[Ultrasonographic and biochemical screening of adnexal masses before operative laparoscopy]

The object of our study was to evaluate how reliable ultrasonographic and biochemical screening of adnexal masses are in the selection of patients eligible for operative laparoscopy.

The study was performed at the First Clinic of Obstetrics and Gynecology, University of Rome La Sapienza, Italy. Eighty-seven women of 36.8 +/- 12 years of age, who underwent operative laparoscopy between January 1999 and January 2000 to remove an adnexal lesion, were enrolled. These adnexal lesions had been previously diagnosed on the basis of a pelvic ultrasonographic imaging; this was performed because of follow-up procedure or pelvic pain. The lesions were evaluated preoperatively according to Sassone echographic scoring system. The CA-125 level was determined in 58 patients.

Surgery was successful in all 87 cases. In one case the operative laparoscopy had to be turned into laparotomy since the histologic examination revealed an atypical proliferative mucinous cystoadenoma. Sassone total average echographic score was 6.0 +/- 1.7; this is below the discriminant cut-off for malignancy (9). The only case in which Sassone score reached 10 was an atypical cystoadenoma. The CA-125 level was higher than 35 IU/ml (cut-off of this marker) in 13.7% of the patients; these were all affected by endometriosis or had a hemorrhagic corpus luteum. In the patient with atypical cystoadenoma, the CA-125 level was within normal range (29.1 UI/ml). The post-operative period was uneventful in all cases but one, in which the occurrence of pulmonary thromboembolism required a prolonged hospitalization.

The use of Sassone echographic scoring system proved to be very useful and effective in the selection of the patients. Tumor markers are relevant factors only if their evaluation is accompanied by an accurate anamnesis and is supported by the findings of abdominal and transvaginal ultrasonography.