Risk of Ovarian Malignancy in Patients Undergoing Surgery for an Adnexal Mass at a High-Volume Cancer Center [36A

Abstract

INTRODUCTION: To characterize a cohort of patients presenting to a high-volume cancer center with an adnexal mass (AM), reporting pathologic outcomes and risk of malignancy. METHODS: All new visits to the gynecology service were prospectively screened from July 1, 2015-5/31/2017. Patients with ovarian complaints were categorized prospectively and followed through treatment. AM was defined as a pelvic mass suspected to originate from the adnexa without apparent metastatic disease based on available clinical and radiographic studies. Clinicopathologic data were collected and analyzed. RESULTS: 7690 new visits were screened and 2964 patients with an ovarian complaint were categorized: AM 35%, suspected advanced ovarian cancer (ovca) 28%, recurrent ovca 13%, hereditary ovca syndrome 14%, endocrine ablation 8%, other 2%. Of the 1046 with AM, 2% had evidence of metastatic disease on preoperative imaging, 40% were recommended observation, and 58% were managed surgically. For the 607 managed surgically, final pathology showed: benign 74%, non-ovarian malignancy 12%, ovca 8%, borderline tumor 5%, serous tubal intraepithelial carcinoma >1%, no pathology available >1%. Of the 51 patients diagnosed with ovca, median age was 57(27-79 years), median CA125 67 U/ml(9-353 U/ml), and median preoperative AM size was 9.8cm(2.6-21.4cm). Final histologic diagnosis was: epithelial ovca 40(78%), sex cord stromal tumor 5(9.8%), germ cell tumor 1(1.9%), other 5(9.8%). The most common epithelial histology was high grade serous 18(45%). CONCLUSION: In patients who underwent surgery for AM with no radiologic evidence of metastatic disease at a high-volume cancer center, risk of ovca was 8% with the majority of patients having benign disease.