Materiały źródłowe

• #1 Adnexal tumors and masses – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adnexal-tumors/symptoms-causes/syc-20355053

  Adnexal tumors and masses are growths of cells that form on the organs and connective tissue around the uterus. Adnexal tumors and masses most often aren’t cancer, but they can be cancer. […] Diagnosis of adnexal tumors and masses involves a careful physical exam, imaging tests and blood tests. Treatment depends on the size of the tumor or mass and its cause. […] Most adnexal tumors and masses are not cancer. But some may be cancer that affects the ovaries, fallopian tubes or the tissue around them.

• #2 Adnexal Mass: Tumor, Cyst, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22015-adnexal-mass-tumors

  An adnexal mass forms near your ovaries, fallopian tubes or surrounding connective tissues. Most adnexal tumors are benign (noncancerous), but they can be malignant (cancerous). […] An adnexal mass (adnexal tumor) is a growth that develops near your uterus, usually in your ovaries, fallopian tubes and neighboring connective tissues. […] Most adnexal masses aren’t cancerous (benign) and go away on their own within a few months. […] Most adnexal masses aren’t serious. Only a healthcare provider can determine if a mass is something to worry about. Adnexal masses aren’t typically cancerous and don’t usually long-term or life-threatening complications. […] No. Most adnexal tumors are benign (noncancerous). But a small percentage are malignant (cancerous). Your risk for having a malignant adnexal tumor increases after menopause.

• #3 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Most of the adnexal masses are benign, without symptoms diagnosed incidentally, and can have expectant management. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Correct differential diagnoses of benign and malignant mass matter. […] Panels of biomarkers is not sufficient for the initial evaluation of an adnexal mass. […] Transvaginal ultrasonography is the single most effective way of evaluating an ovarian mass. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The diagnosis of adnexal mass in women with pelvic symptoms or incidentally represents a routine in gynecological practice and often presents diagnostic and management dilemmas.

• #4 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Pelvic examination has low sensitivity for detecting an adnexal mass; negative pelvic examination findings in a symptomatic woman should not deter further workup. […] A cancer antigen 125 (CA 125) test may assist in the evaluation of an adnexal mass in appropriate patients. […] Transvaginal ultrasonography is the first choice for imaging of an adnexal mass. […] If an adnexal mass larger than 6 cm is found on ultrasonography, or if findings persist longer than 12 weeks, referral to a gynecologist or gynecologic oncologist is indicated.

• #5 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  The clinician needs to interpret symptoms and findings from multiple organ systems and use appropriate imaging to differentiate expeditiously between a benign and a malignant cause of an adnexal mass. […] The differential diagnosis for adnexal masses is broad. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Transvaginal ultrasonography is the first choice for imaging to differentiate between a benign and a malignant adnexal mass, with a sensitivity of 93.5% and a specificity of 91.5%.

• #6 Adnexal Mass: Symptoms, Treatments, and How It Affects Pregnancy

  https://www.healthline.com/health/adnexal-mass

  An adnexal mass is a growth that occurs in or near the uterus, ovaries, fallopian tubes, and the connecting tissues. […] Doctors tend to be more concerned if theyre solid. […] Adnexal masses can occur at any age. […] Whether or not symptoms are present often largely depends on the size of the mass. […] Your symptoms will require further investigation. […] An ovarian tumor is an abnormal lump or growth of cells. […] When the cells inside the tumor arent cancerous, its a benign tumor. […] This means it wont invade nearby tissues or spread to other parts of the body. […] Depending on size, they may or may not produce symptoms. […] Ovarian cancer is one of the most common forms of cancer in women. […] Symptoms are usually present in ovarian cancer and can include: fatigue, indigestion, heartburn, constipation, back pain, irregular periods, painful intercourse.

• #7 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Risk factors for ovarian cancer include age older than 60 years; early menarche; late menopause; nulliparity; infertility; personal history of breast or colon cancer; and family history of breast, colon, or ovarian cancer. […] The U.S. Preventive Services Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, cancer antigen (CA) 125 level, and screening pelvic examination. […] A urine pregnancy test should be performed in any woman of reproductive age who presents with an adnexal mass. […] Despite advances in technology, gray-scale transvaginal ultrasonography remains the standard for the evaluation of adnexal masses. […] The results of the transvaginal ultrasonography will guide clinical management. If a nongynecologic diagnosis is made, the patient should be treated appropriately. For many gynecologic causes, specific medical or surgical treatment should be offered. Evaluation of an ovarian mass depends on clinical, laboratory, or radiographic findings that suggest malignancy.

