Changes in Ultrasound-Based Risk Stratification and Surgical Selection of Adnexal Masses During the COVID-19...

Background/Objectives: The COVID-19 pandemic disrupted gynecologic care pathways and required stricter prioritization of surgical treatment. We evaluated whether the pandemic restriction period was associated with changes in the characteristics of women with adnexal masses reaching surgery and explored ADNEX discrimination within the histologically verified surgical cohort. Methods: This retrospective single-center study included all consecutive women evaluated for an adnexal mass in a dedicated gynecologic ultrasound clinic during a pre-pandemic baseline period and a COVID-19 restriction period. Ultrasound examinations were performed by the same expert using International Ovarian Tumor Analysis (IOTA) terminology and the IOTA Assessment of Different NEoplasias in the adneXa (ADNEX) score was calculated prospectively at the time of examination. Histological analyses were restricted to surgically managed patients. Results: Overall, 340 women were evaluated in the non-COVID period and 211 during the COVID period; 149 (43.8%) and 40 (19.0%), respectively, underwent surgery. After exclusion of five adolescents from the pre-pandemic group, 144 and 40 operated patients were analyzed. The COVID-era surgical cohort was older (median 52.0 vs. 39.0 years, p = 0.0053), had higher ADNEX scores (median 13.7% vs. 4.4%, p = 0.0010), and had a higher proportion of borderline or malignant histology (32.5% vs. 13.2%, p = 0.0083). In an exploratory pooled logistic model, ADNEX score and COVID-period status were associated with non-benign histology. The AUCs were 0.789 and 0.905 in the COVID and non-COVID surgical cohorts, respectively, without a statistically significant between-cohort difference (p = 0.169). Conclusions: The COVID-19 restriction period was associated with a lower proportion of evaluated women proceeding to surgery and with enrichment of the operated cohort for older patients and lesions with higher sonographic risk and non-benign histology. Because surgical selection itself depended partly on ultrasound findings and outcomes were unavailable for non-operated women, these data should not be interpreted as independent validation of ADNEX or proof that deferred management was safe.