{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:58:38Z","timestamp":1792425518212,"version":"4.5.0"},"reference-count":48,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: We aimed to determine the reliability of simple ultrasound (US) markers and CA-125 measurements in diagnosing peri- and postmenopausal ovarian masses. Methods: The study was conducted in a retrospective setting. The preoperative imaging properties of peri- (PEM) and postmenopausal (POM) ovarian cysts were examined. Based on ultrasound findings, lesions were categorized as either (1) simple cysts, defined as unilocular, anechoic structures without solid components, or (2) complex cysts, characterized by any deviation from this morphology. Imaging characteristics, mass size, and demographic data were matched with histology and CA125 levels. Results: In total, 379 cystic structures (PEM: N = 195, average age: 45.6 years; range: 40\u201354 years, POM: N = 184, average age 61.2 years; range: 41\u201388 years) were analyzed. In the PEM group, there were 75 simple (\u00d8 &lt; 5 cm N = 32, \u00d8 \u2265 5 cm N = 43) and 122 complex cysts (\u00d8 &lt; 5 cm N = 29, \u00d8 \u2265 5 cm, N = 93), while in the POM group, 49 simple (\u00d8 &lt; 5 cm N = 9, \u00d8 \u2265 5 cm N = 40) and 135 complex cysts (\u00d8 &lt; 5 cm N = 15, \u00d8 \u2265 5 cm N = 120) were found. In the PEM group, malignancy was detected in complex cysts larger than 5 cm (N = 16, 17.58%). In the POM group, malignancy was present in 40 cases, and 3 of them proved to be smaller than 5 cm. The majority of cysts were functional (54.36%) in the PEM group. In the POM group, serous cysts were the most frequent (38.04%), followed by malignant (21.74%) and mucinous cysts (13.04%). CA125 was elevated in 66 of 217 cases (30.41%); only 23 were malignant (NPV: 0.95, PPV: 0.35). Conclusions: Functional cysts are frequently found among perimenopausal ovarian cysts, with malignancy occurring exclusively in complex cysts exceeding 5 cm in diameter. However, complex cysts of any size carry a significant risk of malignancy in menopause, thus, surgery is recommended. Simple cysts can be followed by serial scans in both groups. CA-125 does not give added value to the detection of malignancy in perimenopausal patients. However, in postmenopausal complex morphology cysts larger than 5 cm, it may give added value to the suspicion of malignancy.<\/jats:p>","DOI":"10.3390\/cancers17081370","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:15:06Z","timestamp":1745180106000},"page":"1370","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The Clinical Relevance of Distinguishing Between Simple and Complex Adnexal Cystic Structures by Ultrasound in Peri- and Postmenopause"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0215-9852","authenticated-orcid":false,"given":"Balazs","family":"Erdodi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"},{"name":"Doctoral School of Clinical Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4126-0058","authenticated-orcid":false,"given":"Gergo Jozsef","family":"Szollosi","sequence":"additional","affiliation":[{"name":"Coordination Center for Research in Social Sciences, Faculty of Economics and Business, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoltan","family":"Toth","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2149-3935","authenticated-orcid":false,"given":"Zoard Tibor","family":"Krasznai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-2297","authenticated-orcid":false,"given":"Attila","family":"Jakab","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/S1470-2045(09)70026-9","article-title":"Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: Results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)","volume":"10","author":"Menon","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1067\/mob.2001.108330","article-title":"Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: A comparison between ultrasonographic morphologic imaging and histopathologic diagnosis","volume":"184","author":"Ekerhovd","year":"2001","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_3","first-page":"14","article-title":"Prospective evaluation of serum CA 125 levels for early detection of ovarian cancer","volume":"80","author":"Einhorn","year":"1992","journal-title":"Obs. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/S0140-6736(98)10261-1","article-title":"Screening for ovarian cancer: A pilot randomised controlled trial","volume":"353","author":"Jacobs","year":"1999","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00001703-199802000-00007","article-title":"Screening strategies for ovarian cancer","volume":"10","author":"Collins","year":"1998","journal-title":"Curr. Opin. Obs. Gynecol."},{"key":"ref_6","first-page":"1380","article-title":"A new risk malignancy index to predict ovarian cancer: A bicentric preliminary study","volume":"23","author":"Iatrakis","year":"2018","journal-title":"J. Buon."},{"key":"ref_7","first-page":"8","article-title":"The postmenopausal cystic adnexal mass: The potential role of ultrasound in conservative management","volume":"73","author":"Goldstein","year":"1989","journal-title":"Obs. Gynecol."},{"key":"ref_8","first-page":"70","article-title":"Transvaginal sonographic characterization of ovarian disease: Evaluation of a new scoring system to predict ovarian malignancy","volume":"78","author":"Sassone","year":"1991","journal-title":"Obs. