Ultrasonography Findings and Risk of Ovarian Cancer


Key Points

  • Complex cysts and solid masses on ultrasonography were associated with increased risk of cancer.
  • Simple cysts were not associated with increased risk of disease.

In a study reported in JAMA Internal Medicine, Smith-Bindman et al found that the appearance of ovarian masses on ultrasonography was highly associated with risk of ovarian cancer in a large unselected population of women undergoing pelvic ultrasonography.

Study Details

The study was a nested case-control study among 72,093 women enrolled in Kaiser Permanente Washington who underwent pelvic ultrasonography between January 1997 and December 2008. Analysis was completed in April 2017.

Risk of Cancer

Of the 72,093 women, 210 were subsequently diagnosed with ovarian cancer. Among these, 49 were aged < 50 years and 161 were aged ≥ 50 years; among women without cancer, 54,403 were aged < 50 years and 17,480 ≥ were aged 50 years.

Ultrasonography findings were found to be predictive of cancer (C statistic = 0.89). The risk of cancer was significantly elevated in women with findings of complex cysts and solid masses compared with women with normal ovaries. Among women aged < 50 years, likelihood ratios for developing cancer were 8.20, 8.34, and 8.08 for those with complex cysts, complex cysts with ascites, and solid masses, respectively; among those aged ≥ 50 years, likelihood ratios were 7.60, 74.17, and 10.08, respectively. The 3-year risks of cancer per 1,000 women with these findings were 9.4, 11.0, and 8.9, respectively, for those aged < 50 years and 65.2, 429.8, and 101.6, respectively, for those aged ≥ 50 years.

The 23.8% of women aged < 50 years and the 13.4% of women aged ≥ 50 years with simple cysts did not have significantly increased risk of cancer compared with women with normal ovaries.

Likelihood ratios associated with the detection of a simple cyst were 0.00 in women aged < 50 years (no cancers identified) and 0.10 in those aged ≥ 50 years, with the 3-year risk of cancer being 0 and 0.5 cases per 1000 women in the two age groups.

The investigators concluded, “According to this study, the ultrasonographic appearance of ovarian masses is strongly associated with a woman’s risk of ovarian cancer. Simple cysts are not associated with an increased risk of ovarian cancer, whereas complex cysts or solid masses are associated with a significantly increased risk of ovarian cancer.”

This study was supported by grants from the National Cancer Institute.

Rebecca Smith-Bindman, MD, of the Department of Radiology and Biomedical Imaging, University of California, San Francisco, is the corresponding author for the JAMA Internal Medicine article.

Disclosure: See study authors’ full disclosures at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.