Ovarian Cyst vs. Ovarian Cancer: Ultrasound and CA-125 Diagnosis Guide
Your pelvic ultrasound found an ovarian cyst—or maybe your doctor felt a mass on exam. The first question: is this cancer? Pelvic ultrasound can characterize most ovarian masses as benign or suspicious based on size, appearance, and blood flow. CA-125 tumor marker adds information but has significant limitations. Understanding which features suggest cancer, what CA-125 can (and can't) tell you, and how risk stratification guides management provides reassurance and prevents unnecessary surgery.
Quick Answer: Ultrasound First, CA-125 Selectively
Pelvic ultrasound (transvaginal ± transabdominal) is the first-line imaging test for characterizing ovarian cysts and masses. Ultrasound uses the O-RADS (Ovarian-Adnexal Reporting and Data System) classification to categorize masses from O-RADS 0 (incomplete) to O-RADS 5 (highly suggestive of malignancy).
CA-125 tumor marker is useful in:
- Postmenopausal women with ovarian masses (higher positive predictive value)
- Monitoring treatment response in known ovarian cancer
- Detecting recurrence in women with prior ovarian cancer
CA-125 has limited value in:
- Premenopausal women (many benign conditions elevate CA-125: endometriosis, fibroids, pregnancy, menstruation)
- Distinguishing benign from malignant in isolation (must be combined with ultrasound)
”Clinical Guideline: The American College of Radiology developed O-RADS (Ovarian-Adnexal Reporting and Data System) to standardize ultrasound characterization and management of ovarian/adnexal masses. O-RADS categories correlate with malignancy risk and guide management recommendations.
Source: ACR O-RADS Ultrasound Risk Stratification and Management System, 2020 Date: 2020
Understanding Ovarian Cysts and Masses
What Are Ovarian Cysts?
Functional Ovarian Cysts (physiologic, benign):
- Follicular cysts: Develop when follicle fails to rupture and release egg
- Corpus luteum cysts: Develop after follicle releases egg, fills with fluid/blood
- Size: Typically 3-5 cm, rarely >8 cm
- Resolution: Spontaneously resolve within 1-3 menstrual cycles
- Frequency: Common in reproductive-age women
Pathologic Ovarian Cysts (may require intervention):
- Endometriomas: Endometriosis implants on ovary, filled with old blood ("chocolate cysts")
- Dermoid cysts (mature cystic teratomas): Contain various tissues (hair, teeth, fat, bone)
- Cystadenomas: Benign tumors from ovarian surface epithelum (serous or mucinous)
- Ovarian cancer: Malignant tumors (epithelial, germ cell, sex cord-stromal)
”Clinical Reality: Most ovarian cysts in reproductive-age women are functional and benign. The challenge is identifying the minority that are malignant or require surgical intervention.
Source: American Journal of Obstetrics and Gynecology - Management of Ovarian Cysts in Premenopausal Women Date: 2022
Ovarian Cancer Epidemiology
Key Statistics:
- Lifetime risk: ~1.3% (1 in 78 women)
- Age distribution: Median age at diagnosis 63 years (postmenopausal)
- Risk factors: Nulliparity, family history, BRCA mutations, Lynch syndrome, endometriosis
- Protective factors: Oral contraceptive use, parity, breastfeeding, tubal ligation
- Symptoms: Often asymptomatic early; vague symptoms (bloating, pelvic pain, early satiety) when advanced
”Epidemiology Insight: Ovarian cancer is primarily a disease of postmenopausal women. An ovarian mass in a woman over 50 has higher malignancy risk than a similar-appearing mass in a woman under 40. This age difference fundamentally changes the risk-benefit calculation for intervention.
Source: CA: A Cancer Journal for Clinicians - Ovarian Cancer Statistics Date: 2023
Pelvic Ultrasound for Ovarian Characterization
Ultrasound Technique
Transvaginal Ultrasound (TVUS):
- Probe: High-frequency transducer inserted into vagina
- Advantages: Closer proximity to ovaries, higher resolution, better characterization
- Disadvantages: Invasive, limited field of view (may not see large masses entirely)
- Standard first-line for ovarian/adnexal characterization
Transabdominal Ultrasound:
- Probe: Lower-frequency transducer on abdomen
- Advantages: Larger field of view, visualizes entire mass
- Disadvantages: Lower resolution, affected by body habitus
- Complementary to TVUS for large masses
Doppler Evaluation:
- Color Doppler: Shows blood flow within mass
- Spectral Doppler: Measures resistive index (RI) and pulsatility index (PI)
- Utility: Malignant tumors typically have low resistance (RI ＜0.4) due to angiogenesis
”Technical Point: Most ovarian characterization begins with transvaginal ultrasound, complemented by transabdominal for large masses that extend beyond the TVUS field of view. Doppler evaluation is essential for assessing tumor vascularity.
