Clinical Outcomes and Radiological Patterns of Ovarian Cysts in Post-Hysterectomy Women a Cross-Sectional Study

Abstract

Background: Cysts in the ovaries can form even after having a hysterectomy. It is common for these cysts to show symptoms that are vague or nonspecific so obtaining a proper diagnosis can be even more difficult. The cysts can be visualized in radiological forms from simple to even showing complex and suspicious structures. Knowing how to read these images of the cysts while having a background on possible clinical outcomes is important.

Objectives: Assessing the radiological patterns, clinical presentations and differential outcomes with respect to ovarian cysts in women with a history of hysterectomy and the relationship of the patterns of the cyst with respect to the rationale of undergoing surgery versus taking a watch-and-wait approach.

Methodology: This cross-sectional study includes post-hysterectomy women who were displaying cysts in their ovaries in ultrasounds or CT scans. Claimed clinical history, indications on the type of hysterectomy performed, and all radiological detail were all documented. Cysts were all reported and classified on the basis of morphology into simple, complex, and suspicious. Management results were grouped into outcomes of conservative follow-ups, complications, or worse. Surgical and other forms of intervention were also analyzed. All data were processed with the SPSS 24.0 data software with application of chi-squared and logistic regression for analysis of the data. The threshold for statistical significance in this study was set at P < 0.05.

Results: 120 post-hysterectomy women whose ages were 52.6 ± 8.4 years. 58% had pelvic or lower abdominal pain, while 21% were asymptomatic, and their condition was diagnosed by chance during their medical imaging. Radiologically, there were 47.5% simplistic, 35% were complex, and 17.5% were considered suspicious. simplistic cysts were the average thin-walled and unilocular and complex and suspicious, the lesions would often contain more paired walls, and in addition, solid parts or greater blood flow were also present. A statistically significant association was observed between cyst morphology and symptom severity (p = 0.002), complex and suspicious cysts more likely leading to more pain or pressure symptoms. The size of the cyst also affected how it was managed; those greater than 5cm in diameter were much more (p = 0.003) likely to be surgically removed than those equal to or less than 5cm in diameter. Overall, 38 (31.7%) of these patients had surgery, most of these patients had suspicious features in their medical imaging, or had symptoms that would do little to disappear, and were also suspicious in nature.

Conclusion: Cysts that occur in the ovaries are not an uncommon finding in women who have previously undergone a hysterectomy. These cysts present with various patterns on any diagnostic imaging conducted. Certain characteristics of the cysts, such as being more complex in configuration and/or increasing in size, are more likely to require surgical intervention. The majority of the lesions, however, are likely to be benign, which supports the notion of more conservative approaches to the monitoring of these cysts, particularly when the imaging shows fewer concerning features. The significance of more in-depth imaging should not be understated in these patients, particularly as it can lower overall morbidity..