Benign Adnexal Masses Research Articles

Early detection of ovarian cancer using cell-free DNA fragmentomes and protein biomarkers.

Ovarian cancer is a leading cause of death for women worldwide in part due to ineffective screening methods. In this study, we used whole-genome cell-free DNA (cfDNA) fragmentome and protein biomarker (CA-125 and HE4) analyses to evaluate 591 women with ovarian cancer, benign adnexal masses, or without ovarian lesions. Using a machine learning model with the combined features, we detected ovarian cancer with specificity >99% and sensitivity of 72%, 69%, 87%, and 100% for stages I-IV, respectively. At the same specificity, CA-125 alone detected 34%, 62%, 63%, and 100% of ovarian cancers for stages I-IV. Our approach differentiated benign masses from ovarian cancers with high accuracy (AUC=0.88, 95% CI=0.83-0.92). These results were validated in an independent population. These findings show that integrated cfDNA fragmentome and protein analyses detect ovarian cancers with high performance, enabling a new accessible approach for noninvasive ovarian cancer screening and diagnostic evaluation.

Serum miRNA improves the accuracy of a multivariate index assay for triage of an adnexal mass

ObjectiveTo determine whether a multimodal assay combining serum microRNA with protein biomarkers and metadata improves triage assessment of an adnexal mass. MethodsSerum samples from 468 training subjects (191 cancer cases and 277 benign adnexal mass controls or healthy controls) were analyzed for seven protein biomarkers and 180 miRNA. Circulating analyte data were combined with age and menopausal status (metadata) into a neural network model to classify samples as cases or controls. Forward regression with ten-fold cross-validation minimized the dimensionality of the model while maximizing linear separation between cases and controls. Model validation proceeded using both internal (44 cases and 56 controls) and external validation sets (51 cases and 59 controls). ResultsThe total study population comprised 678 subjects, including 286 cases and 392 controls. Overall, 290 (43%) of the subjects were premenopausal. A panel of 10 miRNA delivered optimal performance when combined with protein and metadata features. The combined model improved the Receiver Operator Characteristic Area Under the Curve (ROC AUC) on the internal (AUC = 0.9; 95% CI 0.81–0.95) and external validation sets (AUC = 0.95; 95% CI 0.90–0.98) compared to miRNA alone or proteins plus metadata (without miRNA). On external validation, the combined model offered 92% sensitivity at 80% specificity overall, with 80% and 100% sensitivity for early and late-stage cancers, respectively, including 78% sensitivity for early-stage, serous ovarian cancers and 82% sensitivity for early-stage, non-serous cancers. ConclusionsA multimodal assay combining miRNA with protein biomarkers, age, and menopausal status improves surgical triage of an adnexal mass.

Single-port laparoscopy versus conventional laparoscopy for management of benign adnexal masses during pregnancy: a comparative study

Single-port laparoscopy versus conventional laparoscopy for management of benign adnexal masses during pregnancy: a comparative study

Comparison of conventional diffusion-weighted imaging, diffusion kurtosis imaging and intravoxel incoherent motion in characterization of sonographically indeterminate adnexal masses.

To evaluate the role of conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI), and intravoxel incoherent motion (IVIM) in distinguishing benign from malignant adnexal masses. 38 patients with 45 adnexal masses were enrolled in this prospective study and assessed with multiparametric MRI, including the IVIM-DKI sequence, on a 3T MRI system. The mean apparent diffusion coefficient (ADC) from conventional DWI, the apparent diffusion coefficient derived from DKI (Dapp), the apparent kurtosis coefficient (Kapp), true diffusion coefficient (Dt), perfusion fraction (f) and pseudo-diffusion coefficient (Dp) were measured. The mean ADC, Dapp, and Dt were significantly higher in benign adnexal masses than in malignant adnexal masses (p < 0.001). f and Dp were also significantly higher in benign adnexal masses, with p values of 0.026 and 0.002, respectively. Kapp was higher in malignant masses (p < 0.001). Among mean ADC, Dapp, and Dt, mean ADC had the highest area under the curve (AUC) of 0.885. However, no statistically significant differences were observed between the ROCs of various diffusion parameters. The mean ADC, Dapp, and Kapp are useful parameters in discriminating between benign and malignant adnexal masses. Dt derived from IVIM also helps in distinguishing benign and malignant adnexal masses; however, no incremental role of IVIM and DKI over ADC could be identified in our study.

