Adnexal mass referral patterns in Gynecologic Oncology

There is a perceived increase in adnexal mass referrals to Gynecologic Oncology that do not meet American College of Obstetricians and Gynecologists (ACOG) referral criteria. There is little data regarding referral patterns to Gynecologic Oncology. Our primary objective is to determine the proportion of consults meeting ACOG referral criteria over an eleven year period.

A retrospective chart review was conducted for adnexal mass referrals between 2011 and 2021. Variables such as age, menopausal status, imaging findings, tumor markers, surgery and histopathologic diagnosis determined whether the initial consult met ACOG referral criteria.

A total of 864 new consults were reviewed, 84.7 % meeting ACOG referral criteria. When broken down by year, 82.0 %, 78.9 %, 82.2 %, 86.1 %, 92.6 % met criteria for the years 2011, 2012, 2016, 2018, 2021, respectively. There was a significantly higher proportion of consults meeting referral criteria in 2021 compared to 2011 (p = 0.003). In 2011, 37.8 % of surgical cases meeting ACOG criteria were malignant compared to 45.2 % in 2021 (p = 0.145).

Our service has seen an increasing proportion of adnexal mass referrals that meet ACOG referral criteria. There is also a trending increase in malignant histopathology. This may be due to increased scrutiny of referrals by gynecologic oncologists starting in 2016 with appropriate referral to benign gynecology. Improved scrutiny of adnexal mass referrals could decrease the number of benign cases evaluated by Gynecologic Oncology, helping preserve resources for patients with higher risk of malignancy.