clinical, biological, and other MR criteria to suggest a pathological hypothesis.Level of Evidence5Technical Efficacy Stage3.

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mentioning

confidence: 99%

O‐RADS MRI SCORE: An Essential First‐Step Tool for the Characterization of Adnexal Masses

Thomassin‐Naggara

Dabi

Florin

et al. 2023

Magnetic Resonance Imaging

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O-RADS MRI scoring system: key points for correct application in inexperienced hands

Cabedo,

Sebastià,

Munmany

et al. 2024

Insights Imaging

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Objectives To evaluate the efficacy of the O-RADS MRI criteria in the stratification of risk of malignancy of solid or sonographically indeterminate ovarian masses and assess the interobserver agreement of this classification between experienced and inexperienced radiologists. Methods This single-centre retrospective study included patients from 2019 to 2022 with sonographically indeterminate or solid ovarian masses who underwent MRI with a specific protocol for characterisation according to O-RADS MRI specifications. Each study was evaluated using O-RADS lexicon by two radiologists, one with 17 years of experience in gynaecological radiology and another with 4 years of experience in general radiology. Findings were classified as benign, borderline, or malignant according to histology or stability over time. Diagnostic performance and interobserver agreement were assessed. Results A total of 183 patients with US indeterminate or solid adnexal masses were included. Fifty-seven (31%) did not have ovarian masses, classified as O-RADS 1. The diagnostic performance for scores 2–5 was excellent with a sensitivity, specificity, PPV, and NPV of 97.4%, 100%, 96.2%, and 100%, respectively by the experienced radiologist and 96.1%, 92.0%, 93.9%, and 94.8% by the inexperienced radiologist. Interobserver concordance was very high (Kappa index 0.92). Almost all the misclassified cases were due to misinterpretation of the classification similar to reports in the literature. Conclusion The diagnostic performance of O-RADS MRI determined by either experienced or inexperienced radiologists is excellent, facilitating decision-making with high diagnostic accuracy and high reproducibility. Knowledge of this classification and use of assessment tools could avoid frequent errors due to misinterpretation. Critical relevance statement Up to 31% of ovarian masses are considered indeterminate by transvaginal US and 32% of solid lesions considered malignant by transvaginal US are benign. The O-RADs MRI accurately classifies these masses, even when used by inexperienced radiologists, thereby avoiding incorrect surgical approaches. Key points • O-RADS MRI accurately classifies indeterminate and solid ovarian masses by ultrasound. • There is excellent interobserver agreement between experienced and non-experienced radiologists. • O-RADS MRI is a helpful tool to assess clinical decision-making in ovarian tumours. Graphical Abstract

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The impact of surgical treatment of benign ovarian tumors on the reproductive health of women, taking into account the International Classification of Functioning

Zakharov,

Kovlen,

Bezmenko

et al. 2024

Opuholi ženskoj reproduktivnoj sistemy

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The article presents a systematic analysis of studies evaluating the impact of surgical treatment of benign ovarian tumors on reproductive health, taking into account the criteria stated by the International Classification of Functioning, Disability and Health. To identify articles, foreign and domestic scientific databases were used (PubMed, Cochrane, eLibrary). After the initial identification of 704 scientific publications, 46 articles were selected using inclusion and exclusion criteria.The conducted systemic analysis allows us to formulate the conclusion that surgical interventions performed for benign ovarian tumors contribute to damage to ovarian tissue, and as a result, a decrease in the ovarian reserve of patients, which is associated with impaired fertility. A number of authors have demonstrated some recovery of anti-Mullerian hormone (AMH) levels 3-12 months after surgery. A significant portion of the studies have demonstrated a more pronounced postoperative decrease in AMH rates in patients with endometriomas compared with women operated on for non-endometrioid ovarian tumors. Lower AMH rates were noted in women with bilateral surgeries for bilateral ovarian tumors compared to patients who had unilateral surgeries. The performed systemic analysis showed higher postoperative AMH rates in patients with intraoperative suture hemostasis in comparison with the use of bipolar energy; in addition, there is a relationship between the number of coagulations and the severity of the decrease in AMH rates. In a few studies, it was noted that patients who underwent surgical treatment of ovarian tumors experienced an earlier onset of menopause. In connection with these possible functional disorders, further clinical studies of a high level of evidence are needed, aimed at developing effective strategies for preserving the functioning of the reproductive system after surgical treatment of benign ovarian tumors.

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The Risk of Infertility After Surgery for Benign Ovarian Cysts

Cited by 6 publications

References 28 publications

O‐RADS MRI SCORE: An Essential First‐Step Tool for the Characterization of Adnexal Masses

O‐RADS MRI SCORE: An Essential First‐Step Tool for the Characterization of Adnexal Masses

O-RADS MRI scoring system: key points for correct application in inexperienced hands

The impact of surgical treatment of benign ovarian tumors on the reproductive health of women, taking into account the International Classification of Functioning

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