SONOGRAPHICALLY GUIDED THERAPEUTIC ASPIRATION OF BENIGN-APPEARING OVARIAN CYSTS AND ENDOMETRIOMAS

OBJECTIVE. The purpose of this study was to investigate the feasibilit y of therapeutic aspiration of symptomatic benign-appearing ovarian cy sts and to show that endometriomas can be successfully aspirated when aspirated in conjunction with hormonal suppression therapy. MATERIALS AND METHODS. Forty-three women referred for sonographically guided asp iration of symptomatic ovarian cysts were considered for the study coh ort. Criteria for selection included sonographic changes consistent wi th a simple cyst (n = 32) or endometrioma (n = 9). In two patients, so nography revealed cysts suggestive of malignancy, and these patients w ere therefore excluded. Seven of the patients were pregnant. Forty-nin e aspirations were attempted in 41 patients, 14 using a transabdominal approach and 35 transvaginal. Forty-eight aspirations were successful , and one attempted aspiration was technically unsuccessful. After asp iration, hormonal suppression therapy was recommended for all patients who had endometriomas. RESULTS. Of the 40 patients who successfully u nderwent aspiration, all experienced relief from symptoms immediately after aspiration. Eleven of the 40 patients eventually experienced rec urrence of symptoms. The overall recurrence rate was 27.5%. The recurr ence rate for benign-appearing cysts was 16.1%. None of the seven preg nant patients had recurrence of symptoms. The recurrence rate for endo metriomas was 66.6%; however, only one of these nine patients complied with hormonal suppression therapy. Those who did ultimately comply af ter undergoing a second aspiration experienced sustained relief of sym ptoms. CONCLUSION. Sonographically guided therapeutic aspiration of sy mptomatic ovarian cysts is a viable alternative to surgical extirpatio n, even in pregnant women. Aspiration of endometriomas may alleviate s ymptoms when hormonal suppression therapy is also instituted.