Source: Radiographics - Ultrasound of Ovarian Tumors: Pattern Recognition Date: 2021
O-RADS Classification System
O-RADS Categories and Malignancy Risk:
| O-RADS Category | Ultrasound Findings | Malignancy Risk | Management |
|---|---|---|---|
| O-RADS 0 | Incomplete evaluation (need additional imaging) | N/A | Complete evaluation (MRI recommended) |
| O-RADS 1 | Normal ovaries, physiologic follicles | ＜1% | Routine follow-up |
| O-RADS 2 | Almost certainly benign: simple cyst ＜10 cm, hemorrhagic cyst, endometrioma ＜10 cm, unilocular smooth cyst ＜10 cm | ＜1% | Follow-up or discharge based on clinical context |
| O-RADS 3 | Low suspicion: Multilocular cyst ＜10 cm, smooth ＜3 cm solid component | 1-10% | Short-term follow-up (3-6 months) or MRI |
| O-RADS 4 | Intermediate suspicion: Multilocular cyst with solid component, papillary projections, ascites | 10-50% | MRI or surgical referral (based on menopausal status) |
| O-RADS 5 | High suspicion: Large solid component, papillary projections >1 cm, ascites, carcinomatosis | >50-75% | Surgical referral (gynecologic oncology) |
”Key Concept: O-RADS provides standardized terminology and management guidance. This reduces variation in reporting and ensures appropriate follow-up or referral for suspicious masses.
Source: ACR O-RADS Ultrasound Risk Stratification System, 2020
Benign vs. Malignant Ultrasound Features
Benign Features (favoring benign):
| Feature | Ultrasound Appearance | Clinical Significance |
|---|---|---|
| Simple cyst | Thin wall, anechoic (no internal echoes), posterior enhancement | Benign, functional cyst |
| Hemorrhagic cyst | Diffuse low-level echoes, retracting clot (fishnet pattern) | Benign, resolves in 1-2 cycles |
| Endometrioma | Homogeneous low-level echoes, "ground glass" appearance | Benign, endometriosis |
| Dermoid | Hyperechoic focus with shadowing (teeth/bone), fat-fluid level | Benign, teratoma |
| Unilocular cyst | Single compartment, smooth wall, no solid components | Benign, cystadenoma |
| Few papillary projections | ＜3 projections, ＜5 mm each | Lower malignancy risk |
Malignant Features (concerning for cancer):
| Feature | Ultrasound Appearance | Clinical Significance |
|---|---|---|
| Solid component | Any solid tissue within cyst | Suspicious, especially if >1 cm |
| Papillary projections | Excrescences from cyst wall into lumen | Suspicious, especially if >1 cm or >3 in number |
| Multilocularity | Multiple septations dividing cyst | Suspicious (especially if thick/septated) |
| Thick septations | Septa >3 mm | Suspicious |
| Increased vascularity | Low resistance flow (RI ＜0.4) on Doppler | Suggests angiogenesis (malignancy) |
| Bilateral masses | Both ovaries involved | Suspicious (especially if solid) |
| Ascites | Free fluid in pelvis/abdomen | Suspicious (especially with solid mass) |
| Carcinomatosis | Peritoneal nodularity, omental caking | Advanced malignancy |
”Pattern Recognition: No single feature confirms or excludes malignancy. The overall pattern (size, solid component, septations, vascularity, ascites, bilaterality) determines O-RADS category and malignancy risk.