• #8 Adnexal tumors and masses – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adnexal-tumors/diagnosis-treatment/drc-20580221

  To diagnose adnexal tumors and masses, a healthcare professional may start with a pelvic exam. Other tests and procedures might include imaging tests and blood tests. […] Imaging tests make pictures of the body. They can show the location and size of an adnexal tumor or mass. Tests might include an ultrasound, computerized tomography scan, also called CT scan, and magnetic resonance imaging, also called MRI. […] Blood tests may be done to help diagnose an adnexal tumor or mass, including: A pregnancy test. Blood tests to find an infection. A blood test for tumor markers that may be signs of cancer. For example, the cancer antigen 125 test, also called CA 125 test, can find a protein that’s often found on the surface of ovarian cancer cells. […] Surgery to remove an adnexal tumor or mass may be advised if the tumor or mass is large, if it’s causing symptoms or if it could be cancer. […] If your health professional suspects that an adnexal tumor or mass could be cancer, you may be referred to a doctor who specializes in cancer of the reproductive organs, called a gynecologic oncologist. […] Could my adnexal tumor or mass go away on its own, or will I need treatment?

• #9 Adnexal Tumors Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/258044-workup

  Serum electrolytes should not be altered by an adnexal mass; however, symptoms associated with masses, such as nausea and vomiting, can cause alterations that must be known before anesthesia and surgery are considered. […] The most commonly performed test to evaluate an adnexal mass is transabdominal or transvaginal ultrasonography. […] This test helps demonstrate the presence of the mass and its location (eg, ovarian, uterine, bowel). […] Scoring systems, such as that suggested by DePriest and associates, can then be used to determine the likelihood of a malignant component. […] CT scans are most useful for assessing the remainder of the abdomen and pelvis when metastatic disease is suspected. […] MRI scans can help characterize adnexal mass characteristics in select cases when ultrasonographic findings are limited. […] In limited settings, aspiration of the mass can be performed. However, this approach must be reserved for those women in whom an extremely low chance of a malignant mass exists and/or when surgical intervention is contraindicated.

• #10 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. […] Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. […] The differential diagnosis of an adnexal mass includes benign and malignant gynecologic and non-gynecologic etiologies. The goal of evaluation is to differentiate between benign and more serious conditions, such as ovarian cancer.

• #11 Assessment of adnexal masses using ultrasound: a practical review | IJWH

  https://www.dovepress.com/assessment-of-adnexal-masses-using-ultrasound-a-practical-review-peer-reviewed-fulltext-article-IJWH

  On the other hand, in postmenopausal women, the risk of malignancy and therefore clinical suspicion for malignancy are higher. […] Ultrasound features suggestive of epithelial malignancy include thick septations (23 mm in width), solid components, and cyst wall thickening. […] The addition of Doppler flow measurements to the grayscale parameters described above may provide additional information in suspicious cases, and has been thought to increase the sensitivity, specificity, and positive predictive value of ultrasound in diagnosing ovarian malignancy. […] However, despite initial interest in this feature, studies have failed to show a significant improvement in detection of malignancy over traditional morphological assessment. […] The best approach to the correct diagnosis of malignancy now appears to be a combined assessment of gray scale morphologic features and color Doppler imaging. […] Use of grayscale ultrasound combined with Doppler measurements when necessary allows the experienced sonographer to reliably diagnose functional, benign, and malignant adnexal masses.

• #12 Imaging and diagnostic approach of the adnexal mass: what the oncologist should know – Vázquez-Manjarrez – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/54757/html

  Early detection and characterization of ovarian lesions is of utmost importance for adequate management. The adequate discrimination between benign and malignant lesions is the most important starting point for a correct and optimal management. Ultrasound is the method of choice up until now for adequate assessment of adnexal abnormalities, no other method has proven superior. The Gynecology Imaging Reporting and Data System (GI-RADS), published in 2019, concluded that their classification system of diagnosis of adnexal masses by ultrasound has a high reliability with a sensitivity and specificity of 92.9% and 97.5% respectively. The International Ovarian Tumor Analysis (IOTA) group standardized in 2013 the approach of adnexal pathology descriptions by ultrasound with the limitation of needing pathologic reports for complete assessment. The Ovarian Adnexal Reporting and Data System (O-RADS) is a lexicon designed in 2018 to standardize definitions of characteristics by ultrasound. This system offers an interpretation method to decrease ambiguity and recommends management guides according to its classification.

