Early diagnosis and predictors of malignancy of adnexal masses

Ovarian cancer is an important cause of death among women with a malignant gynecological tumor. Cure rates for the disease at an early stage are around 80-90%, but survival is only 50% as the majority of women already show advanced disease upon diagnosis. The combination of gynecological examination, ultrasonography, and systemic tumor marker assay is considered to be a good strategy for the early diagnosis of ovarian neoplasia.

Today, new technologies such as ultrasonography and tumor marker assay have increased the diagnosis rate for adnexal masses. These non-invasive methods, however, frequently do not distinguish benign conditions from malignant ones, which results in unnecessary surgery. Transvaginal ultrasonography is useful for diagnosing adnexal masses, but benign and malignant adnexal masses can present similar morphological characteristics. Combination with color Doppler ultrasonography and/or tumor markers may improve the accuracy of the method. Gene-expression array, proteomics and mathematical models form new approaches, but proper prospective studies are needed to validate them.

The techniques of pelvic examination, ultrasonography, color Doppler ultrasonography, and tumor markers can be indicated for the diagnosis of ovarian cancer. The differentiation between benign and malignant ovarian tumor is, however, a clinical challenge. Until better diagnostic methods become available, patients and their physicians can use these techniques to decide on management.