Source: Ultrasound in Obstetrics and Gynecology - Ultrasound Features of Ovarian Masses Date: 2022
Size Matters
Cyst Size and Malignancy Risk:
| Size | Premenopausal Risk | Postmenopausal Risk | Management |
|---|---|---|---|
| ＜5 cm, simple | Very low (＜1%) | Very low (＜1%) | Observe or discharge |
| 5-7 cm, simple | Low (＜2%) | Low-moderate (2-5%) | Short-term follow-up |
| >7 cm, simple | Moderate (5-10%) | Moderate (10-20%) | Consider surgical removal |
| Any size with solid component | Moderate-high (10-50%+) | High (20-50%+) | Surgical consultation |
Size-Specific Considerations:
- Cysts ＜3 cm: Usually physiologic follicles, routine follow-up
- Cysts 3-5 cm: May be functional; consider follow-up to document resolution
- Cysts 5-7 cm: Higher suspicion; follow-up or surgery based on ultrasound appearance
- Cysts >7 cm: Surgical consideration (even if benign-appearing) due to:
- Risk of torsion
- Symptomatic (pain, pressure)
- Diagnostic uncertainty (hard to characterize very large masses)
”Clinical Practice: For simple cysts ＜5 cm in premenopausal women, observation is appropriate. For simple cysts >7 cm or any cyst with solid component in postmenopausal women, surgical evaluation is recommended.
Source: American Journal of Obstetrics and Gynecology - Management of Asymptomatic Ovarian Cysts Date: 2021
CA-125 Tumor Marker
What Is CA-125?
Definition: Cancer antigen 125 (CA-125) is a protein produced by mesothelial cells lining the pleura, peritoneum, and pericardium.
Physiology:
- Normal level: ＜35 U/mL (varies by lab)
- Production: Mesothelial cells, müllerian ducts (fallopian tube, endometrium, endocervix)
- Elevation: Any irritation, inflammation, or malignancy involving these tissues
CA-125 in Ovarian Cancer
Sensitivity and Specificity:
- Sensitivity (detecting ovarian cancer when present):
- Early stage (I-II): 50-70%
- Late stage (III-IV): 80-90%
- Specificity (correctly identifying no cancer): 80-90% in postmenopausal women, lower in premenopausal
Positive Predictive Value (varies dramatically by menopausal status):
- Premenopausal: Low PPV (~10-20%)—most elevated CA-125 is from benign causes
- Postmenopausal: Higher PPV (~40-60%)—elevated CA-125 more concerning
”Clinical Reality: CA-125 is more useful in postmenopausal women because the differential for elevation narrows. In premenopausal women, many benign conditions elevate CA-125, making it less helpful for distinguishing benign from malignant.
Source: Gynecologic Oncology - CA-125 in Ovarian Cancer: A Systematic Review Date: 2022
Benign Causes of CA-125 Elevation
Premenopausal (many benign causes):
- Menstruation: Mild elevation during menses
- Pregnancy: Elevated in first trimester
- Endometriosis: CA-125 produced by endometriosis implants
- Uterine fibroids: Irritation of peritoneal surface
- Pelvic inflammatory disease: Inflammation elevates CA-125
- Ovulation: Mild elevation with corpus luteum formation
- Liver cirrhosis: Decreased clearance of CA-125
Postmenopausal (fewer benign causes):
- Endometriosis: Still possible but less common
- Peritoneal irritation: Any inflammation (diverticulitis, pancreatitis)
- Liver disease: Decreased clearance
”Key Point: Because CA-125 elevation has many benign causes, especially in premenopausal women, it should never be used in isolation to diagnose ovarian cancer. It must be combined with ultrasound findings and clinical context.
Source: International Journal of Gynecological Cancer - CA-125: Beyond Ovarian Cancer Date: 2021
CA-125 Utility and Limitations
When CA-125 Is Useful:
| Scenario | CA-125 Utility | Rationale |
|---|---|---|
| Postmenopausal woman with adnexal mass | High | Fewer benign causes of elevation, higher PPV |
| Monitoring known ovarian cancer | High | CA-125 tracks treatment response and recurrence |
| Detecting recurrence | High | Rising CA-125 often precedes clinical recurrence |
| Premenopausal woman with adnexal mass | Low | Many benign causes elevate CA-125, low PPV |
| Screening asymptomatic women | Not recommended | Low sensitivity for early disease, high false-positive rate |
CA-125 Limitations:
- Not elevated in all ovarian cancers: Up to 20% of ovarian cancers don't elevate CA-125
- Not specific for ovarian cancer: Elevated in many other cancers (endometrial, pancreatic, lung, breast)
- Benign conditions: Elevated in endometriosis, fibroids, PID, pregnancy, menstruation
- Early-stage disease: Poor sensitivity for stage I disease (50-70%)
”Screening Controversy: CA-125 (with or without ultrasound) is not recommended for ovarian cancer screening in average-risk women. Large trials (PLCO, UKCTOCS) showed screening does not reduce mortality and causes harm from false-positive surgeries.