• #13 Imaging and diagnostic approach of the adnexal mass: what the oncologist should know – Vázquez-Manjarrez – Chinese Clinical Oncology

  https://cco.amegroups.org/article/view/54757/html

  The goal of an early diagnosis is to reduce unnecessary surgical procedures and minimize unfavorable ovarian cancer outcomes. In contrast with other neoplasms, adnexal masses should not be biopsied, thus making imaging findings is crucial for diagnosis and management. […] The IOTA group has proposed a three-step strategy to improve the adnexal mass assessment. First step is using Simple Descriptors by pattern recognition. Second step, IOTA Simples Rules and third step a subjective assessment of an expert radiologist. This method has been proven to be the one with the best sensibility and specificity to classify adnexal masses. […] The ADNEX model is a risk prediction model than can distinguish between benign, borderline, stage I invasive, stage IIIV invasive, and secondary metastatic adnexal ovarian tumors. It is a risk prediction model that uses 9 predictors. O-RADS risk stratification and management system by the American College of Radiology was created to unify interpretations and reduce ambiguity in the management and classification of adnexal masses. This system includes the pattern-based approach and algorithm IOTA-ADNEX model system; it consists in a system of six categories (0 to 5). Each of these categories shows an estimated risk percentage of malignancy and provides management recommendations for each risk group, divided into pre and postmenopausal patients. […] The largest diagnostic accuracy study regarding sonographic differentiation of benign and malignant adnexal masses was the IOTA study.

• #14

  https://link.springer.com/article/10.1007/s41974-020-00134-y

  Over the past decades ultrasound has become an indispensable extension of the gynecologists hands and eyes. It provides the examiner with all the necessary proxies to assess tissue texture, vascularization, mobility and tenderness. The complementary information generated from this low-cost, dynamic examination in addition to static imaging modalities is undisputed. […] Adequately discriminating benign adnexal lesions from their malignant counterparts is of paramount importance, as this allows to select the most appropriate treatment effectuated by the most appropriate physician, guided by the most appropriate second-stage examinations. […] The ADNEX model is a multiclass or polytomous risk prediction model developed on IOTA phases 1, 1b and 2, temporally validated on phase 3 and ultimately retrained using the total dataset of 5909 patients.

• #15 Approach to Imaging the Adnexal Mass | Radiology Key

  https://radiologykey.com/approach-to-imaging-the-adnexal-mass/

  Computed tomography (CT) is useful for staging masses suspected of being ovarian cancer but has little role in the routine characterization of adnexal masses. Although adnexal masses are usually evident by CT and are often detected incidentally by CT, the CT features of most adnexal masses do not usually allow a confident diagnosis. […] Admittedly, if CT identifies fat in an ovarian mass, a dermoid can be diagnosed. CT may be able to identify features of malignant masses, but when considering all adnexal masses, US and MRI have better predictive value than CT and also do not use ionizing radiation. […] It is important to remember that not all adnexal masses arise in the ovary. Extraovarian masses account for 2% to 10% of adnexal masses in surgical series. […] Although most adnexal masses arise from the ovary, diagnostic errors will be made if one does not consider the possibility that an adnexal mass may arise outside the ovary.

• #16 Approach to Imaging the Adnexal Mass | Radiology Key

  https://radiologykey.com/approach-to-imaging-the-adnexal-mass/

  Ultrasound (US) remains the primary imaging modality to evaluate an adnexal mass. When faced with a known or suspected adnexal mass, there are numerous possibilities to be considered. In the majority of cases, US findings should allow either one diagnosis to be considered most likely or significantly narrow the likely possibilities to a few entities. […] In the uncommon instance where the likely diagnosis is not clear by US, magnetic resonance imaging (MRI) is generally the next best imaging modality. MRI is most useful when the mass has an unusual sonographic appearance (such that it is not typical of malignancy or of any of the common benign entities), is of unclear origin, or when the mass is not well visualized by US (which is most commonly the result of body habitus and/or the superior or lateral location of the mass).

• #17 Diagnosis of a Malignant Tumor in a Patient with an Adnexal Mass Using Endoscopic Ultrasound Elastography

  https://jsms.sch.ac.kr/journal/view.php?number=207

  Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. […] The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. […] Currently a variety of radiological imaging modalities can be used to characterize the tissues of ovarian malignancies, including ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT. […] EUS-EG might be useful to differentiate adnexal masses. […] In distinguishing malignant/borderline tumors from benign ovarian masses, the accuracy of PET/CT (92%) was higher than that of pelvic ultrasound (83%) and abdominopelvic CT or pelvic MR imaging (75%).

