Ovarian cyst or mass found on ultrasound
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Simple cyst (unilocular, fluid-filled) before menopause
- No laboratory test: management relies on transvaginal ultrasound and its follow-up.
Do not order
Complex or solid mass (before age 40)
Laboratory tests (before the gynaecological opinion)
- Serum β-hCG
- Alpha-fetoprotein
- LDH
- CA 125 (not reimbursed in France for diagnosis)if needednon-French guidelineSuspected ovarian cancer: NICE has CA 125 measured with AFP and hCG in women under 40 years [9]; before the menopause, it is unreliable (false positives: fibroids, endometriosis, adenomyosis, pelvic infection) [4].
Do not order
- CA 19-9, CEA, CA 72-4: their performance is inferior to that of CA 125 and HE4, and they are no longer recommended for the diagnosis of a presumed benign ovarian tumour [3].
Cyst after menopause
Laboratory tests
- CA 125 (not reimbursed in France for diagnosis)if neededCyst larger than 3 cm, or not simple: the RCOG assesses any cyst in a postmenopausal woman with CA 125 and transvaginal ultrasound [11], whereas the CNGOF does not recommend routine measurement of it for a unilocular fluid-filled mass in a postmenopausal woman, even if persistent (grade C) [2]. A simple, unilocular, unilateral, asymptomatic cyst of 3 cm or less needs no follow-up [11].
Do not order
Sources (11)
- Collège national des gynécologues et obstétriciens français (CNGOF). Les tumeurs de l'ovaire présumées bénignes. Recommandations pour la pratique clinique (texte court), 2013.
- Collège national des gynécologues et obstétriciens français (CNGOF). Les tumeurs de l'ovaire présumées bénignes. Recommandations pour la pratique clinique (texte court), 2013. Version anglaise : Brun JL, Fritel X, Aubard Y, et al. Management of presumed benign ovarian tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2014;183:52-8.
- Lahlou N, Brun JL. Marqueurs tumoraux des tumeurs ovariennes présumées bénignes (RPC CNGOF 2013). J Gynecol Obstet Biol Reprod (Paris). 2013;42(8):752-9.
- Royal College of Obstetricians and Gynaecologists, British Society for Gynaecological Endoscopy. Management of Suspected Ovarian Masses in Premenopausal Women. Green-top Guideline No. 62, novembre 2011.
- Timmerman D, Planchamp F, Bourne T, et al. ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors. Int J Gynecol Cancer. 2021;31(7):961-982.
- Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG). Richtlijn Het vergrote ovarium, modules « Tumormarkers », « Follow-up duur benigne ovarium cyste » et « Diagnostische modellen », 11 mars 2021 (Pays-Bas).
- Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016;93(8):676-681.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 7325 (antigène CA 125), 0320 (alpha-fœtoprotéine), 7402 (hCG), 0521 (LDH).
- National Institute for Health and Care Excellence. Ovarian cancer: recognition and initial management. Clinical guideline CG122, avril 2011 (recommandations 1.2.1).
- National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline NG12, publiée le 23 juin 2015, dernière mise à jour le 15 avril 2026 (recommandations 1.5.1 à 1.5.11).
- Royal College of Obstetricians and Gynaecologists. The Management of Ovarian Cysts in Postmenopausal Women. Green-top Guideline No. 34, juillet 2016, mise à jour mineure décembre 2025.