Abstract 982: Variation of cell-free DNA concentrations in liquid biopsies

Abstract Introduction: Liquid biopsies are promising noninvasive tools for cancer detection. Variation in cell-free DNA concentrations (cfDNA-conc) has been observed between individuals with and without cancer. We assessed cfDNA-conc in 2287 treatment-naive individuals including those without cancer, with benign or high-risk conditions, or with one of eight cancer types. Methods: Plasma (0.3 to 9.8 mL) was separated from whole blood collected in Streck or EDTA tubes from individuals with bile duct, breast, colorectal, gastric, ovarian, liver, lung, pancreatic, or metastatic cancer (n=23, 54, 28, 26, 264, 75, 180, 31, 22, respectively) as well as benign or high-risk conditions (n=550, 133, respectively) such as cirrhosis or hepatitis B or C virus infection (HBV/HCV), and without cancer (n=901). cfDNA was extracted using the Qiagen QIAamp Circulating Nucleic Acid Kit. Quality and quantity were assessed using the High Sensitivity DNA assay on the Agilent Bioanalyzer. Total amount (ng) of cfDNA from all nucleosomal peaks was evaluated per volume (mL) of plasma to assess significance across cohorts using unpaired two-sample Wilcoxon tests. Results: We observed that in individuals without cancer, cfDNA-conc increased with age (Pearson R2=0.59; 18-40yrs vs 41-55yrs, vs 56-65yrs, vs 66-85yrs; p=2.31E-09, 1.50E-12, 8.31E-17, respectively). No difference was observed between cfDNA-conc from EDTA and Streck plasma from the same individual (n=9, p=0.359, Wilcoxon signed-rank test two-tailed). Individuals with benign adnexal masses or cirrhosis had similar cfDNA-conc compared to those without cancer while individuals with benign lung lesions or HBV/HCV had significantly different cfDNA-conc (p=0.70, 0.35, 6.96E-04, 1.88E-09, respectively). These observations were not affected by age. Individuals with cancer had significantly higher cfDNA-conc compared to those without cancer (bile duct p=2.08E-14, breast p=4.44E-16, colorectal p=6.04E-10, gastric p=5.93E-04, ovarian p=9.99E-16, liver p=1.22E-15, lung p=0, pancreatic p=8.57E-03, metastatic p=1.18E-06). Ovarian cancer exhibited higher cfDNA-conc than benign adnexal masses which was more pronounced in later stage disease (I/II p=3.83E-06, III/IV p=8.18E-08). Compared to cirrhosis or HBV/HCV we observed a stepwise increase in cfDNA-conc in liver cancer with progressing stage (0/A p= 6.50E-04, B p= 5.69E-10, C p= 1.47E-08). Higher cfDNA-conc were also observed with higher stage of lung cancer compared to benign lung lesions (I/II p=4.99E-03, III/IV p=3.89E-06). Using cfDNA-conc (ng/mL) as a single feature, we distinguished individuals with and without cancer with an AUC of 0.72 (95% CI=0.70-0.75). Conclusions: In a cohort of 2287 individuals, we observed cfDNA-conc increases with age and cancer stage that varied across cancer types. As a classifier, cfDNA-conc can be predictive of cancer status, yet further work is needed to understand the contribution of other comorbidities. Citation Format: Sarah Short, Akshaya V. Annapragada, Jamie E. Medina, Zachariah H. Foda, Dimitrios Mathios, Carolyn Hruban, Elaine J. Chiao, Kavya Boyapati, Adrianna Bartolomucci, Keerti Boyapati, Vilmos Adleff, Robert B. Scharpf, Victor E. Velculescu, Jillian Phallen. Variation of cell-free DNA concentrations in liquid biopsies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 982.

Potential tools for predicting response to chemotherapy in OC: Assessment of immune dysbiosis, participant’s self-rated health and microbial dynamics