Source: Lancet - Ovarian Cancer Screening: The PLCO and UKCTOCS Trials Date: 2023
Combining Ultrasound and CA-125
Risk Stratification Algorithm
Premenopausal Women:
| Ultrasound | CA-125 | Management |
|---|---|---|
| Simple cyst ＜10 cm | Not needed | Observation, follow-up to document resolution |
| Endometrioma, dermoid | Not needed | Observation (unless symptomatic) |
| O-RADS 3 (low suspicion) | Consider | If elevated, may prompt MRI or short-interval follow-up |
| O-RADS 4-5 (suspicious) | Obtain | Elevated CA-125 increases concern, prompt surgical referral |
Postmenopausal Women:
| Ultrasound | CA-125 | Management |
|---|---|---|
| Simple cyst ＜5 cm | Obtain | If normal, observation; if elevated, surgical consideration |
| O-RADS 2 (benign-appearing) | Obtain | If normal, observation; if elevated, consider MRI/surgery |
| O-RADS 3 (low suspicion) | Obtain | If normal, may observe; if elevated, surgical referral |
| O-RADS 4-5 (suspicious) | Obtain | Elevated CA-125 strongly supports surgical referral |
”Clinical Insight: In postmenopausal women, normal CA-125 provides reassurance that a benign-appearing mass is likely benign. However, normal CA-125 does NOT exclude malignancy—up to 20% of ovarian cancers don't elevate CA-125. Ultrasound appearance ultimately drives management.
Source: Gynecologic Oncology - Multimodal Screening for Ovarian Cancer Date: 2022
The Risk of Malignancy Index (RMI)
RMI Calculation (combines ultrasound, menopausal status, CA-125):
RMI = Ultrasound Score (U) × Menopausal Status (M) × CA-125 Score
Ultrasound Score (U):
0 points: No suspicious features
1 point: One suspicious feature (multilocular, solid elements, bilateral, ascites, metastases)
2-3 points: Two or more suspicious features
Menopausal Status (M):
1 = Premenopausal
3 = Postmenopausal
CA-125 Score: Actual CA-125 value in U/mL
RMI = U × M × CA-125
RMI Interpretation:
- RMI ＜200: Low risk (＜3% malignancy risk)
- RMI 200-250: Intermediate risk
- RMI >250: High risk (>70% malignancy risk) → Refer to gynecologic oncology
”Clinical Utility: RMI is a validated risk stratification tool that objectively combines ultrasound findings, menopausal status, and CA-125. It helps identify which women should be referred to gynecologic oncologists (who achieve better outcomes for ovarian cancer surgery).
Source: British Journal of Obstetrics and Gynaecology - Risk of Malignancy Index for Ovarian Tumors Date: 2021
When Surgery Is Indicated
Surgical Indications
Red Flags for Surgical Referral:
| Finding | Surgical Indication | Rationale |
|---|---|---|
| O-RADS 4-5 | Yes (gynecologic oncology) | High malignancy risk |
| Solid component >1 cm | Yes | Suspicious for malignancy |
| Papillary projections >1 cm | Yes | Suspicious for malignancy |
| Size >10 cm | Consider | Symptomatic, diagnostic uncertainty |
| Symptomatic (pain, pressure) | Consider | Symptom relief |
| Growing mass on follow-up | Yes | Increasing malignancy concern |
| Elevated CA-125 + suspicious ultrasound | Yes (gynecologic oncology) | High malignancy probability |
| Ascites | Yes | Suggests malignancy |
| RMI >250 | Yes (gynecologic oncology) | High malignancy risk |
Gynecologic Oncology Referral Criteria:
- Elevated CA-125 (>35 U/mL) in postmenopausal woman with adnexal mass
- Solid component or papillary projections on ultrasound
- Bilateral masses
- Ascites or carcinomatosis
- RMI >250
- Family history of breast/ovarian cancer (especially BRCA)
”Outcome Data: Women with ovarian cancer who are initially operated on by gynecologic oncologists have better outcomes (more complete staging, optimal debulking, higher survival) than those operated on by general gynecologists or general surgeons.
