Sonographically guided therapeutic aspiration of benign-appearing ovarian cysts and endometriomas.

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Abstract
The purpose of this study was to investigate the feasibility of therapeutic aspiration of symptomatic benign-appearing ovarian cysts and to show that endometriomas can be successfully aspirated when aspirated in conjunction with hormonal suppression therapy. Forty-three women referred for sonographically guided aspiration of symptomatic ovarian cysts were considered for the study cohort. Criteria for selection included sonographic changes consistent with a simple cyst (n = 32) or endometrioma (n = 9). In two patients, sonography revealed cysts suggestive of malignancy, and these patients were therefore excluded. Seven of the patients were pregnant. Forty-nine 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 aspiration, hormonal suppression therapy was recommended for all patients who had endometriomas. Of the 40 patients who successfully underwent aspiration, all experienced relief from symptoms immediately after aspiration. Eleven of the 40 patients eventually experienced recurrence of symptoms. The overall recurrence rate was 27.5%. The recurrence rate for benign-appearing cysts was 16.1%. None of the seven pregnant patients had recurrence of symptoms. The recurrence rate for endometriomas was 66.6%; however, only one of these nine patients complied with hormonal suppression therapy. Those who did ultimately comply after undergoing a second aspiration experienced sustained relief of symptoms. Sonographically guided therapeutic aspiration of symptomatic ovarian cysts is a viable alternative to surgical extirpation, even in pregnant women. Aspiration of endometriomas may alleviate symptoms when hormonal suppression therapy is also instituted.