Epithelial ovarian cancer (OC) is the deadliest female reproductive cancer; an estimated 13,270 women will die from OC in 2023. Platinum-based chemotherapy resistance mechanisms contribute to poor OC 5-year survival rates. Peripheral inflammation is linked to various disease states and we previously identified unique peritoneal microbial features predictive of OC. We hypothesized that unique peripheral immune profiles and peritoneal microbial features may be predictive of disease-free interval (time to recurrence) and response to chemotherapy in participants with OC. We also investigated self-rated health (SRH) scores in the context of peripheral inflammation as a potential screening tool for OC. Blood and peritoneal fluid were collected from participants with OC or a benign adnexal mass (BPM). Lymphocyte populations were analyzed using Fluorescence Activated Cell Sorting, serum cytokine levels were analyzed using the Human Th17 Magnetic Bead Panel assay and peritoneal fluid microbial features were analyzed using Next Generation Sequencing (NGS). Participants completed a standardized questionnaire on self-rated physical and emotional health. Participants were classified into three chemotherapy response categories: platinum-refractory, platinum-resistant or platinum-sensitive. A significant positive correlation was found between elevated inflammatory status on the day of surgery and longer disease-free interval. SRH measures did not correlate with immune status in participants with OC or a BPM. We identified a correlation between peritoneal microbial features and chemotherapy response. We conclude that immune dysbiosis may be useful in predicting OC recurrence. The immune findings reported here set the framework for additional studies utilizing immune profiles to predict platinum-based chemotherapy responsiveness in OC.

Abstract A040: Improving specificity for ovarian cancer screening using a novel extracellular vesicle-based blood test

Abstract Introduction: The low incidence of ovarian cancer (OC) in average risk individuals dictates any OC screening method needs to be both highly sensitive and highly specific. Even using the multimodal OC screening strategy combining longitudinal serum CA125 and transvaginal ultrasound, 16% of OCs were not detected and false positives due to benign ovarian tumors, which are 5-10 times more prevalent than OC, remained high. Due to lack of mortality benefit, population screening is still not recommended. We hypothesized that detecting multiple colocalized protein or glycosylation epitopes (PGEs) on single tumor-derived extracellular vesicles (EVs) would increase specificity and sensitivity for detection of OC. Methods: The Mercy Halo™ OC test employs immunoaffinity capture and proximity-ligation qPCR to detect combinations of up to 3 PGE biomarkers to maximize specificity and measures multiple combinations to maximize sensitivity. We selected 3 PGE combinations to form a panel test to distinguish high-grade serous ovarian cancer (HGSC) from benign ovarian tumors and normal patients and compared performance of our test to CA125. We used a case-control training set from university-associated Canadian biobanks comprised of EDTA plasma from 124 healthy controls, 89 HGSC cases (17 Stage I, 35 Stage II, 37 Stage III)(10 BRCA+), and 192 benign adnexal masses to lock down the test, the data interpretation algorithm, and the cut-off between cancer and non-cancer. Performance was verified in an independent blinded diagnostic case-control set of 397 serum samples from 138 healthy controls, 111 benign adnexal masses, 20 borderlines, 66 HGSC and 62 non-HGSC from the UK Ovarian Cancer Population Study. For comparison, a CA125 ELISA was run for all samples in both studies. Results: Using the locked assay, algorithm, and cut-off established in the training cohort, our test showed a specificity in healthy controls of 92.8% (128/138; 95% CI: 0.87-0.96), a sensitivity in HGSC of 97.0% (64/66; 95% CI: 0.90-0.99), and an AUC of 0.92 (95% CI 0.89-0.95) in the verification cohort. We correctly identified 11/13 Stage I and all 54 Stage II/III/IV HGSC cases. Our test also detected 76.8% (63/82) of the borderline and non-HGSC histotypes. CA125 detected 92.4% (61/66) of the HGSC cases and 84.1% (69/82) of the borderlines and non-HGSC. The greatest improvement in test performance relative to CA125 was seen with benign adnexal masses. In the verification cohort 35.1% (39/111) of the benign samples were CA125 positive compared to 21.6% (24/111) with our test. This reduction in false positives was seen across 10 benign histotypes tested. Conclusions: These results demonstrate that our test using colocalized PGEs on EVs can detect OC, especially HGSC, in both plasma and serum with high sensitivity and specificity. The combinations of 5 biomarkers rather than CA125 alone also decreased benign false positives. The test performance suggests that our test may be useful in average and/or high-risk ovarian cancer screening. Future studies will explore this in asymptomatic populations. Citation Format: Emily S. Winn-Deen, Sanchari Banerjee, Daniel Gusenleitner, Laura T. Bortolin, Jonian Grosha, Kelly M. Biette, Karen Copeland, Christopher R. Sedlak, Bilal Hamzeh, Anthony D. Couvillon, Delaney M. Byrne, Peter A. Duff, Lauren T. Cuoco, MacKenzie S. King, Aleksandra Gentry-Maharaj, Sophia Apostolidou, Dawn R. Mattoon, Christine D. Berg, David F. Ransohoff, Steven J. Skates, Usha Menon. Improving specificity for ovarian cancer screening using a novel extracellular vesicle-based blood test [abstract]. In: Proceedings of the AACR Special Conference on Ovarian Cancer; 2023 Oct 5-7; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_2):Abstract nr A040.

