Ultrasound-Guided Aspiration with Methotrexate Injection for Benign Ovarian Cysts

A Prospective Interventional Study

Abstract

·  Background: Ovarian cysts are common and often require surgical management, which carries risks and can impact ovarian reserve. Ultrasound-guided aspiration alone is associated with high recurrence rates. This study aimed to evaluate the efficacy and safety of this procedure when combined with intralesional methotrexate injection as a minimally invasive treatment.

·  Methods: A prospective interventional study was conducted at Latakia University Hospital (Latakia, Syria) from 2023 to 2025. After an initial follow-up period of 50 patients, 35 women with benign persistent ovarian cysts (simple or endometriotic cysts, diameter 3–10 cm, CA125 < 35 U/mL) underwent ultrasound-guided aspiration, followed by intralesional injection of methotrexate 30 mg. Patients were followed for 12 months to assess cyst resolution and complications.

·  Results: Among the 35 patients, complete cyst resolution was achieved in 29 patients (82.9%) after the first treatment cycle. A second treatment cycle led to recovery in an additional 4 patients, bringing the overall success rate to 94.3% (33 of 35) without the need for surgery.