Evaluation of adnexal masses – Correlation of clinical and radiologic features with histopathologic findings: an observational study in a tertiary care center of Eastern India

Abstract

Background: Ovarian carcinoma is the seventh most common cause of carcinoma-induced deaths among women of the world. Adnexal masses often pose a diagnostic challenge to a treating physician. The aim of the present study was to find out the incidence of various categories of ovarian tumors and their correlation with clinicopathologic parameters among patients attending a tertiary care center of Eastern India. Another aim was the evaluation of diagnostic accuracy of clinical, laboratory, and radiological findings. Methods: A prospective, observational study was carried out for a period of 1 year. Female patients with adnexal masses were included in the study. Clinical, laboratory, and sonographic findings of each patient were recorded along with their histopathological reports. Results: The median age of 59 patients included in the study was 36 years. Most patients (32, 54.2%) were between 30 and 50 years of age. Thirty-six (61%) ovarian tumors were found to be benign and the rest (23, 39%) malignant. Surface epithelial tumors were the most common type (35, 59.3%), followed by germ cell tumors (11, 18.6%) and sex cord stromal tumors (9, 15.3%). A statistically significant association was noted between parity, menstrual status, laterality, size, gross appearance of tumor, and nature (benign/malignant) of the mass. Sensitivity (57%) and specificity (86%) of the clinical diagnosis were good, but diagnostic accuracy (88%) of sonographic findings was better. While serum CA125 level measurement had a diagnostic accuracy of 78%, the risk of malignancy index (RMI) 2 score, with an accuracy of 86%, has the potential to guide further management in a patient with adnexal mass. Conclusion: Increased incidence of malignancy was noted with postmenopause, nulliparity, bilaterality of tumors, and complex tumor morphology. All these risk factors were found to be statistically significant. RMI 2 score may be used routinely for diagnosis and guidance of further management of adnexal masses.