Pelvic Inflammatory Disease Mimicking Ovarian Cancer: A Case Series from A Tertiary Cancer Center

AbstractThe female pelvis has a complex anatomy, and benign adnexal diseases can present as malignant ovarian masses clinically and radiologically. Between 1 June 2011 and 28 September 2022, we included in this study all the patients who were diagnosed initially with suspicious ovarian masses in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt, and after surgical exploration revealed pelvic inflammatory disease and we assessed their diagnostic, operative, and postoperative outcomes. In this case series we had 41 patients of a total of 803 cases with suspicious adnexal mass that revealed pelvic inflammatory disease after surgical exploration, abdominal pain was the common presentation in 53.7% of the cases, and low-grade fever was reported in seven cases. The serum cancer antigen 125 was elevated in 70.7% of the cases. Unilateral adnexal mass was found in 30 cases and 11 cases had bilateral adnexal masses. We followed up on the patients within 47 months (range 12–88 months); recurrent pelvic inflammatory disease has developed in one case after 62 months and ovarian cancer has developed in another case after 80 months. We concluded that benign adnexal masses such as tubo-ovarian abscess secondary to pelvic inflammatory disease should be considered a differential diagnosis in patients with radiological suspicious adnexal masses when the tumor markers such as cancer antigen 125 are normal or mildly elevated, especially in premenopausal women, and the clinical presentations are not specific to either benign or malignant adnexal diseases.

Comparative diagnostic accuracy of the IOTA SRR and LR2 scoring systems for discriminating between malignant and Benign Adnexal masses by junior physicians in Chinese patients: a retrospective observational study

BackgroundThe accuracy of ultrasound in distinguishing benign from malignant adnexal masses is highly correlated with the experience of ultrasound physicians. In China, most of ultrasound differentiation is done by junior physicians.PurposeTo compare the diagnostic performance of the International Ovarian Tumour Analysis (IOTA) Simple Rules Risk (SRR) and IOTA Logistic Regression Model 2 (LR2) scoring systems in Chinese patients with adnexal masses.MethodsRetrospective analysis of ovarian cancer tumor patients who underwent surgery at a hospital in China from January 2016 to December 2021. Screening patients with at least one adnexal mass on inclusion and exclusion criteria. Two trained junior physicians evaluated each mass using the two scoring systems. A receiver operating characteristic curve was used to test the diagnostic performance of each system.ResultsA total of 144 adnexal masses were retrospectively collected. Forty masses were histologically diagnosed as malignant. Compared with premenopausal women, postmenopausal women had a much higher rate of malignant masses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of the SRR was 97.5% (95% CI: 86.8 -99.9%), 82.7% (95% CI: 74.0 -89.4%), 68.4% (95% CI: 58.7 -76.8%) and 98.9% (95% CI: 92.5 -99.8%). The sensitivity, specificity, PPV, NPV of the LR2 were 90.0% (95% CI: 76.5 -97.2%), 89.4% (95% CI: 81.9 -94.6%), 76.6% (95% CI: 65.0 -85.2%), and 95.9% (95% CI: 90.2 -98.3%). There was good agreement between two scoring systems, with 84.03% total agreement and a kappa value of 0.783 (95% CI: 0.70-0.864). The areas under the curve for predicting malignant tumours using SRR and LR2 were similar for all patients (P > 0.05 ).ConclusionThe two scoring systems can effectively distinguish benign from malignant adnexal masses. Both scoring systems have high diagnostic efficacy, and diagnostic efficacy is stable, which can provide an important reference for clinical decision making.

Effectiveness of Prophylactic Laparoscopic Surgery for Benign Adnexal Mass during Pregnancy: A Single-center Retrospective Study.

