•  Non-tender, right adnexal mass
• Mobile
• Smooth surface
• No evidence of ascites

• 6-cm, simple, right ovarian cyst
• Normal uterus with a thin endometrium

• Asymptomatic ovarian cyst
• Premenopausal woman

• Review in 3-6m
•  MRI pelvis and abdomen
•  Image-guided cyst aspiration
• Ovarian cysectomy
•  Oophorectomy

Review in 3-6 m

A pelvic ultrasound is the single most effective way of evaluating an ovarian mass with transvaginal ultrasonography being
preferable.

The International Ovarian Tumor Analysis(IOTA) group has derived a set of simple rules that classify ovarian masses as benign (B-rules) or malignant (M-rules) based on ultrasonographic morphology. The use of specific ultrasound findings withoutCA-125has been shown to have high sensitivity, specificity and likelihood ratios.

The presence of any of the M-rules on ultrasonography indicate referral to a gynecologic oncologic service.

Many ovarian masses in the premenopausal woman can be managed conservatively. Asymptomatic simple cysts 30–50 mm indiameter do not require follow-up, cysts 50–70 mm require follow-up, and cysts more than 70 mm in diameter should be considered for either further imaging (MRI) or surgical intervention due to difficulties in examining the entire cyst adequately at time of ultrasound.

Aspiration of ovarian cysts, either vaginally or laparoscopically, is not sufficiently effective and is associated with a high rate of
recurrence.

• Ovarian Masses in Premenopausal Women, Management of Suspected (Green-top Guideline No. 62). https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg62/.
• Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses.
  Obstet Gynecol [2016]. Available from:https://pubmed.ncbi.nlm.nih.gov/27776072/