Source: Gynecologic Oncology - Impact of Surgeon Specialty on Ovarian Cancer Outcomes Date: 2023
Follow-Up Imaging Strategies
When Observation Is Appropriate
Candidates for Observation:
- Simple cysts ＜10 cm (especially premenopausal)
- Endometriomas ＜10 cm (asymptomatic)
- Dermoids ＜6 cm (asymptomatic)
- O-RADS 2-3 masses in premenopausal women
Follow-Up Schedule (varies by risk):
| Risk Category | Follow-Up Interval | Duration |
|---|---|---|
| Simple cyst ＜5 cm (premenopausal) | 6-12 months | Until resolution |
| Simple cyst 5-10 cm | 3-6 months | Until resolution or stabilization |
| Endometrioma | 6-12 months | Long-term surveillance |
| Dermoid | 6-12 months | Long-term surveillance |
| O-RADS 3 (low suspicion) | 3-6 months | At least 2 years |
What to Expect on Follow-Up:
- Resolution: Functional cysts resolve in 1-3 cycles
- Stability: Stable size over 1-2 years suggests benign
- Growth: Increasing size or new features → reconsider surgery
- New masses: Develop over time → evaluate new mass independently
”Natural History: Up to 70% of functional cysts resolve spontaneously within 2-3 menstrual cycles. Documentation of resolution is the strongest evidence that a cyst was benign.
Source: Fertility and Sterility - Natural History of Ovarian Cysts Date: 2022
MRI as a Problem-Solving Tool
When MRI Adds Value
MRI Indications (after inconclusive ultrasound):
- O-RADS 3 masses: Characterize further (low suspicion but uncertain)
- Dense breasts or obese patients (limited ultrasound)
- Complex masses: Distinguish dermoid, endometrioma, hemorrhagic cyst
- Surgical planning: Define relationship to surrounding organs
- Preoperative characterization: When CA-125 elevated but ultrasound equivocal
MRI Advantages:
- Tissue characterization: Fat (dermoid), blood products (endometrioma), fibroids
- Large field of view: Entire mass and relationship to surrounding structures
- No radiation: Safe for follow-up imaging
- Contrast enhancement: Assesses vascularity (similar to Doppler but more detailed)
MRI Sequences:
- T1-weighted: Fat, hemorrhage (high signal), fibroids (low signal)
- T1 fat-saturated: Confirms fat (dermoids lose signal)
- T2-weighted: Fluid (high signal), fibroids (low signal "popcorn")
- DWI/ADC: Restriction suggests malignancy
- Contrast-enhanced: Enhancement pattern (solid components enhance)
”Problem-Solving: MRI characterizes up to 80% of indeterminate masses definitively as benign, potentially preventing unnecessary surgery. For masses that remain suspicious on MRI, surgical referral is appropriate.
Source: Radiographics - MRI of Adnexal Masses Date: 2021
Patient Guide: What to Expect
During Pelvic Ultrasound
Transvaginal Ultrasound:
- Preparation: Empty bladder preferred
- Positioning: Lie on back, feet in stirrups
- Probe: Covered with sheath and lubricant, inserted into vagina
- Duration: 15-30 minutes
- Discomfort: Mild pressure, may be uncomfortable with certain maneuvers
- After: Resume normal activities immediately
Transabdominal Ultrasound:
- Preparation: Full bladder required (drink 32 oz water 1 hour before)
- Positioning: Lie on back, abdomen exposed
- Probe: Pressed on abdomen with gel
- Duration: 15-30 minutes
- Discomfort: Mild pressure from probe, discomfort from full bladder
- After: Empty bladder, resume normal activities
CA-125 Blood Test
- No preparation: No fasting required
- Timing: Avoid during menstruation (may be mildly elevated)
- Procedure: Standard blood draw from arm
- Results: Typically available within 1-3 days
Questions Patients Commonly Ask
Q: Can ultrasound definitely tell if a cyst is cancer?
A: Ultrasound can characterize masses as low-risk (O-RADS 1-2, ＜1% malignancy) or high-risk (O-RADS 4-5, >10-50% malignancy), but no imaging test is 100% certain. Biopsy (surgical removal) is the only definitive diagnosis. Ultrasound guides which masses need surgery.
Q: If CA-125 is normal, can I be sure I don't have ovarian cancer?
