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Ovarian Cyst Management Page 1 of 3

This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers.

Less than or equal to 5 cm


INITIAL Pre-menopausal 4
CLINICAL
EVALUATION Ultrasound follow-up
PRESENTATION Greater than 5 cm at 6-12 weeks
Less than or equal to 3 cm
Benign-appearing Early Greater than 3 cm but less Ultrasound follow-up
cyst1 post-menopausal4 than or equal to 5 cm at 6-12 weeks
Incidental Adnexal Cystic Mass
on CT or MRI (greater than or Ultrasound and disposition
Greater than 5 cm as clinically indicated
equal to 1 cm) Post-Menarchal,
Non-Pregnant Less than or equal to 3 cm
Late
post-menopausal4 Ultrasound and disposition Benign,
1
Should have all of the following features:
Greater than 3 cm as clinically indicated no follow-up
(a) oval or round; (b) unilocular, with uniform
fluid attenuation or signal (layering hemorrhage Less than or equal to 3 cm
acceptable if premenopausal); (c) regular or
imperceptible wall; (d) no solid area, mural Greater than 3 cm but less Ultrasound follow-up
Pre-menopausal4 at 6-12 weeks
nodule; and (e) 10 cm in maximum diameter. than or equal to 5 cm
2
Refers to an adnexal cyst that would otherwise
meet the criteria for a benign-appearing cyst Ultrasound and disposition
Probably benign Greater than 5 cm as clinically indicated
except for one or more of the following specific
observations: (a) angulated margins, (b) not round cyst2
Less than or equal to 3 cm
or oval in shape, (c) a portion of the cyst is poorly Early
imaged (eg, a portion of the cyst may be obscured 4
post-menopausal Ultrasound and disposition
by metal streak artifact on CT of the pelvis), and Greater than 3 cm as clinically indicated
(d) the image has reduced signal-to-noise ratio,
usually because of technical parameters or in some Late Less than or equal to 1 cm
cases because the study was performed without 4
intravenous contrast post-menopausal Greater than 1 cm Ultrasound and disposition
3
Features of masses in this category include: as clinically indicated
(a) solid component, (b) mural nodule, Other imaging Features not specific
(c) septations, (d) higher than fluid attenuation, features3
and (e) layering hemorrhage if postmenopausal Probable diagnostic features Manage as appropriate for diagnosis
4
Pre-menopausal (includes the perimenopausal) patient less than 50 years of age
Post-menopausal patient greater than or equal to 50 years of age
Early post-menopausal: Late post-menopausal:
Within 5 years of the final menstrual period or Greater than 5 years from the final menstrual period or
Ages 50-55 years, when the last menstrual period is unknown. Age greater than 55 years, if the last menstrual period is unknown. Department of Clinical Effectiveness V1
Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 12/13/2016
Ovarian Cyst Management Page 2 of 3
This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers.

SUGGESTED READINGS

Patel, M. D., Ascher, S. M., Paspulati, R. M., Shanbhogue, A. K., Siegelman, E. S., Stein, M. W., & Berland, L. L. (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. Journal of the American College of Radiology, 10(9), 675-681.

Department of Clinical Effectiveness V1


Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 12/13/2016
Ovarian Cyst Management Page 3 of 3
This practice algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson,
including the following: MD Andersons specific patient population; MD Andersons services and structure; and MD Andersons clinical information. Moreover, this algorithm is not
intended to replace the independent medical or professional judgment of physicians or other health care providers.

DEVELOPMENT CREDITS

This practice consensus algorithm is based on majority expert opinion of the Ovarian Cyst Management work group at the University of Texas MD Anderson
Cancer Center. It was developed using a multidisciplinary approach that included input from the following:

Tharakeswara Bathala, MD
Deepak Bedi, MD
Therese Bevers, MD
Priya Bhosale, MD
Yoliette Goodman, MBA
Aurelio Matamoros, MD
Denise Nebgen, MD
Ott Le, MD
Christina Perez
Gaiane Rauch, MD, PhD
Gloria Trowbridge, RN


Core Development Team

Clinical Effectiveness Development Team

Department of Clinical Effectiveness V1


Copyright 2017 The University of Texas MD Anderson Cancer Center Approved by the Executive Committee of the Medical Staff on 12/13/2016