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0090-8258(03)00414-1","article-title":"Preoperative differentiation of malignant from benign ovarian tumors: The efficacy of morphology indexing and Doppler flow sonography","volume":"91","author":"Ueland","year":"2003","journal-title":"Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/0090-8258(89)90031-0","article-title":"Macroscopic characterization of ovarian tumors and the relation to the histological diagnosis: Criteria to be used for ultrasound evaluation","volume":"35","author":"Granberg","year":"1989","journal-title":"Gynecol. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"c6839","DOI":"10.1136\/bmj.c6839","article-title":"Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: Prospective validation by IOTA group","volume":"341","author":"Timmerman","year":"2010","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/j.1440-1673.2007.01723.x","article-title":"The ability of ultrasound to detect gynaecological neoplasms and their ultrasound morphological features","volume":"51","author":"Tan","year":"2007","journal-title":"Australas. Radiol."},{"key":"ref_13","first-page":"757","article-title":"Three-dimensional ultrasonography and power Doppler in ovarian cancer screening of asymptomatic peri- and postmenopausal women","volume":"46","author":"Kurjak","year":"2005","journal-title":"Croat. Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"255","DOI":"10.7863\/jum.2005.24.3.255","article-title":"The complexity of a \u201ccomplex mass\u201d and the simplicity of a \u201csimple cyst\u201d","volume":"24","author":"Goldstein","year":"2005","journal-title":"J. Ultrasound. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/AOG.0b013e318298def5","article-title":"Frequency and Disposition of Ovarian Abnormalities Followed With Serial Transvaginal Ultrasonography","volume":"122","author":"Pavlik","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1111\/j.1471-0528.2012.03297.x","article-title":"Triaging women with ovarian masses for surgery: Observational diagnostic study to compare RCOG guidelines with an International Ovarian Tumour Analysis (IOTA) group protocol","volume":"119","author":"Timmerman","year":"2012","journal-title":"BJOG"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/uog.12323","article-title":"Improving strategies for diagnosing ovarian cancer: A summary of the International Ovarian Tumor Analysis (IOTA) studies","volume":"41","author":"Kaijser","year":"2013","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"g5920","DOI":"10.1136\/bmj.g5920","article-title":"Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: Prospective multicentre diagnostic study","volume":"349","author":"Valentin","year":"2014","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1038\/bjc.2016.227","article-title":"Evaluating the risk of ovarian cancer before surgery using the ADNEX model: A multicentre external validation study","volume":"115","author":"Sayasneh","year":"2016","journal-title":"Br. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1002\/uog.17225","article-title":"Estimating risk of malignancy in adnexal masses: External validation of the ADNEX model and comparison with other frequently used ultrasound methods","volume":"49","author":"Meys","year":"2017","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_21","first-page":"593","article-title":"Accuracy of the pelvic examination in detecting adnexal masses","volume":"96","author":"Padilla","year":"2000","journal-title":"Obs. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1067\/mob.2000.107401","article-title":"Complex ovarian cysts in postmenopausal women are not associated with ovarian cancer risk factors: Preliminary data from the prostate, lung, colon, and ovarian cancer screening trial","volume":"183","author":"Hartge","year":"2000","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1006\/gyno.1998.4965","article-title":"The malignant potential of small cystic ovarian tumors in women over 50 years of age","volume":"69","author":"Bailey","year":"1998","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1006\/gyno.1994.1340","article-title":"Management of the adnexal mass","volume":"55","author":"Curtin","year":"1994","journal-title":"Gynecol. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0378-5122(98)00102-9","article-title":"Differential diagnosis of peri- and postmenopausal ovarian cysts","volume":"31","author":"Reimer","year":"1999","journal-title":"Maturitas"},{"key":"ref_26","first-page":"1455","article-title":"A comparison of biochemical and immunohistochemical assessment of EGFR expression in ovarian cancer","volume":"12","author":"Owens","year":"1992","journal-title":"Anticancer Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1038\/bjc.1995.339","article-title":"Epidermal growth factor, oestrogen and progesterone receptor expression in primary ovarian cancer: Correlation with clinical outcome and response to chemotherapy","volume":"72","author":"Scambia","year":"1995","journal-title":"Br. J. Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1111\/j.1471-0528.1990.tb02448.x","article-title":"A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer","volume":"97","author":"Jacobs","year":"1990","journal-title":"Br. J. Obs. Gynaecol."},{"key":"ref_29","first-page":"921","article-title":"Relative frequency of primary ovarian neoplasms: A 10-year review","volume":"74","author":"Koonings","year":"1989","journal-title":"Obs. Gynecol."