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Published on: January 22, 2022
Risk analysis of torsion and malignancy for adnexal masses during pregnancy
Chih-Feng Yen1, Shu-Ling Lin, William Murk
1Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Tao-Yuan, Taiwan.
Objective:
To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy.
Design:
Retrospective, historical cohort study.
Setting:
University hospital.
Patient(S):
Patients from 1990 to 2004 with adnexal tumors >or=4 cm during pregnancy.
Intervention(S):
Surgery undertaken antepartum, concurrently with cesarean delivery, or postpartum.
Main Outcome Measure(S):
Tumor size, progression, pathology, incidence of malignancy, and torsion.
Result(S):
Almost all 213 managements analyzed had good surgical and obstetric outcomes. In 174 patients who were followed through pregnancy with known tumor existence, 14.84% +/- 3.05% encountered tumor torsion. Adnexal masses with sizes between 6 and 8 cm had a significantly higher risk of torsion compared with other sizes (22.41% vs. 9.48%; odds ratio 2.8, 95% confidence interval [CI], [1.1, 6.6]). Sixty percent of the torsion happened between the 10th and 17th weeks of gestation, and only 5.9% happened after 20 weeks. The incidence of malignancy was 3.4%, while that of ovarian cancer was 2.3%. Tumor diameters >or=10 cm at initial diagnosis had a higher risk of malignancy versus smaller sizes (8.77% vs. 0.85%; odds ratio 11.2, 95% CI, [1.3, 97.9]), and tumor growth rates >or=3.5 cm/week also had a significantly higher risk of malignancy versus lower rates (8.33% vs. 0.88%; odds ratio 10.2, 95% CI, [1.0, 101.2]).
Conclusion(S):
Adnexal tumors bearing higher risks for torsion and malignancy should be strongly considered for an aggressive strategy of management during pregnancy.
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