US of Incidental Adnexal Cysts: Adherence of Radiologists to the 2010 Society of Radiologists in Ultrasound Guidlines

Purpose: To retrospectively evaluate the adherence of radiologists to the 2010 Society of Radiologists in Ultrasound (SRU) guidelines for management of adnexal cysts. Materials and Methods: One radiologist reviewed the interpreting radiologists' reports for 398 adnexal cysts detected at ultrasonography in 398 patients (mean age +/- standard deviation, 41.1 years +/- 14.3; range, 18- 87 years) and classified the management recommendations according to adherence to SRU guidelines. Recommendations that were not adherent were classified as overmanagement, undermanagement, or incomplete. The effects of menopausal status, cyst size and other features, and the individual interpreting radiologist on adherence were assessed by using x(2) tests, and the association of these factors with over- and undermanagement was identified. Results: Overall adherence was 59%; overmanagement, 27%; undermanagement, 9%; and incomplete, 6%. Menopausal status, cyst size, and other cyst features significantly affected adherence (P <.001). For evaluation of premenopausal patients, adherence was 63% (overmanagement, 30%) and of postmenopausal patients, 42% (undermanagement, 26%). For evaluation of cysts 1- 3 cm in size, adherence was 65% (overmanagement, 21%); for cysts 3- 5 cm, 33% (overmanagement, 49%); for cysts 5- 7 cm, 47% (overmanagement, 20%); for cysts larger than 7 cm, 77% (over- and undermanagement, 12% each). Recommendations were adherent in most instances for corpora lutea (88%), simple cysts (56%), and cysts suggestive of benign diagnosis (60%), or with a nodule or multiple thin or thick septations (60%- 100%). Cysts with recommentations for overmanagement in most instances were hemorrhagic (59%) and those with a single thin septation (67%); 31% of cysts measuring 1- 7 cm in postmenopausal patients were undermanaged. Adherence varied significantly among radiologists (40%- 75% adherence among radiologists who interpreted 20 or more examinations; P =.004). Conclusion: Adherence to SRU guidelines for management of adnexal cysts at our institution was 59%. Overmanagement generally occurred for physiologic cysts in premenopausal patients; undermanagement was observed for simple cysts in postmenopausal patients.