• #18 Adnexal Tumors Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/258044-workup

  Possible laboratory tests in the evaluation of adnexal mass include serum markers, Papanicolaou test, CBC count, urinalysis (U/A), stool for blood, and electrolytes. […] CA-125 is elevated in approximately 80% of all women with ovarian cancer. In stage I disease, the sensitivity of this biomarker is approximately 50%, which rises to 90% in patients with advanced disease. […] However, it can also be elevated in many other conditions, including gynecologic etiologies such as endometriosis, uterine fibroids, and pregnancy, and nongynecologic conditions such as gastroenteritis, pancreatitis, cirrhosis, and congestive heart failure. […] As such, the specificity of CA-125 is limited and is not recommended for routine screening purposes in the general population. […] Although elevated, levels of serum CA-125 do not appear to be a significant predictor of malignant transformation of endometriosis. Significant predictive factors for the presence of malignant transformation of endometriosis appear to include age older than 49 years and cysts that are multilocular and have solid components.

• #19 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  CA 125 testing is not recommended as the sole factor for differentiating between a benign and a malignant adnexal mass. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. […] Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #20 Adnexal Tumors Workup: Laboratory Studies, Imaging Studies, Diagnostic Procedures

  https://emedicine.medscape.com/article/258044-workup

  Several predictive models which combine multiple serum markers with or without ultrasound, such as the Copenhagen Index (CPH-I), Risk of Malignancy Index (RMI), and Risk of Ovarian Malignancy Algorithm (ROMA), and OVA-1 have been developed to differentiate benign from malignant adnexal masses. […] Urine or serum beta human chorionic gonadotropin (-hCG) should be obtained in women of reproductive age to rule out pregnancy and pregnancy-related etiologies of adnexal masses. […] Other serum markers such as AFP and LDH can be helpful when a germ cell tumor is suspected. […] A Papanicolaou test should be considered in women undergoing a gynecologic surgery. […] A CBC count helps evaluate for presence of inflammation and anemia. […] U/A results are generally normal in the presence of an adnexal mass.

• #21 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  Patients with values greater than 200 are at 42 times greater risk of cancer than patients with an RMI of 0.15. […] Ovarian carcinomas should be treated in referral centers due to the high morbidity and mortality of this disease. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] The surgical specimen should be removed from abdominal cavity without intraperitoneal spillage in the plastic retrieval bag through the umbilical port, small Pfannenstiel incision, or transvaginally. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation.

• #22 Adnexal mass: diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10316833/

  The mainstream to management of adnexal masses is excluding malignancies. […] The characterization of malignancy findings on the image (TVUS or MRI) is the key since women with ovarian cancer should preferably be treated in oncological referral centers as soon as possible. […] The false-negative rates are uncommon and benign adnexal masses can have expectant management or undergo conservative surgery in general hospitals. […] The effectiveness of using panels of biomarkers combined with clinical and radiologic evaluation for the distinction between benign and malignant adnexal masses has been studied. […] Currently, there is no strong enough evidence to recommend a particular test. […] The risk of malignancy index (RMI) algorithm combines the value of CA 125 serum levels, ultrasound, and menopausal status.

• #23 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Assessment cannot preclude malignancy. […] Malignancy histology revealed during or after diagnostic laparoscopy; the comprehensive surgical medical report belongs to the patient, and images should move to a cancer center for further management. […] Consider opportunistic salpingectomy as risk reduced surgery for ovarian cancer during benign operation. […] The effectiveness of using panels of biomarkers combined with clinical and radiologic evaluation for the distinction between benign and malignant adnexal masses has been studied. […] Although these biomarker panels should not be used in the initial evaluation of adnexal masses, they can help determine the patient that can benefit from referrals to gynecologic oncology. […] Currently, there is no strong enough evidence to recommend a particular test.

• #24 eMedicine – Adnexal Tumors : Article by Nelson Teng, MD, PhD

  https://www.csh.org.tw/dr.tcj/educartion/f/web/Adnexal%20Tumors/index.htm

  The leading clinical presentation is asymptomatic. […] The vast majority of adnexal masses presents as asymptomatic, small, and simple cystic masses. […] On the other hand, these same asymptomatic masses can be early ovarian cancers that require immediate attention. […] The use of CA125 values to screen for the presence of cancer should be discouraged. […] The most commonly performed test to evaluate an adnexal mass is an ultrasound, either trans abdominal or transvaginal. […] In limited cases, a diagnostic laparoscopy may be needed to evaluate an adnexal mass. […] All adnexal masses that are symptomatic or have characteristics of a malignancy must be addressed with surgical removal. […] Most adnexal masses require little more than the normal annual gynecological examination for follow-up as they rarely recur. […] The major adverse outcomes in the treatment of adnexal masses are related to complications resulting from surgical therapy. […] Most adnexal masses are benign; the outcome and prognosis is very good. […] The major controversy surrounding adnexal masses is when and how to treat them.

