Intracystic Injection of Methotrexate in Postmenopausal Female Suffering from Simple Ovarian Cyst with Low Malignancy Index
Summary
Objective: To evaluate Intracystic injection of methotrexate in postmenopausal female suffering from simple ovarian cyst with low malignancy index.
Methods: Clinical randomized controlled study, two group of post-menopausal females each group had 25 patients with ovarian cyst with low malignancy index (less than 25), group I : underwent ultrasound guided aspiration of the cyst followed by methotrexate injection Group II: had no interference. Both group will be followed up for 6 months .
Results: Epidemiological data and the characteristics of the cyst at the beginning of the study showed insignificant relationship between two groups. In group I (study group) the time of the procedure was 12.15±1.035 min., with no complications. After follow up of the cases for 6 month it shows significant difference as regard recurrence / persistence of the cyst ( I case recurred in group1 ,and 15 case persist in group 2) with P value 0.000022 .While there was insignificant relationship as regard new symptoms , presence of complications and need for surgery .
Conclusion: This technique is considered a promising technique for its management, but it couldn’t be recommended by our study as this process is invasive and it shows only single advantage over expectant management.
Keywords: Post menopause; Cyst; Malignancy index; Methotrexate
Introduction
Although ovarian cysts are more prevalent in premenopausal women, but ovarian cysts in postmenopausal women are common also, this attributed to the advances in the use of ultrasound in the screening and diagnosis of different lesions [1]. Before the era of use of ultrasound, most gynecologists were depending on palpable postmenopausal ovaries in their management, and it was considered as an indication for surgery [2].
In order to evaluate women, and exclusion of malignancy, simple and available tests are used. At present, these tests are serum CA125 measurement and ultrasound [3]. Of course, the best method for diagnosis of ovarian cancer is offered if a laparotomy and full staging procedure is carried. But, the large prevalence of benign ovarian cysts in the postmenopausal population and the increase in their diagnosis means that it would not be feasible [4].
management of postmenopausal ovarian cyst was a matter of debate for fear of malignancy. But after the advances in the diagnostic imaging technique especially ultrasound, the first step in management of postmenopausal ovarian cyst is to evaluate the lesion by transvaginal ultrasound, Doppler ultrasound could be used also but it is value is not well established, also the role of other imaging modalities like magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET), not also clearly established [5].
In over 80% of ovarian cancer cases had raised Serum CA125 and, if a cut-off of 30 u/ml is used, the test has a sensitivity of 81% and specificity of 75%.5 Ultrasound is also achieving a sensitivity of 89% and specificity of 73% when using a morphology index [6].
It is recommended that a ‘risk of malignancy index’ should be. An effective way of triaging women into those who are at low, moderate, or high risk of malignancy and who hence may be managed by a general gynecologist, or in a cancer unit or cancer center respectively [7].
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