Ultrasound-guided Transvaginal Aspiration of Cystic Pelvic Lesions

NCT06988280 | Recruiting

• 1 other identifier: S68671
• Study Type: observational
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Adnexal cysts or pseudocysts are a common finding on transvaginal ultrasound, especially in premenopausal women. Due to the size of some cysts, they may cause discomfort. Moreover, a genuine risk of ovarian torsion presents when these lesions grow. During the last decades, great advancements have been made in the correct differentiation of benign from malignant lesions. However, there still is controversy concerning the optimal treatment approach of symptomatic adnexal cysts with a low risk of malignancy, consisting of both surgery or ultrasound-guided transvaginal aspiration. Factors such as comorbidities and lesion characteristics need to be considered when counselling patients, as well as the possibility of short term recurrence. Surgically removing them may result in longer hospital stays and recovery, with higher costs, while transvaginal needle aspiration techniques can be performed during a consultation. Additional benefits in avoiding surgery, particularly in women of reproductive age, are fertility preservation and less pelvic adhesions. On the other hand, the main arguments against cyst aspiration are the relatively high recurrence rate of cysts, the minimal risk of malignant cell dissemination (In case of a false negative diagnosis) and the cytological instead of a histopathological examination. With this in mind, it is important to base management decisions on the sonographic features of the lesions. In addition, cyst aspiration can also be considered in large symptomatic cysts with a high risk of malignancy, but where curative treatment with surgical or chemotherapeutical intervention cannot be considered due to poor general condition of the patient. Especially in the absence of large volume ascites or peritoneal carcinomatosis, but with significant symptoms due to lesion size, cyst aspiration may give short term symptom alleviation. Given the risk of cancer cell dissemination, this intervention is always discussed in a multidisciplinary team discussion, to balance risk and benefits for patients with no other treatment options, Transvaginal needle aspiration is also being used in pelvic abscesses. The study of K. Gjelland et al. found that transvaginal aspiration combined with antibiotic treatment of pelvic abscesses is equally effective as surgically removing them. They state that this should be first-line treatment for abscesses, as it is minimally invasive, leading to better patient tolerance and avoiding the risks associated with anesthesia and surgery. Saline irrigation of the abscess cavity can be performed, making the process of pus aspiration easier when the consistency is too viscous. The literature still lacks studies about the symptom relief in patients receiving treatment for pelvic cystic lesions. Given that this is an important outcome parameter in determining the feasibility of performing procedures, more research in this area is needed. The main aim of this prospective study is to evaluate the patient's symptom relief and cyst recurrence rate after ultrasound-guided transvaginal aspiration of pelvic cystic lesions or abscess drainage. Secondly, the safety and the patient's overall experience during as well as immediately after the procedure will be assessed.

Conditions

Pelvic Abscess; Adnexal Cyst; Ovarian Neoplasms

Keywords

adnexal cyst; transvaginal aspiration; cyst recurrence; pelvic abscess; symptom relief

Outcome Measures

Primary Outcomes (2)

• Pain on verbal rating scale (0-10)

  Pain scores indicated by the patient prior to the procedure, during the procedure, one week after and three months after the procedure.

  • Pain scores indicated by the patient prior to the procedure, during the procedure, one week after and three months after the procedure (based on a verbal rating scale).

• Recurrence of cyst (binary outcome after 12 months)

  Clinical and sonographic follow-up of possible recurrence (up till 12 months). Routine assessment will be done after 3 and 12 months

  12 months

Secondary Outcomes (2)

• General experience during the procedure (based on verbal rating scale 0-10)

  Right after the procedure to 3 days after.

• Complications (based on Clavien Dindo classification)

  Immediately after the procedure to 6 weeks after the procedure.

Other Outcomes (3)

• Cytological and possible microbial analysis of the aspirate.

  From the procedure (enrollment) to 2 weeks after the procedure.

• Difference of inflammatory markers (White blood cell count)

  From the procedure (enrollment) to 2 weeks after the procedure.

• Difference in inflammatory markers (C-reactive protein)

  From the procedure (enrollment) to 2 weeks after the procedure.

Study Arms (1)

Patients with pelvic cystic lesions (i.e adnexal lesions and abscesses)

Patients with cystic lesions (i.e adnexal lesions and abscesses), undergoing an ultrasound-guided transvaginal drainage as per our standard of practice.

Diagnostic Test: Ultrasound-guided transvaginal aspiration of cystic pelvic lesions.

Interventions

Ultrasound-guided transvaginal aspiration of cystic pelvic lesions. DIAGNOSTIC_TEST

Ultrasound-guided transvaginal aspiration is a minimally invasive procedure used to drain cystic pelvic lesions, such as adnexal cysts or pelvic abscesses. A thin needle is inserted through the vaginal wall under ultrasound guidance to aspirate fluid from the cyst, reducing its size.

Patients with pelvic cystic lesions (i.e adnexal lesions and abscesses)

Eligibility Criteria

• Age: 18 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

All patients elligible based on the above mentioned criteria in University Hospitals Leuven.

You may not qualify if:

• Patients \<18 years
• Poor performance status contra-indicating the procedure
• Vaginal stenosis (severe atrophy - virgo - vaginismus)
• Purely solid lesions
• Cystic lesions with a presumed malignant diagnosis and a risk of tumor dissemination in a curative setting
• Physiological cysts in asymptomatic patients (in case of doubt the patient is reassessed after 3-6 months)

Sponsors & Collaborators

• Universitaire Ziekenhuizen KU Leuven: lead

Study Sites (1)

University Hospitals Leuven

Leuven, Vlaams-Brabant, 3000, Belgium

RECRUITING

Related Publications (13)

• Saokar A, Arellano RS, Gervais DA, Mueller PR, Hahn PF, Lee SI. Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. AJR Am J Roentgenol. 2008 Nov;191(5):1352-8. doi: 10.2214/AJR.07.3808.

