Recommendations for clinical practice: Presumed benign ovarian tumors--short text

These guidelines from the French College of Gynecologists and Obstetricians on the diagnosis and treatment of presumed benign ovarian tumors (PBOT) concern physicians whether gynecologists, obstetricians, surgeons, radiologists, pediatricians, and general practitioners. Vaginal pelvic ultrasound is the first-line imaging examination in case of PBOT in adult women (grade A). In case of pure fluid unilocular mass less than 7 cm size, ultrasound is sufficient to characterize the mass (grade A). MRI is recommended as second-line to explore indeterminate masses or masses greater than 7 cm (grade B). Serum CA125 assay is not recommended as first-line diagnostic in adult women (grade C). Among women with a pure unilocular liquid cyst, hormonal therapy is ineffective (LE1) and is not recommended (grade A). Ultrasound-guided puncture is not recommended (grade B). In adult women without history of cancer, abstention is possible in case of asymptomatic pure unilocular cyst less than 10 cm (grade B). If symptoms develop, laparoscopy is the reference approach for PBOT surgical treatment (grade A). A conservative surgical treatment (cystectomy) should be preferred to oophorectomy in non-menopausal women without previous history of cancer (grade C). In cases of suspected adnexal torsion, laparoscopic surgical exploration is recommended (grade B). Conservative treatment, untwisting without oophorectomy, is recommended for non-menopausal women whatever the estimated duration of the twist and the macroscopic appearance of the ovary (grade B). During pregnancy, expectation is recommended for asymptomatic unilocular liquid masses less than 6 cm (grade C).