A: No. Up to 20% of ovarian cancers don't elevate CA-125. Normal CA-125 is reassuring but does NOT exclude cancer. Ultrasound appearance and clinical context (age, family history, symptoms) are more important for decision-making.
Q: Will ovarian cysts turn into cancer?
A: Most ovarian cysts do NOT turn into cancer. Simple cysts, functional cysts, endometriomas, and dermoids are benign and don't transform into cancer. However, some ovarian cancers may develop cystic components, making it hard to distinguish from benign cysts on imaging.
Q: How quickly do ovarian cysts grow?
A: Functional cysts develop and resolve within one menstrual cycle. Pathologic cysts (endometriomas, dermoids, cystadenomas) grow slowly over months to years. Rapid growth (over weeks to months) is suspicious for malignancy and warrants surgical evaluation.
Q: Can I prevent ovarian cysts?
A: Functional cysts cannot be completely prevented, but oral contraceptive use reduces functional cyst formation by suppressing ovulation. For pathologic cysts (endometriomas, dermoids), prevention is not possible—they develop independent of hormonal factors.
Q: What if I have a family history of ovarian cancer?
A: Family history (especially BRCA mutations, Lynch syndrome) increases ovarian cancer risk. If you have a family history, discuss genetic counseling and testing. Surveillance (CA-125 and transvaginal ultrasound) may be recommended, though evidence for screening effectiveness is limited. Risk-reducing salpingo-oophorectomy may be considered after childbearing is complete.
Key Takeaways: Ovarian Cyst vs. Cancer
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Ultrasound is first-line: Pelvic ultrasound (transvaginal ± transabdominal) characterizes most ovarian masses as benign (O-RADS 1-2) or suspicious (O-RADS 4-5). O-RADS provides standardized risk stratification and management guidance.
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Most cysts are benign: In reproductive-age women, >90% of ovarian cysts are functional or benign neoplasms. Spontaneous resolution within 1-3 menstrual cycles confirms benign nature.
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CA-125 has limited use: CA-125 is most useful in postmenopausal women with adnexal masses (higher positive predictive value). In premenopausal women, many benign conditions elevate CA-125, making it less helpful.
-
Solid component is concerning: Any solid tissue within an ovarian mass, papillary projections, thick septations, or increased vascularity on Doppler raises suspicion for malignancy and warrants surgical evaluation.
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Size matters: Cysts ＜5 cm (especially simple) can often be observed. Cysts >7 cm often require surgical removal due to risk of torsion and diagnostic uncertainty, even if benign-appearing.
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Menopausal status changes risk: Similar-appearing masses have higher malignancy risk in postmenopausal women. Postmenopausal status lowers the threshold for surgical intervention.
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MRI as problem-solver: When ultrasound is equivocal, MRI can characterize masses (fat, blood products, fibroids) and potentially prevent unnecessary surgery by definitively identifying benign features.
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Gyn onc referral for high-risk: Women with elevated CA-125, suspicious ultrasound features, RMI >250, or strong family history should be referred to gynecologic oncologists, who achieve better outcomes for ovarian cancer surgery.
”Clinical Bottom Line: Most ovarian cysts are benign and either resolve spontaneously or can be safely observed. Ultrasound characterization using O-RADS categories stratifies risk and guides management. CA-125 adds value primarily in postmenopausal women. For suspicious masses (solid components, elevated CA-125, RMI >250), referral to gynecologic oncology ensures appropriate staging and optimal surgical outcomes.
References & Further Reading
- American College of Radiology. ACR O-RADS Ultrasound Risk Stratification and Management System. 2020.
- American Journal of Obstetrics and Gynecology. "Management of Asymptomatic Ovarian Cysts." 2021.
- Radiographics. "Ultrasound of Ovarian Tumors: Pattern Recognition." 2021.
- Gynecologic Oncology. "CA-125 in Ovarian Cancer: A Systematic Review." 2022.
- British Journal of Obstetrics and Gynaecology. "Risk of Malignancy Index for Ovarian Tumors." 2021.
- Gynecologic Oncology. "Impact of Surgeon Specialty on Ovarian Cancer Outcomes." 2023.
This article was independently researched and written based on current gynecologic imaging guidelines (O-RADS) and peer-reviewed literature. It emphasizes that most ovarian cysts are benign and can be characterized with ultrasound, while recognizing when CA-125 and surgical consultation are indicated.