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Ovarian cyst aspiration
1.
2. BY
Mohammad Emam
Prof. OB& GYN
Mansoura Faculty of Medicine
Mansoura Integrated Fertility Center
2021
Ultrasonic – guided Ovarian
Cyst Aspiration:
Role Of Gynecologist
3. Definition Of ovarian cyst
•Is a sac filled
with liquid or
semiliquid
material that
arises in an
ovary.
4. Epidemiology of Ovarian Cysts?
Many types.
Different cause.
Occur from Fetus to menopause.
Majority during reproductive age.
Majority are asymptomatic.
Can cause serious problems.
5.
6.
7. Methods Of ovarian cyst
Aspiration
•Either by:
•1 ) Ultrasonic guided.
• OR
•2) laparoscopy ( Prior to ov. Cystectomy)
8. Rationale
Wide increase of ovarian
cysts aspiration by (GG )
due to its simplicity,
short hospital stay and
rapid recovery
9. To highlight awareness of Gynecologist regarding:
1. Principles of Diagnosis
2. Principles of management & choice line
3. Interventional (ultrasound – guided Aspiration ):
• Indications update
• Contraindications
• Disadvantages
Objective
10. Principles of Diagnosis
• History & Examination.
• Investigations
– Tumor markers – CA-125.
– Imaging techniques:
– TVS
– CT – assess LN, pelvic and abdominal structures.
– MRI – best for DD malignant from benign .
• DD
13. Peritoneal Pseudo cyst (PPCS)
Cysts formed by
trapping and
collection of fluid
inside Post
inflammatory &
Postoperative
adhesive pockets
of peritoneal
cavity.
14. PPSC (bizarre lump-shaped cyst)
Thin wall
• Fine internal septations .
• ovary suspended among
adhesions.
On follow up :
Slow growing
( As more fluid is secreted by
the ovaries and not
reabsorbed by the
peritoneum).
22. PCOM VS. Multi cystic Ovaries
PCOM
Multiple cysts(≥12
follicles within the
ovary
Cyst diam 2-<10 mm
Stroma increased
Irreversible
Multi cystic ovaries
– Fewer ( 6- 12) cysts
– Cyst diam > 10 mm
– Stroma not increased
– Reversible
23. Principles For Management
1) Establish the type of cyst :
• Non neoplastic & Neoplastic .
• Benign or malignant.
2) Age (from fetus to Post menopause).
3 ) Presentation
4 ) pregnant or not
24. Types Of Ovarian Cysts
Neoplastic
1. Epithelial T
2. Sex cord T
3. Germ cell T.
4. others
( Metastatic….)
( Benign & Malignant)
Non Neoplastic
Functional
1) Follicular cyst`
2) Corpus luteum cyst
3) Theca lutein cyst
Pathological
1) Inflammatory
Tubo-ovarian abscess
2) Endometrioma
3) Luteoma Of pregnancy
32. Choice Line of ttt :
Conservative
surgery ( laparoscopy
& laparotomy).
Interventional
(ultrasound
Aspiration ).
33. Indications for Ovarian
Cyst Aspiration
1)Some Functional ovarian cysts.
2) During second trimester of pregnancy
3)Ovarian cysts in fetuses.
4) Retention cysts after GnRH
analogue during long protocol of ICSI.
35. 1) TREATMENT Of Functional ov cysts
Incidence of functional ovarian cysts is (about 45 % ).
Small ( less than 6 cm):
Conservative (disappear spontaneously
within 3 cycles )
Large ( more than 6cm) :
Prolonged downregulation with either:
Progesterone-only pill
COC.
surgical ( laparoscopy or laparotomy)
Interventional ultrasound Aspiration :
A ) Prior to COS.
B) If symptomatic or complicated
37. A ) Aspiration Of functional ov cyst
Prior to COS.
Cochrane 2014:
Insufficient evidence to
determine value of
drainage of functional
ovarian cysts prior to
ovarian stimulation .
38. B ) Aspiration of functional ov cyst If
symptomatic or complicated
When the criteria by IOTA and CA 125 is benign
So :
1) Aspiration is better than laparoscopy.
2) Cytology is mandatory.
3) Follow up.
39. ovarian cyst US
Unilocular Multilocular
-Homogenous
-Thin walls
Low vascularity
-No vegetation
- Heterogeneous
-Thick walls
Vascular walls
-vegetation
C.A. 125
<35 >35 ( DD)
Laparoscopy or laparotomy
Observe
<6 cm >6 cm
Observe 3 months
COC , Minipill or Aspiration.
Cytology
Benign Suspicious
40. 2) Ovarian cyst during second
trimester of pregnancy
1) The traditional management is:
laparotomy (between 16 and 20 w).
NO intervention if the size less than 6 cm.
2) TA or TV ultrasonic aspiration:
with strict ultrasonic characteristics of benign cysts , is
very successful.
3) Follow up after delivery .
42. 3) Fetal Ovarian cysts
Usually detected during antenatal care & followed after
delivery as neonatal ovarian cyst.
Due to mechanical complications , in
utero aspiration of cysts > 6 cm may
prevent complications .
The safety and efficiency of this
approach , seem encouraging .
45. 4 ) Retention cysts during GnRH
analogue long protocol
Controversies:
1. Cancel the cycle +OCS.
2. The continuation of the cycle .
3. TVS aspiration.
This indication has regressed with wide
use of antagonist protocols
46. Advantages Of aspiration of the retention cyst
during long protocol of ICSI.
provide the continuation of the cycle
& minimize cancellation
Improve the follicular recruitment.
Improve the psychology of patient if
cycle is canceled.
47. Disadvantages of Ovarian Cyst Aspiration
Recurrence.
Inconclusive cytology .
Dissemination (Neoplastic cells).
Need frequent follow up.
48. Trials to minimize recurrence
GNRH a
Alternatives substances to fluid aspirated :
Methotrexate.
Sclerosing agents (ethanol,
bleomycin…..etc)
Tetracycline
Erythromycin
49. Conclusion
The correct diagnosis of ovarian cyst
allows conservative treatment &
Avoiding :
unnecessary surgery.
Abuse of aspiration.
50. conclusion
Following strict criteria to
exclude malignancy as :
TVS & IOTA
C.A. 125
will help in selection of cases for
U.S. guided cyst aspiration
51. Conclusion
There are 4 indications for
Ovarian cyst aspiration as an
alternative for laparotomy or
laparoscopy, with applications
of precautions to minimize
recurrence & dissemination of Neoplastic
cells.
52. Practical Message
Remember the number 4
1. Four important DD .
2. Four indications
3. Four contraindications
4. Four disadvantages