• #25 MR imaging of ovarian masses: classification and differential diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-015-0455-4

  Preoperative biopsy should not be performed in ovarian masses, particularly if the mass appears to be surgically resectable at the moment, as this invasive procedure raises the risk of spreading cancer cells and potentially leads to iatrogenic upstaging worsening the prognosis. […] MRI is also reliable in detecting local invasion. […] In the evaluation of adnexal masses indeterminate on ultrasound, unenhanced MRI has shown a sensitivity and a specificity of 76 and 97 %, respectively, in the diagnosis of ovarian cancer; assessment with contrast-enhanced MRI increases sensitivity to 81 % and specificity to 98 %. […] The role of 1.5 T MRI in the assessment of ovarian masses has been widely established, but only in recent years have 3 T MR systems been applied in the study of gynaecologic diseases.

• #26 Diagnostic Ultrasound in the Assessment of the Adnexal Mass | GLOWM

  https://beta.glowm.com/section-view/heading/Diagnostic-Ultrasound-in-the-Assessment-of-the-Adnexal-Mass/item/15

  Many different scoring systems exist for discriminating benign from malignant adnexal masses. These scoring systems evaluate masses for solid elements, cyst wall thickness, number, thickness, and irregularity of septations, and the presence of ascitic fluid. […] Recent logistic regressions by Tailor and coworkers and Schelling and associates have confirmed that the presence of solid elements within a mass is the most predictive in identifying malignancy. […] The management of adnexal masses has been reviewed in a ACOG practice bulletin from 2007. […] Expectant management of physiologic functional cysts and hemorrhagic cysts is critical in avoiding unnecessary surgery. […] The role of expectant management of simple menopausal cysts less than 5 cm has been studied by Bailey and colleagues. […] The malignant potential is believed to be less than 1%.

• #27 Diagnostic Ultrasound in the Assessment of the Adnexal Mass | GLOWM

  https://beta.glowm.com/section-view/heading/Diagnostic-Ultrasound-in-the-Assessment-of-the-Adnexal-Mass/item/15

  Once the mass has been characterized into one of Osmers’s five categories, a histologic differential should be provided if appropriate. […] The addition of color or power Doppler as a secondary test can be helpful in differentiating these entities, and is reviewed in the following section. […] The published literature is replete with contrasting views of the efficacy of color and power Doppler in assessing the malignant nature of an adnexal mass. […] Using power Doppler as a secondary test, Guerriero and associates found that the specificity for correctly identifying benign disease was improved from 80% to 90%. […] There is no evidence to date that ultrasound can be used effectively to screen for Stage I ovarian cancer in high risk women. […] The outcomes of two major screening trials in postmenopausal patients, one American and one British should be available in the next 5 years. […] Even with the system described above, errors will occur in the prediction of benign and malignant processes. […] It is anticipated that the addition of new serum tumor markers will enhance the clinician’s ability to discriminate between benign and malignant disease.

• #28

  https://link.springer.com/article/10.1007/s41974-020-00134-y

  This model has shown to uphold high sensitivity and specificity values and an area under the curve (AUC) of 0.954 of the Receiver Operating Characteristic (ROC) plot, thereby outperforming previous IOTA models and paralleling expert sonography. […] Not only have the aforementioned prediction models and consensuses aided in attaining a broader consensus and unified reporting among gynecologists globally, they have also intertwined with radiologists practice. […] When comparing computed tomography (CT) to MRI, notwithstanding the good spatial resolution of the former, it has repetitively shown inferior to the latter in contrast resolution, thereby being inferior in site-based lesion detection and not allowing for as adequate an estimation of intestinal disease and distant (nodal) metastasis. […] It is therefore audacious yet not inconceivable to say that the decades to come might surprise us with a paradigm shift away from CT and towards ultrasound supplemented with MRI in second stage, be it for further characterization or defining disease extent.

• #29 Pre-op Diagnosis of Ovarian Cancer in Patients Presented with Adnexal Mass

  https://www.contemporaryobgyn.net/view/pre-op-diagnosis-ovarian-cancer-patients-presented-adnexal-mass

  The RMI developed by Jacobs et al (6) for distinguishing benign and malignant pelvic masses pre-operatively at a cut-off level of 200 had a sensitivity of 85.4% and a specificity of 96.9%. […] The risk of malignancy index provides a quantitative assessment of the risk of malignancy and can be used to discriminate between benign and malignant disease. Its application in clinical practice would provide a rational basis for specialist referral of patients with malignant disease before diagnostic surgery.