This study aimed to evaluate the effectiveness of prophylactic laparoscopic surgery for avoiding adnexal torsion in pregnant women with benign adnexal masses. This report contains two analyses, each for a different group of patients. Analysis 1: Surgical and pregnancy outcomes were examined among the 126 cases who underwent laparoscopic assisted cystectomy for adnexal masses during pregnancy in our hospital between January 2001 and December 2020. Analysis 2: The incidence of adnexal torsion during pregnancy was evaluated among the cases with adnexal masses ≥5 cm who opted for conservative follow-up in our hospital between January 2011 and December 2020. In analysis 1, the most common pathological diagnosis was a mature cystic teratoma (76.2%). The mean gestational age at surgery was 13.1 ± 1.3 weeks. No cases were converted to laparotomy and oophorectomy. Regarding delivery outcomes, 97.4% of cases went on to have full-term deliveries. In Analysis 2, the incidence of adnexal mass ≥5 cm that did not resolve spontaneously during pregnancy was 89 cases (0.8%). The frequency of malignancy was 3 cases (0.03%). In 28 cases who opted for conservative treatment, 5 (17.9%) underwent emergency surgery for adnexal torsion. Prophylactic surgery for benign adnexal masses during pregnancy can be performed laparoscopically and preserved ovarian functions. In pregnant women with adnexal masses that do not resolve spontaneously, planning laparoscopic surgery is considered beneficial for complications, such as adnexal torsion.

Accuracy of Multi-Detector Computed Tomography In the Diagnoses of Adnexal Masses

Background: Ovarian cancer is the 5th common cause of death in women. patients older than 30 years are high malignant potential group. The lifetime risk of dying from invasive ovarian cancer is about 1 in 95. Modern imaging techniques have demonstrated significant accuracy in the diagnosis and staging of adnexal masses that help the clinician in surgical and post-surgical treatment planning. Objective: To determine the accuracy of multidetector computed tomography (MDCT) in diagnoses of benign and malignant adnexal masses, compare it with histopathological diagnoses and find out the sensitivity, specificity, positive predictive value, negative predictive value of MDCT in diagnoses of benign and malignant adnexal masses. Materials and Methods: This cross-sectional observational study was carried out between January 2013 to December 2014 with 45 patients referred for an MDCT scan of the pelvic organ with a suspicion of adnexal mass in Dhaka Medical College, Dhaka. All the patients were evaluated by detailed history and clinical examination. CT scan of the pelvic organ was performed in all cases and the report was checked by the radiologists of DMCH. Operated patients were followed up after surgery up to histopathological diagnosis and correlated with CT scan findings. Results: CT diagnosis for evaluation of benign adnexal mass, sensitivity was 90.0%, specificity 92.0%, accuracy 91.1%, PPV was 90.0% and NPV 92.0%. In the case of malignant mass, sensitivity is 92.0%, specificity 90.0%, accuracy 91.1%, PPV 92.0% and NPV 90.0%. Conclusion: MDCT is a valuable modality in the diagnosis of benign and malignant adnexal masses.KYAMC Journal Vol. 14, No. 02, July 2023: 74-78.

Subjective assessment and IOTA ADNEX model in evaluation of adnexal masses in patients with history of breast cancer.

To evaluate the performance of subjective assessment and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in discriminating between benign and malignant adnexal tumors and between metastatic and primary adnexal tumors in patients with a personal history of breast cancer. This was a retrospective single-center study including patients with a history of breast cancer who underwent surgery for an adnexal mass between 2013 and 2020. All patients had been examined with transvaginal or transrectal ultrasound using a standardized examination technique and all ultrasound reports had been stored and were retrieved for the purposes of this study. The specific diagnosis suggested by the original ultrasound examiner in the retrieved report was analyzed. For each mass, the ADNEX model risks were calculated prospectively and the highest relative risk was used to categorize each into one of five categories (benign, borderline, primary Stage I, primary Stages II-IV or metastatic ovarian cancer) for analysis of the ADNEX model in predicting the specific tumor type. The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal tumors and between primary and metastatic adnexal tumors was evaluated, using final histology as the reference standard. Included in the study were 202 women with a history of breast cancer who underwent surgery for an adnexal mass. At histology, 93/202 (46.0%) masses were benign, 76/202 (37.6%) were primary malignancies (four borderline and 72 invasive tumors) and 33/202 (16.3%) were metastases. The original ultrasound examiner classified correctly 79/93 (84.9%) benign adnexal masses, 72/76 (94.7%) primary adnexal malignancies and 30/33 (90.9%) metastatic tumors. Subjective ultrasound evaluation had a sensitivity of 93.6%, specificity of 84.9% and accuracy of 89.6%, while the ADNEX model had higher sensitivity (98.2%) but lower specificity (78.5%), with similar accuracy (89.1%), in discriminating between benign and malignant ovarian masses. Subjective evaluation had a sensitivity of 51.5%, specificity of 88.8% and accuracy of 82.7% in distinguishing metastatic and primary tumors (including benign, borderline and invasive tumors), and the ADNEX model had a sensitivity of 63.6%, specificity of 84.6% and similar accuracy (81.2%). The performance of subjective assessment and the ADNEX model in discriminating between benign and malignant adnexal masses in this series of patients with history of breast cancer was relatively similar. Both subjective assessment and the ADNEX model demonstrated good accuracy and specificity in discriminating between metastatic and primary tumors, but the sensitivity was low. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Improving risk stratification of indeterminate adnexal masses on MRI: What imaging features help predict malignancy in O-RADS MRI 4 lesions?

