Management of the Adnexal Mass: Considerations for the Family Medicine Physician

Abstract

Ovarian cancer is the most deadly gynecological cancer, so proper assessment of a pelvic mass is necessary in order to determine which are at high risk for malignancy and should be referred to a gynecologic oncologist. However, in a family medicine setting, evaluation and treatment of these masses can be challenging due to a lack of resources. A number of risk assessment tools are available to family medicine physicians, including imaging techniques, imaging systems, and blood-based biomarker assays each with their respective pros and cons, and varying ability to detect malignancy in pelvic masses. Effective utilization of these assessment tools can inform the care pathway for patients which present with an adnexal mass, such as expectant management for those with a low risk of malignancy, or referral to a gynecologic oncologist for surgery and staging, for those at high risk of malignancy. Triaging patients to the appropriate care pathway improves patient outcomes and satisfaction, and family medicine physicians can play a key role in this decision-making process.

Ovarian Masses: The Value of Acoustic Shadowing on Ultrasound Examination

“…Early intervention and referral to a gynecologic oncologist are known to significantly increase the chance of long‐term survival if malignancy is found 6,7 . However, not every mass requires oncologic assessment, and most (around 85%) adnexal masses prove to be benign and can be managed in a more conservative, fertility‐sparing way 6–8 . Even in the postmenopausal age group, most adnexal masses are benign, with serous or mucinous cystadenomas, simple cysts, and fibromas as the main diagnoses 7,9 .…”

“…6,7 However, not every mass requires oncologic assessment, and most (around 85%) adnexal masses prove to be benign and can be managed in a more conservative, fertility-sparing way. [6][7][8] Even in the postmenopausal age group, most adnexal masses are benign, with serous or mucinous cystadenomas, simple cysts, and fibromas as the main diagnoses. 7,9 In the premenopausal group, the most prevalent benign lesions are endometriomas and mature cystic teratomas, 4 and it can be further subcategorized according to different age groups.…”

Automatic segmentation of malignant and benign adnexal lesions on ultrasound scans

“…Lesions of the ovary and fallopian tube, i.e., adnexal lesions, are a common finding among women, 1 with a wide differential diagnosis including benign, borderline, and malignant tumor subtypes. 2 Ultrasound imaging is the initial imaging modality for the characterization and assessment of patients with adnexal lesions, with subjective assessment by expert examiners known to have the highest diagnostic accuracy.…”

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

“…In 2019, based on the IOTA terms and data sets, the American College of Radiology (ACR) introduced the Ovarian-Adnexal Reporting and Data System (O-RADS) model, which also provides management recommendations (Figure 1). However, neither of the IOTA models were widely adopted in the US, and the O-RADS system was only recently introduced with limited uptake . Challenging the use of standardized models were findings showing that subjective expert assessment had the highest accuracy .…”

“…However, neither of the IOTA models were widely adopted in the US, and the O-RADS system was only recently introduced with limited uptake. 1,[22][23][24] Challenging the use of standardized models were findings showing that subjective expert assessment had the highest accuracy. 18 However, acquiring such expertise in reviewing pelvic sonograms requires extensive training and may not be possible in low-volume practices.…”