[Operative laparoscopy and the adnexal cystic mass: where to set the limit?]

To study the importance and the consequences of several managements options for adnexal cystic masses suspicious at ultrasound and/or at laparoscopy.

The importance of this question was evaluated by studying the correlation between the ultrasonographic appearance, the macroscopic diagnosis and the pathologic diagnosis in a series of 1098 patients operated over a 14-year period. The laparotomy rates obtained with the managements proposed were calculated by adding the laparotomies which would be performed because of the suspicious appearance to the laparotomies effectively performed in the department when treating the non suspicious masses.

32 of the 323 suspicious cases at ultrasound were malignant. The negative predictive value of the laparoscopic diagnosis of malignancy was 100%. Depending on the management used, the incidence of laparotomy could have varied from 6.1% to 31.3% between 1987 and 1991, and from 12.9% to 41.9% between 1992 and 1993. These results were related to preoperative selection.

Using a simple management which includes diagnostic laparoscopy for masses suspicious at ultrasound and laparotomy for masses suspicious at laparoscopy, 80.1% of the patients would be treated by laparoscopic. This management seems reasonable until the long term results of large series about the laparoscopic treatment of ovarian cancer become available.