PurposeOvarian-Adnexal Reporting and Data System (O-RADS) MRI uses a 5-point scale to establish malignancy risk in sonographically-indeterminate adnexal masses. The management of O-RADS MRI score 4 lesions is challenging, as the prevalence of malignancy is widely variable (5–90%). We assessed imaging features that may sub-stratify O-RADS MRI 4 lesions into malignant and benign subgroups. MethodRetrospective single-institution study of women with O-RADS MRI score of 4 adnexal masses between April 2021–August 2022. Imaging findings were assessed independently by 2 radiologists according to the O-RADS lexicon white paper. MRI and clinical findingswere compared between malignant and benign adnexal masses, and inter-reader agreement was calculated. ResultsSeventy-four women (median age 52 years, IQR 36–61) were included. On pathology, 41 (55.4%) adnexal masses were malignant. Patients with malignant masses were younger (p = 0.02) with higher CA-125 levels (p = 0.03). Size of solid tissue was greater in malignant masses (p = 0.01–0.04). Papillary projections and larger solid portion were more common in malignant lesions; irregular septations and predominantly solid composition were more frequent in benign lesions (p < 0.01). Solid tissue of malignant lesions was more often hyperintense on T2-weighted and diffusion-weighted imaging (p ≤ 0.03). Other imaging findings were not significantly different (p = 0.09–0.77). Inter-reader agreement was excellent–good for most features (ICC = 0. 662–0.950; k = 0. 650–0.860). ConclusionVarious MRI and clinical features differed between malignant and benign O-RADS MRI score 4 adnexal masses. O-RADS MRI 4 lesions may be sub-stratified (high vs low risk) based on solid tissue characteristics and CA-125 levels.

Evaluating the Frequency and Characteristics of Unexpected Ovarian Malignancy in Postmenopausal Women Who Have Undergone Laparoscopic Surgery for Adnexal Masses - A Review of Five Years.

Aim The aim of this study was to estimate the frequent existence of unexpected ovarian malignant lesions after laparoscopic surgery for an apparent benign adnexal mass and assess its clinical and ultrasound characteristics in postmenopausal women. Methods We re-examined the hospital records of 96 cases of postmenopausal women who underwent laparoscopic surgery for benign adnexal mass over five years. The age of the patient, parity, ultrasound findings, tumor markers level, intraoperative findings, and histopathological report were collected. Pearson's Chi-squared test and Fisher's exact test were used for statistical analysis, and a p-value of <0.05 was accepted as statistically significant. Results Of a total of 96, benign adnexal mass was in 93 (96.83%), an unexpected ovarian malignancy was observed in two (2.08%) cases, and one (1.04%) had a borderline ovarian tumor. Tumor marker CA-125 was done for all those cases of adnexal mass in postmenopausal women, and not a single case was found to have above 35 IU/ml, defined as the cut-off value for CA-125. Statistically significant differences were observed between the benign and malignant groups in relation to symptoms (p<0.05), ultrasound score (p=0.001), and bilaterality (p=0.013) of the tumor mass. Conclusion In postmenopausal women, the critical concern for laparoscopic surgery of benign adnexal mass is unexpected malignancy. So it is essential to select patients carefully for laparoscopic surgery. If a benign-looking adnexal mass turned out to be malignant on the histopathological report, we should try to post the patient for subsequent staging laparotomy as soon as possible.

