Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update

Stein, Erica B.; Roseland, Molly E.; Shampain, Kimberly L.; Wasnik, Ashish P.; Maturen, Katherine E.

doi:10.1007/s00261-020-02812-z

Cited by 24 publications

(14 citation statements)

References 35 publications

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“…The SRU guidelines propose that within an ovarian or adnexal cystic lesion, multiple thin septations (<3 mm) or an avascular, solid non-hyperechoic nodule are indeterminate characteristics, often found in benign neoplasms. If the cyst is more than 10 cm in size or continues to have indeterminate findings, surgical evaluation should be considered (16). In the past, the resection of the cystic mass by an exploratory laparotomy was the preferred management strategy (9).…”

Section: Discussionmentioning

confidence: 99%

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

et al. 2021

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BackgroundOvarian cysts are very common diseases of the female reproductive system. Giant ovarian cysts refer to the tumors with diameters greater than 10 cm. In recent years, due to the development of clinical diagnosis, imaging modalities, and the improvement of patients’ cognition of the diseases, the occurrence of giant ovarian cysts has become rare. The purpose of this study was to show a new operation method of single-port laparoscopy to treat giant ovarian cysts.MethodsWe report a case series of five patients with giant ovarian cysts who underwent single-port laparoscopic surgery in the gynecology department of the Shengjing Hospital of China Medical University between June 2020 and March 2021. The inclusion criteria were ovarian cysts at least 20 cm in diameter, and cases when the tumor might be malignant were excluded.ResultsThe patients’ mean age was 26.2years. The most common clinical presentation was progressive abdominal distension. Median size of the cysts at imaging was 39.2 cm (range 21–63 cm). All patients underwent single-port laparoscopic surgery, and none of them converted to laparotomy. On final pathological reports, two cysts were serous cystadenomas, and three were mucinous cystadenomas. All patients recovered well and were discharged on time.ConclusionGiant ovarian cysts can be treated by single-port laparoscopic surgery. In addition to the well-known advantages of laparoscopic surgery (e.g., small pelvic interference, fast postoperative recovery), it can also play the role of perfect cosmetic results, which has more advantages for young women.

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Section: Discussionmentioning

confidence: 99%

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

et al. 2021

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“…Patients were included if they had a surgical intervention within 180 days or had adequate clinical or imaging follow-up. Follow-up was defined as adequate 16,[26][27][28][29] if the adnexal mass resolved or decreased in size by at least 10% on subsequent imaging, remained unchanged over 1 year, or was identified as a classic lesion (eg, dermoid, endometrioma) on computed tomography or magnetic resonance imaging (MRI) scans. Patients from the prospective database without adequate follow-up were also included if a second review by an ultrasonography expert with more than 20 years of experience (R.E.L.)…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

et al. 2023

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ImportanceUltrasonography-based risk models can help nonexpert clinicians evaluate adnexal lesions and reduce surgical interventions for benign tumors. Yet, these models have limited uptake in the US, and studies comparing their diagnostic accuracy are lacking.ObjectiveTo evaluate, in a US cohort, the diagnostic performance of 3 ultrasonography-based risk models for differentiating between benign and malignant adnexal lesions: International Ovarian Tumor Analysis (IOTA) Simple Rules with inconclusive cases reclassified as malignant or reevaluated by an expert, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX), and Ovarian-Adnexal Reporting and Data System (O-RADS).Design, Setting, and ParticipantsThis retrospective diagnostic study was conducted at a single US academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically or conservatively between January 2017 and October 2022.ExposureEvaluation of adnexal lesions using the Simple Rules, ADNEX, and O-RADS.Main Outcomes and MeasuresThe main outcome was diagnostic performance, including area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Surgery or follow-up were reference standards. Secondary analyses evaluated the models’ performances stratified by menopause status and race.ResultsThe cohort included 511 female patients with a 15.9% malignant tumor prevalence (81 patients). Mean (SD) ages of patients with benign and malignant adnexal lesions were 44.1 (14.4) and 52.5 (15.2) years, respectively, and 200 (39.1%) were postmenopausal. In the ROC analysis, the AUCs for discriminative performance of the ADNEX and O-RADS models were 0.96 (95% CI, 0.93-0.98) and 0.92 (95% CI, 0.90-0.95), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.93 (95% CI, 0.90-0.96), which was similar to that for O-RADS. The Simple Rules combined with expert reevaluation had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 91.9% specificity (95% CI, 88.9%-94.3%), and the Simple Rules combined with malignant classification had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 88.1% specificity (95% CI, 84.7%-91.0%). At a 10% risk threshold, ADNEX had 91.4% sensitivity (95% CI, 83.0%-96.5%) and 86.3% specificity (95% CI, 82.7%-89.4%) and O-RADS had 98.8% sensitivity (95% CI, 93.3%-100%) and 74.4% specificity (95% CI, 70.0%-78.5%). The specificities of all models were significantly lower in the postmenopausal group. Subgroup analysis revealed high performances independent of race.Conclusions and RelevanceIn this diagnostic study of a US cohort, the Simple Rules, ADNEX, and O-RADS models performed well in differentiating between benign and malignant adnexal lesions; this outcome has been previously reported primarily in European populations. Risk stratification models can lead to more accurate and consistent evaluations of adnexal masses, especially when used by nonexpert clinicians, and may reduce unnecessary surgeries.

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“…However, the majority of incidentally detected adnexal masses are benign, resulting in many unnecessary oophorectomies. 86 Epithelial ovarian tumors with their serous and mucinous subtypes are the most common tumors and can be further stratified into benign, low malignant potential (borderline-which can offer the option of sparing fertility during resection), or malignant based on pathology, and the most challenging diagnosis of these is the borderline tumor. Borderline tumors have less soft tissue and thinner walls and/or septations than malignant tumors.…”

Section: Ovarian Tumorsmentioning

confidence: 99%

“…Incidental adnexal masses are commonly discovered during CT imaging, and many women undergo surgical evaluation for these lesions. However, the majority of incidentally detected adnexal masses are benign, resulting in many unnecessary oophorectomies 86 . Epithelial ovarian tumors with their serous and mucinous subtypes are the most common tumors and can be further stratified into benign, low malignant potential (borderline—which can offer the option of sparing fertility during resection), or malignant based on pathology, and the most challenging diagnosis of these is the borderline tumor.…”

Section: Genitourinary Applicationsmentioning

confidence: 99%

Exploiting the Potential of Photon-Counting CT in Abdominal Imaging

Schwartz¹,

Samei

Marin³

2023

Invest Radiol

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Photon-counting computed tomography (PCCT) imaging uses a new detector technology to provide added information beyond what can already be obtained with current CT and MR technologies. This review provides an overview of PCCT of the abdomen and focuses specifically on applications that benefit the most from this new imaging technique. We describe the requirements for a successful abdominal PCCT acquisition and the challenges for clinical translation. The review highlights work done within the last year with an emphasis on new protocols that have been tested in clinical practice. Applications of PCCT include imaging of cystic lesions, sources of bleeding, and cancers. Photon-counting CT is positioned to move beyond detection of disease to better quantitative staging of disease and measurement of treatment response.

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Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update

Cited by 24 publications

References 35 publications

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

Giant Ovarian Cysts Treated by Single-Port Laparoscopic Surgery: A Case Series

Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

Exploiting the Potential of Photon-Counting CT in Abdominal Imaging

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