Identifying Borderline Ovarian Tumor Recurrence Using Routine Ultrasound Follow-Up

SIMPLE SUMMARY: Borderline ovarian tumors have a favorable prognosis, and with one third of tumors diagnosed in women under 40 years of age, fertility preserving approaches are necessary. However, recurrence occurs and more frequently in those with fertility preserving treatment, but there is limited evidence regarding recurrence monitoring. The aim of this retrospective chart review was to determine if regular ultrasound follow-up is effective for recurrence monitoring in those with borderline ovarian tumors. We identified 56 patients with borderline ovarian tumors at our institution, all of whom had at least yearly ultrasound follow-up. Recurrence occurred in 6 patients and ultrasound first identified recurrence in 5 patients (83.3%), prior to findings on physical exam or patient-reported symptoms. Thus, our study suggest ultrasound as an accessible, inexpensive, and safe modality of recurrence monitoring that allows early detection of tumor recurrence and thus earlier intervention and prevention of further disease progression. ABSTRACT: Borderline ovarian tumors (BOTs) are non-invasive tumors frequently diagnosed in young patients. Surgical removal of the uterus, fallopian tubes, ovaries, and omentum is considered definitive management, however fertility-sparing approach is a recognized option. Surveillance is important due to known recurrence, but there is controversy over the effectiveness of follow-up modalities. The objective is to determine the efficacy of ultrasound screening in identifying tumor recurrence. This retrospective chart review evaluated all patients consulted and/or treated surgically at our institution from January 2015 to June 2020 diagnosed with BOT. Patients were excluded if concurrently diagnosed with another gynecologic malignancy, did not have yearly ultrasound follow-up, or were lost to follow-up. This study included 56 patients, 17 of whom underwent fertility preserving surgery. The overall rate of recurrence was 10.7%; with recurrence rates of 23.5% for the fertility preserving surgery population and 5.1% for the definitive surgery population. Ultrasound first identified 5 of the 6 (83.3%) recurrences. Overall time to recurrence was 51.5 months. In conclusion, recurrences were identified on routine ultrasound screening prior to symptom onset or detection via physical exam in 83.3% of cases. While the best modality of follow-up remains controversial, this review provides evidence supporting the use of routine ultrasound follow-up for early detection of BOT recurrence.