P25 Complication rates among patients undergoing concurrent hysterectomy with adnexal surgery versus adnexal surgery alone for benign adnexal masses

P25 Complication rates among patients undergoing concurrent hysterectomy with adnexal surgery versus adnexal surgery alone for benign adnexal masses

P-757 The classification and management of adnexal masses identified during pregnancy

Abstract Study question How do we classify adnexal masses (ovarian cysts) identified during pregnancy and how should we manage them? Summary answer Adnexal masses (ovarian cysts) should be managed expectantly in pregnancy, given the low rate of complications and low prevalence of malignancy. What is known already Conservative management of adnexal masses (ovarian cysts) is preferable during pregnancy, due to the maternal and fetal risks associated with surgery. Accurate diagnosis is key to safe expectant management. Various ultrasound-based models exist to classify adnexal masses; however, none have been validated for use in pregnancy. Adnexal mass morphology can change during pregnancy due to decidualisation, which is often difficult to distinguish from underlying neoplastic processes. We aim to evaluate:(1) the performance of current methods of adnexal mass classification in pregnancy, (2) understand the natural course of adnexal masses in pregnancy, particularly the presence of decidualisation and incidence of complications. Study design, size, duration Retrospective analysis of prospectively collected data between January 2017- November 2022. To classify adnexal masses (ovarian cysts), we evaluated: Expert subjective assessment (SA), IOTA Simple Rules (SR) and the IOTA Assessment of Different Neoplasias of the Adnexa (ADNEX) model. The end point was either the histological examination of tissue removed at surgery or the subjective classification of adnexal masses at the postnatal scan in women managed conservatively. Participants/materials, setting, methods Women with an adnexal mass identified on gynaecological ultrasound in pregnancy at a tertiary London University Hospital were included. Relevant clinical data was extracted, including age, gestation and cyst-related complications. Adnexal masses were classified at the first antenatal and postnatal ultrasound examination according to SA, SR and the ADNEX model (10% risk of malignancy cut off) and correlated to histology for adnexal masses managed surgically. IOTA simple descriptors were used to classify benign adnexal masses. Main results and the role of chance 254 women (median age 33-years old, range:18-49) with an adnexal mass/cyst were included at a median gestation of 12 weeks, (range:4-36). 13 (5.1%) conceived through assisted reproductive techniques. Spontaneous resolution occurred in 24.5% of cases, and 21 were lost to follow up (8.3%). According to Simple Descriptors, 38.6% were simple, 22.0% were endometriomas and 19.7% were dermoid cysts. Antenatally, SA outperformed ADNEX, based on specificity (94.6 vs.92.2%) and sensitivity (60 vs.55.6%) respectively. SA and ADNEX had a negative predictive value(NPV) of 96.1% and 98.3% respectively. Postnatally, SA had a higher sensitivity than ADNEX (75 vs.50%), but a lower specificity (94.1 vs.96.9%). SA and ADNEX had a NPV of 94.1% and 97.5% respectively. Three (1.3%) underwent acute surgery during pregnancy: one ovarian torsion (9/40), and two cyst ruptures (11/40, 30/40). Presumed decidualisation occurred in 29.5% of endometriomas. Three (1.3%) underwent cyst removal during caesarean section, two for suspicion of BOTs (one had suspected decidualisation) and one for patient preference. On histology, the suspected decidualised mass was a serous BOT, and the suspected BOT was a struma ovarii. In the postnatal period (12 weeks), four underwent surgery for suspicion of BOTs, two were confirmed BOTs and two were benign cystadenomas on histology. Limitations, reasons for caution The dataset as expected contains a relatively small number of malignancies (prevalence 3.9%) and so any analysis of test performance to discriminate between benign and malignant disease must be interpreted with caution. A larger prospective multicentre study is needed to do this. Wider implications of the findings Our data suggest that a number of cysts in pregnancy will resolve, a few will be associated with acute complications and the risk of malignancy is very low. Accordingly, the study supports an expectant management approach for adnexal masses (ovarian cysts) detected in pregnancy. Trial registration number Not applicable

Diagnostic role of ovarian – adnexal reporting and data system magnetic resonance imaging scoring system for evaluation of indeterminate adnexal lesions

