Guideline: Management of Incidental Adnexal Lesions on CT/MR

Reference: Managing Incidental Findings on Abdominal and Pelvic CT and MRI, Part 1: White

Paper of the ACR Incidental Findings Committee II on Adnexal Findings, Patel et al., J Am Coll Radiol 2013;10:675-681.

Macro name: Guideline incidental adnexal cyst

Macro last updated: 6/18/2014

Note: All measurements are based on long axis dimension.

Patient Age </= 50

Benign </= 5 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring 5 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Benign > 5 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring greater than 5 cm should be further evaluated with pelvic ultrasound in 6-12 weeks (JACR 2013; 10: 675-681).

Probably benign </= 3 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring 3 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Probably benign 3-5 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring 3-5 cm should be further evaluated with pelvic ultrasound in 6 to 12 weeks (JACR 2013; 10: 675-681).

Probably benign > 5 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring greater than 5 cm should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Mass

Based on consensus guidelines, solid adnexal masses or complex adnexal cysts should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Patient Age 51-55

Benign </= 3 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring 3 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Benign 3-5 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring 3-5 cm should be further evaluated with pelvic ultrasound in 6-12 weeks (JACR 2013; 10: 675-681).

Benign > 5 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring greater than 5 cm should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Probably benign </= 3 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring 3 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Probably benign > 3 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring greater than 3 cm should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Mass

Based on consensus guidelines, solid adnexal masses or complex adnexal cysts should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Patient Age >55

Benign </= 3 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring 3 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Benign > 3 cm

Based on consensus guidelines and patient age, asymptomatic simple adnexal cysts measuring greater than 3 cm should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Probably benign </= 1 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring 1 cm or less require no additional imaging follow-up (JACR 2013; 10: 675-681).

Probably benign > 1 cm

Based on consensus guidelines and patient age, asymptomatic poorly characterized adnexal cysts or minimally complex cysts (angular margins, not round/oval, no septations or mural nodule) measuring greater than 1 cm should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).

Mass

Based on consensus guidelines, solid adnexal masses or complex adnexal cysts should be further evaluated with pelvic ultrasound (JACR 2013; 10: 675-681).