A 35-year-old with a 10 cm left ovarian cyst undergoes laparoscopy. Frozen section shows a serous borderline tumour (SBT) with microinvasion (<5 mm). What is the most appropriate next step in management?
- A Conversion to laparotomy and radical staging surgery with oophorectomy
- B Complete laparoscopic cystectomy with contralateral ovarian assessment; bilateral oophorectomy not required if desirous of fertility ✓
- C Immediate bilateral salpingo-oophorectomy given microinvasion
- D Close observation only — borderline tumours with microinvasion do not alter management
Correct answer: B. Complete laparoscopic cystectomy with contralateral ovarian assessment; bilateral oophorectomy not required if desirous of fertility
Explanation
Microinvasion in serous borderline tumours (foci <5 mm) does not upstage the tumour to invasive carcinoma and does not worsen prognosis significantly. For young women wishing to preserve fertility, fertility-sparing surgery (cystectomy with uterus and contralateral ovary retention) is appropriate. Full staging (omentectomy, peritoneal biopsies) should be performed laparoscopically. Bilateral oophorectomy is not mandatory for microinvasion in fertility-age patients. Observation alone without surgical staging would be inadequate.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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