Management of the Adnexal Mass

Abstract

Adnexal masses are commonly encountered in gynecologic practice and often present both diagnostic and management challenges. This is partly because of the fact that the majority of adnexal masses that are identified represent benign entities that do not necessarily require active intervention, yet a small subset will represent malignant processes that require both timely and appropriate surgical intervention for optimal outcome. To determine the best diagnostic and management strategies in this setting, physicians must effectively triage risk for malignancy by having a thorough understanding of the entities on the differential diagnosis and carefully considering the clinical context for each individual patient. Optimal selection and interpretation of diagnostic tests are enhanced by both an accurate clinical risk assessment and an understanding of the inherent accuracy of diagnostic tests considered in this setting. The purpose of this document is to provide clinicians with a practical strategy for distinguishing benign and malignant masses in the nonpregnant woman. Our approach addresses the critical elements of accurate risk stratification, reviews the performance of diagnostic tests for identifying malignancy, and offers evidence-based management algorithms to optimize outcomes for women with adnexal masses.

Strict Criteria for Selection of Laparoscopy for Women with Adnexal Mass

“…The number of gynecology-oncologists, however, is limited around the globe, resulting in the near impossibility that all adnexal tumors be operated by a specialist. 19–25 Appropriate selection and adequate intraoperative management are key points in the laparoscopic approach to adnexal masses.…”

“…17,18 Larger masses seem to increase the rate of conversion to laparotomy, reducing the benefits of a surgery initially begun by laparoscopy 19,20 ; also, larger masses appear to hamper intraoperative manipulation and to be associated with a higher rate of tumor rupture. 17 Because the rupture of an adnexal tumor upstages a malignant tumor, 21 many gynecologic surgeons tend to avoid manipulating large masses by laparoscopy.…”

Performance of three‐dimensional power Doppler angiography as third‐step assessment in differential diagnosis of adnexal masses

“…The differential diagnosis of adnexal masses remains a clinical challenge, but an accurate diagnosis is essential for adequate management. Ultrasound is considered as the first‐line diagnostic imaging tool for this task.…”

Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results

“…Accurate diagnosis of adnexal masses is crucial for their adequate management. Ultrasound is currently considered as the first‐line imaging technique for discriminating between benign and malignant adnexal masses.…”