• #30

  https://step2.medbullets.com/evidence/19835343

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation. Transvaginal ultrasonography remains the standard for evaluation of adnexal masses. Findings suggestive of malignancy in an adnexal mass include a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Family physicians can manage many nonmalignant adnexal masses; however, prepubescent girls and postmenopausal women with an adnexal mass should be referred to a gynecologist or gynecologic oncologist for further treatment. All women, regardless of menopausal status, should be referred if they have evidence of metastatic disease, ascites, a complex mass, an adnexal mass greater than 10 cm, or any mass that persists longer than 12 weeks.

• #31 The Differential diagnosis of an Adnexal mass | Time of Care

  https://www.timeofcare.com/differential-diagnosis-of-an-adnexal-mass/

  Adnexal tumors and masses can be classified into gynecologic and non-gynecologic categories. […] Gynecologic masses are found in the ovaries, fallopian tubes, uterus, or associated with these structures. […] Non-gynecologic masses are located in areas such as the appendix, colon, bladder, and ureters. […] Masses in these locations can be benign or malignant or borderline. […] Diagnosis and management of adnexal masses is crucial for appropriate treatment.

• #32 Adnexal Mass: Types, Causes, and Symptoms to Watch For

  https://www.verywellhealth.com/adnexal-mass-2553380

  An adnexal mass is an abnormal growth that develops near the uterus, usually in the ovaries, fallopian tubes, or surrounding connective tissues. […] This article discusses the different types of adnexal masses and their causes. It also looks at symptoms, diagnosis, and treatment of adnexal masses. […] In premenopausal, non-pregnant women, most adnexal masses are ovarian cysts. […] Other causes of adnexal masses include benign and malignant ovarian tumors, ectopic (tubal) pregnancy, hydrosalpinx (fluid-blocked fallopian tube), uterine fibroids, and tubo-ovarian abscess. […] Masses larger than 6 cm are more likely to be cancerous than smaller masses. […] Adnexal masses are usually diagnosed with an imaging test like a transvaginal ultrasound or an MRI scan. […] Depending on the cause, they may be treated with a watch-and-wait approach or with surgery. […] If an adnexal mass is found and cancer is suspected, it is always best to get a second opinion from a gynecologic oncologist.

• #33 Complex adnexal mass – differential diagnosis (mnemonic) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/complex-adnexal-mass-differential-diagnosis-mnemonic?lang=us

  A mnemonic for the differential diagnosis of complex adnexal masses is: […] C: cystadenoma/cystadenocarcinoma (serous and mucinous) […] H: hemorrhagic ovarian cyst […] E: endometrioma […] E: ectopic pregnancy […] T: teratoma/torsion […] A: abscess (tubo-ovarian) […] H: hydrosalpinx/hematosalpinx (i.e. pelvic inflammatory disease)

• #34 Approach to Imaging the Adnexal Mass | Radiology Key

  https://radiologykey.com/approach-to-imaging-the-adnexal-mass/

  Thus, when one encounters an adnexal mass, an attempt should be made to determine whether the mass arises from the ovary or is extraovarian in origin. […] In general, however, determination of an ovarian versus extraovarian origin will allow one to be more specific in making a diagnosis based on imaging features. […] MRI is often useful when there is a solid adnexal mass and one cannot determine by US whether the mass arises from the ovary or is extraovarian in origin. The most common differential diagnosis in this situation is a pedunculated uterine leiomyoma versus an ovarian fibroma. […] Most extraovarian masses that one will encounter will be of gynecologic origin. […] Evaluating the pelvis for adnexal masses becomes difficult when a definite ovary is not identified or the relationship to the ovary is difficult to determine.

• #35 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  The following masses pose the greatest concern: Those that have a complex internal structure, Those that have solid components, Those that are associated with pain, Masses in prepubescent or postmenopausal women, Large cysts (A variety of cut-off sizes have been proposed. In some institutions, unilocular cysts up to 10 cm have been followed conservatively, even in postmenopausal women. However, the presence of complex cysts in postmenopausal women generally heightens suspicion, regardless of size.), In menstruating women, those who persist beyond the length of a normal menstrual cycle without typical characteristics of a benign process such as a hemorrhagic cyst. […] Determining the true frequency of adnexal masses is impossible because most adnexal cysts develop and resolve without clinical detection. When assessing the clinical significance of an adnexal mass, consideration of several age groups is important.

• #36 Approach to the patient with an adnexal mass – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-an-adnexal-mass

  Approach to the patient with an adnexal mass […] INTRODUCTION […] An adnexal mass (ie, solid or cystic mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic issue. Adnexal masses may be found in females of all ages and have many etiologies (table 1). […] The principal goals of the evaluation of an adnexal mass are to determine whether the mass is „almost certainly benign,” has a „reasonable chance of being malignant,” and whether there is an urgent condition (eg, ectopic pregnancy, ovarian torsion) that requires prompt medical or surgical treatment. Management of nonurgent conditions may involve: […] ●Expectant management – When the mass is not suspicious for malignancy and there are no other indications for surgery or surveillance, no further follow-up is needed.