  PMID: 18941068 BACKGROUND

• Feld R, Eschelman DJ, Sagerman JE, Segal S, Hovsepian DM, Sullivan KL. Treatment of pelvic abscesses and other fluid collections: efficacy of transvaginal sonographically guided aspiration and drainage. AJR Am J Roentgenol. 1994 Nov;163(5):1141-5. doi: 10.2214/ajr.163.5.7976890.

  PMID: 7976890 BACKGROUND

• Caspi B, Goldchmit R, Zalel Y, Appelman Z, Insler V. Sonographically guided aspiration of ovarian cyst with simple appearance. J Ultrasound Med. 1996 Apr;15(4):297-300. doi: 10.7863/jum.1996.15.4.297.

  PMID: 8683664 BACKGROUND

• Troiano RN, Taylor KJ. Sonographically guided therapeutic aspiration of benign-appearing ovarian cysts and endometriomas. AJR Am J Roentgenol. 1998 Dec;171(6):1601-5. doi: 10.2214/ajr.171.6.9843295.

  PMID: 9843295 BACKGROUND

• Corsi PJ, Johnson SC, Gonik B, Hendrix SL, McNeeley SG Jr, Diamond MP. Transvaginal ultrasound-guided aspiration of pelvic abscesses. Infect Dis Obstet Gynecol. 1999;7(5):216-21. doi: 10.1002/(SICI)1098-0997(1999)7:53.0.CO;2-N.

  PMID: 10524665 BACKGROUND

• Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol. 2005 Oct;193(4):1323-30. doi: 10.1016/j.ajog.2005.06.019.

  PMID: 16202721 BACKGROUND

• Urfali FE, Korkmaz M, Zeren S, Yaylak F, Tok Umay S. Percutaneous drainage as an rapid procedure for deep pelvic abscess in the emergency department. Ulus Travma Acil Cerrahi Derg. 2021 Sep;27(5):534-538. doi: 10.14744/tjtes.2020.99478.

  PMID: 34476798 BACKGROUND

• Tsai CC, Shen CC, Changchien CC, Hsu TY, Kung FT, Chang SY, Chang MY, Huang FJ. Ultrasound-guided transvaginal cyst aspiration for the management of pelvic pseudocyst: a preliminary experience. Chang Gung Med J. 2002 Nov;25(11):751-7.

  PMID: 12553363 BACKGROUND

• Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, Wynants L, Van Holsbeke C, Epstein E, Franchi D, Kaijser J, Czekierdowski A, Guerriero S, Fruscio R, Leone FPG, Rossi A, Landolfo C, Vergote I, Bourne T, Valentin L. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016 Apr;214(4):424-437. doi: 10.1016/j.ajog.2016.01.007. Epub 2016 Jan 19.

  PMID: 26800772 BACKGROUND

• Duke D, Colville J, Keeling A, Broe D, Fotheringham T, Lee MJ. Transvaginal aspiration of ovarian cysts: long-term follow-up. Cardiovasc Intervent Radiol. 2006 May-Jun;29(3):401-5. doi: 10.1007/s00270-005-0167-0.

  PMID: 16502175 BACKGROUND

• Diaz de la Noval B, Rodriguez Suarez MJ, Fernandez Ferrera CB, Valdes Lafuente D, Arias Cailleau R, Perez Arias H, Torrejon Becerra JC, Suarez Gil P, Lucio Gonzalez LR. Transvaginal Ultrasound-Guided Fine-Needle Aspiration of Adnexal Cysts With a Low Risk of Malignancy: Our Experience and Recommendations. J Ultrasound Med. 2020 Sep;39(9):1787-1797. doi: 10.1002/jum.15283. Epub 2020 Apr 16.

  PMID: 32298023 BACKGROUND

• Garcia-Tejedor A, Castellarnau M, Burdio F, Fernandez E, Marti D, Pla MJ, Ponce J. Ultrasound-guided aspiration of adnexal cysts with a low risk of malignancy: is it a recommendable option? J Ultrasound Med. 2015 Jun;34(6):985-91. doi: 10.7863/ultra.34.6.985.

  PMID: 26014317 BACKGROUND

• Kostrzewa M, Zajac A, Wilczynski JR, Stachowiak G. Retrospective analysis of transvaginal ultrasound-guided aspiration of simple ovarian cysts. Adv Clin Exp Med. 2019 Nov;28(11):1531-1535. doi: 10.17219/acem/104549.

  PMID: 31660708 BACKGROUND

MeSH Terms

Conditions

Ovarian Neoplasms

Condition Hierarchy (Ancestors)

Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Diseases, Female; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Genital Neoplasms, Female; Urogenital Neoplasms; Genital Diseases; Endocrine System Diseases; Gonadal Disorders

Central Study Contacts

Stefan Timmerman, MD

CONTACT

+32 16 34 47 50; stefan.timmerman@uzleuven.be

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 15, 2025
• First Posted: May 23, 2025
• Study Start: March 13, 2025
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2028
• Last Updated: May 23, 2025

Record last verified: 2025-03

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP

Locations

BE (1)