},{"key":"ref_30","first-page":"594","article-title":"Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter","volume":"102","author":"Modesitt","year":"2003","journal-title":"Obs. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0301-2115(97)00235-2","article-title":"Evaluation of ovarian tumors in postmenopausal women by transvaginal sonography","volume":"77","author":"Osmers","year":"1998","journal-title":"Eur. J. Obs. Gynecol. Reprod. Biol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/(SICI)1097-0096(199605)24:4<175::AID-JCU3>3.0.CO;2-C","article-title":"Follow-up of small, postmenopausal ovarian cysts using vaginal ultrasound and CA-125 antigen","volume":"24","author":"Auslender","year":"1996","journal-title":"J. Clin. Ultrasound"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/uog.11167","article-title":"Lesion size affects diagnostic performance of IOTA logistic regression models, IOTA simple rules and risk of malignancy index in discriminating between benign and malignant adnexal masses","volume":"40","author":"Testa","year":"2012","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1002\/uog.26080","article-title":"Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: Retrospective validation in IOTA5 multicenter cohort","volume":"61","author":"Landolfo","year":"2023","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/S0002-9378(96)70157-6","article-title":"Preoperative evaluation of ovarian tumors in the premenopause by transvaginosonography","volume":"175","author":"Osmers","year":"1996","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1148\/radiol.10100213","article-title":"Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement","volume":"256","author":"Levine","year":"2010","journal-title":"Radiology"},{"key":"ref_37","first-page":"1293","article-title":"Variables Associated With Resolution and Persistence of Ovarian Cysts","volume":"142","author":"Lasher","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_38","first-page":"559","article-title":"Natural history and malignant potential of simple ovarian cysts in postmenopausal women: A systematic review and meta-analysis","volume":"30","author":"Liu","year":"2023","journal-title":"Menopause"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1056\/NEJM198310133091503","article-title":"A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer","volume":"309","author":"Bast","year":"1983","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/oxfordjournals.humrep.a136832","article-title":"The CA 125 tumour-associated antigen: A review of the literature","volume":"4","author":"Jacobs","year":"1989","journal-title":"Hum. Reprod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"369","DOI":"10.7863\/jum.1998.17.6.369","article-title":"Simple cyst in the postmenopausal patient: Detection and management","volume":"17","author":"Conway","year":"1998","journal-title":"J. Ultrasound. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1006\/gyno.1995.9952","article-title":"Meigs\u2019 syndrome with elevated serum CA 125 levels: Two case reports and review of the literature","volume":"59","author":"Timmerman","year":"1995","journal-title":"Gynecol. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1002\/uog.12551","article-title":"Are serum HE4 or ROMA scores useful to experienced examiners for improving characterization of adnexal masses after transvaginal ultrasonography?","volume":"43","author":"Kaijser","year":"2014","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1515\/CCLM.2011.075","article-title":"The ROMA (Risk of Ovarian Malignancy Algorithm) for estimating the risk of epithelial ovarian cancer in women presenting with pelvic mass: Is it really useful?","volume":"49","author":"Montagnana","year":"2011","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.ygyno.2013.01.018","article-title":"A comparison between an ultrasound based prediction model (LR2) and the risk of ovarian malignancy algorithm (ROMA) to assess the risk of malignancy in women with an adnexal mass","volume":"129","author":"Kaijser","year":"2013","journal-title":"Gynecol. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/uog.6415","article-title":"Adding a single CA 125 measurement to ultrasound imaging performed by an experienced examiner does not improve preoperative discrimination between benign and malignant adnexal masses","volume":"34","author":"Valentin","year":"2009","journal-title":"Ultrasound Obs. Gynecol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e240044","DOI":"10.1148\/radiol.240044","article-title":"The Ovarian-Adnexal Reporting and Data System (O-RADS) US Score Effect on Surgical Resection Rate","volume":"313","author":"Shen","year":"2024","journal-title":"Radiology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"440.e1","DOI":"10.1016\/j.ajog.2024.04.019","article-title":"Ovarian cancer risk among older patients with stable adnexal masses","volume":"231","author":"Hung","year":"2024","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1370\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:18:13Z","timestamp":1760030293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/8\/1370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,20]]},"references-count":48,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["cancers17081370"],"URL":"https:\/\/doi.org\/10.3390\/cancers17081370","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,20]]}}}