• #37 Evaluation of the Adnexal Mass in an Older Patient

  https://exxcellence.org/pearls-of-exxcellence/list-of-pearls/evaluation-of-the-adnexal-mass-in-an-older-woman/

  Serum markers such as Cancer Antigen 125 (CA125), Human Epididymis 4 (HE4) and newer Multivariate Index Assays (OVA1, OVA2, ROMA) are added tools to evaluate adnexal masses. CA125 can be elevated in both benign and malignant conditions. CA125 and HE4 together may have improved diagnostic value for differentiating benign and malignant masses. The clinical utility of multivariate index assays is unclear and an active area of investigation. […] Asymptomatic simple unilocular cysts up to 10 cm in size have less than 1% risk of malignancy and should be followed with ultrasound imaging in four to six months. Resolution will occur in up to two thirds of patients. Multilocular and solid/cystic masses are seen in up to 3.2% of postmenopausal woman. Women with asymptomatic multilocular or solid/cystic lesions less than 5 cm and a normal CA125 can undergo repeat imaging and CA125 in four weeks. If the size of the mass or CA125 increases, surgery is appropriate. If the mass shrinks, CA125 falls, or the clinical picture is unchanged, the patient can be followed conservatively with ultrasound at three to six months. Although evidence-based guidance is lacking, if all parameters have been stable for 18 to 24 months, repeat imaging and marker levels can be discontinued. If the tumor is 5 cm or there is any evidence of papillary projections or ascites, the patient should be referred to a gynecologic oncologist.

• #38 Approach to the patient with an adnexal mass – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-an-adnexal-mass

  ●Surveillance – Surveillance is an option if the suspicion of malignancy is low but has not been completely excluded. Surveillance usually includes one or more pelvic ultrasounds and/or measurement of serum tumor markers. […] ●Surgery – Surgery is performed when there is a high risk of malignancy, histologic diagnosis is desired, or the patient has persistent pain or other symptoms.

• #39 Adnexal Mass: Symptoms, Treatments, and How It Affects Pregnancy

  https://www.healthline.com/health/adnexal-mass

  If the adnexal mass is small and you have no symptoms, then it may not require treatment at all. […] Surgery will be needed if: the mass begins to grow, you develop symptoms, a cyst develops solid elements. […] Once removed, the adnexal mass will be tested to determine whether or not the cells contained within it are cancerous. […] Adnexal masses are usually diagnosed by a pelvic exam, ultrasound, or both. […] Imaging and lab tests can be used to determine the underlying cause of the adnexal mass. […] Your doctor will also probably have you take a pregnancy test to rule out an ectopic pregnancy, since this will need immediate treatment. […] The majority of adnexal masses arent harmful. […] Many adnexal masses will resolve themselves without any intervention. […] In a very small number of cases, the cause of the adnexal mass will be ovarian cancer. […] If the cancer is found and treated before its spread outside of the ovary, the five-year survival rate for ovarian cancer is 92 percent, according to the American Cancer Society.

• #40 Circulating tumor cells in the differential diagnosis of adnexal masses | Oncotarget

  https://www.oncotarget.com/article/20428/

  The aim of this study was to evaluate circulating tumor cell (CTC) detection in the differential diagnosis of adnexal masses. […] Preoperative diagnostic modalities including CTC detection, risk of ovarian malignancy algorithm, risk of malignancy index, and computed tomography or magnetic resonance imaging were compared. […] CTC detection had sensitivities of 77.4%, 100%, and 100% for benign vs. all stage cancer (n = 74), benign vs. stage III cancer (n = 53), and benign vs. stage I cancer (n = 49), respectively. […] In conclusion, our study findings suggest that preoperative CTCs could have a substantial role in differentiating early stage cancer from benign tumors for adnexal masses.

• #41 Diagnosis of a Malignant Tumor in a Patient with an Adnexal Mass Using Endoscopic Ultrasound Elastography

  https://jsms.sch.ac.kr/journal/view.php?number=207

  EUS-EG is useful for differentiating solid pancreatic masses. […] In this context, we applied EUS-EG to the adnexal mass. […] Our patient presented with adnexal mass of less intense FDG uptake (average SUV, 2.11). […] These results provide evidence that EUS-EG may be potentially useful to diagnosis of ovarian malignancy. […] EUS-EG may be useful to differentiate adnexal masses. […] Future studies will be required to ascertain the diagnostic accuracy of EUS-EG in the differentiation of benign form malignant lesions in patients presenting adnexal masses.

