Andrea Siobhan Kierans MD, Presenter: Nothing to Disclose

Andrew B. Rosenkrantz MD, Abstract Co-Author: Nothing to Disclose

To evaluate adherence to the 2010 Society of Radiologists in Ultrasound (SRU) guidelines for management of incidental adnexal cysts imaged at ultrasound.

398 adnexal cysts initially detected at ultrasound were included; all studies had been performed after publication of the SRU guidelines and guideline review at departmental conferences. The ultrasound reports were retrospectively reviewed to determine whether the management recommendations were adherent to the guidelines. Non-adherent cases were categorized as over-management, under-management, or as incomplete in their recommendation. Impact of categories determining appropriate recommendation (menopausal status, cyst size, and other cyst imaging features) was assessed via the chi-square test, and the primary cause for non-adherence (over- vs. under-management) in each sub-category was identified.  

Among all 398 adnexal cysts, the frequency of adherence was 55%, over-management was 27%, under-management was 12%, and incomplete recommendation was 6%. Menopausal status, cyst size, and other cyst imaging features all significantly impacted adherence rate (all p<0.001). In pre-menopausal patients, adherence was 61% (over-management in 30%); in post-menopausal patients, adherence was 29% (under-management in 35%). In cysts < 3 cm, adherence was 66% (over-management in 19%), in cysts between 3 and 5 cm, adherence was 33% (over-management in 50%), and in cysts > 5 cm, adherence was 24% (under-management in 42%). Lesions adherent in most instances were simple cysts (55%), para-ovarian cysts (71%), corpus luteums (88%), and cysts suggestive of, but not classic for, a hemorrhagic cyst, endometrioma, or dermoid (57%). Lesions with under-management in most instances were cysts with multiple thin septations (83%), thick irregular septations (33%), or an avascular nodule (67%), and dermoids (78%). Lesion with over-management in most instances was cyst with one thin septation (64%).

Radiologists at our institution adhered to the SRU guidelines for incidental adnexal cysts at ultrasound in 55% of cases. Non-adherence was greater in post-menopausal patients, larger cysts, and cysts with greater complexity.

Our findings will be used to direct future efforts to improve adherence to the SRU guidelines, which in turn will improve patient care. Causes of both under- and over-management will be addressed.

Kierans, A, Rosenkrantz, A, Radiologists' Adherence to the 2010 Society of Radiologists in Ultrasound Guidelines for the Management of Incidental Adnexal Cysts Imaged at Ultrasound: Frequency and Associated Factors.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13013521.html