Introduction: Magnetic resonance imaging (MRI) plays an important role in distinguishing malignant from benign adnexal mass which are indistinguishable from ultrasonography. This can help in early diagnosis and treatment of indeterminate adnexal lesions. This study aims to evaluate the features suggestive of malignant features and accuracy of ovarian adnexal reporting and data system (O-RADS) MRI score in distinguishing benign from malignant lesions when compared with histopathology which is gold standard.&#x0D; Method: This was a retrospective study of MRI pelvis carried out in patients with indeterminate adnexal lesions who had MRI pelvis done from 2018 to 2022 at Patan Hospital, Lalitpur, Nepal. Ethical approval was obtained from the institutional review committee of Patan Academy of Health Sciences. MRI diagnosis based on O-RADS MRI score was compared with histopathology diagnosis and sensitivity, specificity was calculated. Chi square test was computed and p-value less than 0.05 was considered statistically significant.&#x0D; Result: Among 175 patients, 135 had benign and 40 had malignant lesions. Malignancy was common in middle aged patients (41-60years).MRI features of malignancy were multilocular, solid cystic lesion with contrast enhancement, septations and diffusion restriction. Significant statistical association of O-RADS MRI score was found with histopathology diagnosed malignancy. 92.5% of malignancy had O-RADS MRI score of 4 and 5.The sensitivity and specificity of MRI diagnosing indeterminate lesion was 92.5% and 91.85% respectively.&#x0D; Conclusion: O-RADS MRI scoring is significantly associated with histopathology proven adnexal malignancy hence helps in accurately diagnosing indeterminate adnexal lesions and stratisfying the risk of malignancy.

Diagnostic Accuracy of Risk of Malignancy Index RMI in Patients with Adnexal Mass

Background: Gynecological cancers often begin in the ovaries. Malignant pelvic masses may often be predicted using the Risk of Malignancy Index (RMI). Objective: To evaluate the RMI for its ability to differentiate between benign and malignant adnexal masses. Methods: A cross-sectional study in a gynecology and obstetrics OPD of Saidu Group Of teaching hospital,swat was carried out. 55 women who were hypothesized to have adnexal masses were included after informed consent. Each patient menopausal status, ultrasonography (USG) score and blood CA-125 level was measured. For every participant, the RMI was determined. Results: Thirty-five of the recruited women had noncancerous adnexal mass, whereas twenty had cancerous ones. Benign adnexal mass was seen in 19 premenopausal women and 16 postmenopausal women, and in malignant adnexal mass there were 13 premenopausal women and 7 postmenopausal women. Participants' mean ages were 44 years for benign adnexal mass and 40 years for malignant adnexal mass. USG score and CA-125 have significant variation between the benign and malignant adnexal masses, with p value of 0.000. High sensitivity (80%) and specificity (71.3%), as well as positive (77.3%) and negative (74.7%) predictive values, were found for the RMI at a cut-off of &lt;200 when used to differentiate between benign and malignant adnexal masses. Conclusion: In conclusion, the RMI seems to be a trustworthy, easy, and cost-effective technique for clinical distinction between benign and malignant adnexal masses. Keywords: adnexal mass, USG score, ovarian cancer, ovary malignancies

Implikacije pandemije Kovida 19 na laparoskopsku i abdominalnu hirurgiju benignih adneksalnih stanja - iskustvo jednog centra

Introduction/Aim: COVID-19 pandemic posed a challenge in patient treatment and caused problems in the organization of health systems in many countries. The study aimed to analyze and quantify the influence of COVID-19 pandemic on performing surgeries for benign adnexal conditions with classic (open abdominal) and minimally invasive (laparoscopic) approach at the Clinic for Gynecology and Obstetrics University Clinical Center of Serbia. Material and Methods: The study retrospectively analyzed all patients who were operated due to benign adnexal masses at our Clinic during the past five years. We compared numbers and types of operations before and during the pandemic. Results: The study included 2166 patients who significantly more often had laparoscopic (61.9%) than open surgeries (38.1%). Surgeries of benign adnexal masses were elective in 53.2% cases, whereas in 46.8% cases those were emergency surgeries. Before the pandemic laparoscopic surgeries (mostly cystectomies) were on the rise. A reduction in laparoscopic and open surgeries was seen in the year 2020 (p=0.001). Moreover, the majority of surgeries were emergency surgeries (76.2%; p=0.001). Nevertheless, this decrease was significant only for laparoscopic cystectomies (p=0.001), but not for adnexectomies (p=0.224) and salpingectomies (p=0.762). Likewise, the 2020 reduction in open cystectomies (p=0.073), adnexectomies (p=0.836) and salpingectomies (p=0.241) was not significant either. During 2021, the number of surgical procedures for benign adnexal masses started to rise again (p=0.023). No intra-hospital COVID-19 infections were registered. Conclusion: The total number of operations of benign adnexal masses in our Clinic decreased and was limited to emergencies, which was mostly reflected in minimally invasive surgery.

14-year experience in the Management of Benign Adnexal Masses by Laparoscopy

14-year experience in the Management of Benign Adnexal Masses by Laparoscopy