• #42 MR imaging of ovarian masses: classification and differential diagnosis | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-015-0455-4

  Proton MR spectroscopy is a non-invasive diagnostic tool that may contribute to the differential diagnosis of subtypes in ovarian tumours. […] The various subtypes of malignant epithelial ovarian tumours (serous, clear cell, endometrioid, and mucinous) respond differently to chemotherapy. […] In conclusion, we’d like to indicate some key imaging features and general advice that could be of help in the differential diagnosis of adnexal masses: non-neoplastic lesions should always be taken into consideration; in a patient with endometriosis, the presence of a complex and rapidly growing mass with contrast enhancement should raise the suspicion of endometrioid or clear cell tumour; a very low signal intensity on T2-weighted images indicates a fibrotic component, suggesting a tumour of the thecoma/fibroma group, a cystadenofibroma or a Brenner tumour; sequences with fat saturation are helpful when facing a mass with high signal intensity on T1-weighted images, because the signal suppression is suggestive of a teratoma; otherwise, an endometrial cysts or other haemorrhagic lesions should be considered; a stained glass appearance with cystic loculi of variable signal intensity usually refers to a mucinous tumour, because of the different mucin concentration; metastasis should be considered if a complex enhancing mass is demonstrated in both ovaries (eventually looking for an unknown primary tumour); however, it must be remembered that serous epithelial tumours can be bilateral as well.

• #43 A Deep Learning Model System for Diagnosis and Management of Adnexal Masses

  https://www.mdpi.com/2072-6694/14/21/5291

  A Deep Learning Model System for Diagnosis and Management of Adnexal Masses […] This was a multicenter study on the development of a deep learning (DL) model system to diagnose adnexal masses on ultrasound images. […] Appropriate clinical management of adnexal masses requires a detailed diagnosis. […] The DL system identified benign, borderline, and malignant tumors with macro-F1 scores that varied from 0.684 to 0.791, a benefit to preventing both delayed and overextensive treatment. […] The accuracy and sensitivity of the DL system were comparable to that of the expert and intermediate sonographers and exceeded that of the junior sonographer. […] To overcome current diagnostic limitations, we attempted to establish a DL model system that could provide a complete diagnostic interpretation of ultrasound images, including: detecting and locating adnexal masses; distinguishing between benign, borderline, and malignant tumors; and distinguishing the pathological subtypes including endometriomas, other epithelial tumors except endometriomas, germ cell tumors, sex cord-stromal tumors, and inflammation for benign tumors. […] The DL model system could identify the existence of the tumor and recognize the area of the mass and papillary projection precisely. […] The discrimination between benign and malignant tumors could also be achieved through deep learning in other studies. […] The ability to discriminate borderline tumors is essential in choosing the appropriate treatment for patients with adnexal masses. […] The subtype classifier of the DL system was able to discern most subtypes of benign tumors with macro F1-scores of 0.831 in the internal validation dataset, 0.826 in external test dataset 1, and 0.714 in external test dataset 2. […] The DL system had an excellent diagnostic performance, exceeding the accuracy and sensitivity of the junior sonographer and matching that of the intermediate and expert sonographers.

• #44 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Frozen sections for the intraoperative diagnosis of a suspicious adnexal mass is recommended in settings in which availability and patient preference allow. […] Referrals to oncology specialists for additional treatment should occur when malignancy is found during laparoscopy or after histology. […] The differential diagnosis between benign adnexal masses is made by clinical history, ultrasound, other imaging methods and tumor markers. […] No method alone or in combination has sufficient sensitivity and specificity to formalize the diagnosis of malignancy.

• #45 Adnexal/pelvic mass – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/obstetrics-and-gynecology/adnexal-pelvic-mass/

  In the United States, the diagnosis of an adnexal or pelvic mass will occur in five to ten percent of women in their lifetime. Although commonly benign, a small percentage (15 to 20 percent) will be malignant and diagnosis of these at the earliest possible stage is of critical importance. […] The presence of a pelvic or adnexal mass, as stated earlier, is most commonly demonstrated on an imaging study for either gynecologic or other unrelated issues. Imaging studies are most commonly performed in response to symptoms rather than concern on a pelvic or abdominal exam. […] The most commonly performed imaging study for the suspicion of a pelvic mass is an ultrasound. It is recommended that transvaginal as well as transabdominal ultrasound be performed whenever possible. […] Serum marker screening can play a significant role in the further evaluation of a pelvic mass. These include studies that may be helpful in determining the nature of mass as well as new developments in multiple marker studies to help stratify risk and direct the patient to the most appropriate surgical strategy.

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