Adnexal Masses: Diagnosis and Management

Area of Science:

• Gynecologic Oncology
• Radiology
• Women's Health

Background:

• Pelvic masses affect up to 20% of women, encompassing diverse gynecologic and non-gynecologic origins.
• Adnexal masses, primarily in the ovaries and fallopian tubes, are frequently benign but require evaluation for potential malignancy.
• Risk factors for malignancy include specific symptoms and family history, necessitating thorough diagnostic workups.

Purpose of the Study:

• To outline the evaluation and management of pelvic and adnexal masses in women.
• To differentiate between benign and malignant adnexal masses.
• To guide clinical decision-making based on mass characteristics and patient risk factors.

Main Methods:

• Clinical assessment for symptoms suggestive of malignancy (e.g., pain, bloating, early satiety).
• Consideration of reproductive status and relevant biomarkers (e.g., beta human chorionic gonadotropin for ectopic pregnancy).
• Transvaginal ultrasonography as the primary imaging modality, supplemented by CT or MRI when necessary; utilization of risk of malignancy index.

Main Results:

• Transvaginal ultrasonography is key for assessing adnexal mass size and complexity.
• Specific ultrasonographic features (size >10 cm, solid components, high Doppler flow) indicate high malignancy risk.
• Multimodal tools combining imaging and biomarkers aid in diagnosing and excluding malignancy.

Conclusions:

• Asymptomatic, presumed benign masses may be managed expectantly.
• Symptomatic or emergent conditions like ectopic pregnancy or ovarian torsion require prompt gynecologic consultation.
• Adnexal masses with a high risk of malignancy necessitate referral to gynecologic oncology.