Diagnosis Of Benign Adnexal Masses Research Articles

What is the success of ultrasonography of benign adnexal masses?

To assess the diagnostic accuracy of the ultrasonographic discrimination of benign adnexal masses. This was a prospective study, evaluating 245 consecutive cases using real-time gray-scale ultrasonography in a tertiary education hospital. Diagnostic accuracy was high for simple cysts and solid masses as κ-values of 0.824 and 0.816 and accuracy was moderate for endometriomas, dermoid cysts and cystadenomas as κ-values of 0.758, 0.689 and 0.627, respectively, and low for hemorrhagic cysts as a κ-value of 0.587. A logistic regression model was developed using ultrasonographic characteristics of the adnexal masses. Irregularity at lining of the inner wall, presence of solid component, papillary projections and echogenicity were shown to have a strong impact on the diagnosis of benign masses. Although ultrasonography is a useful technique for the diagnosis of benign adnexal masses, it is limited in diagnostic accuracy. Pattern recognition is the most favored method for ultrasonographic diagnosis. Logistic regression analysis can contribute to diagnostic accuracy.

Adding Cancer Antigen 125 Screening to Gray Scale Sonography for Predicting Specific Diagnosis of Benign Adnexal Masses in Premenopausal Women: Is It Worthwhile?

Adding Cancer Antigen 125 Screening to Gray Scale Sonography for Predicting Specific Diagnosis of Benign Adnexal Masses in Premenopausal Women: Is It Worthwhile?

Adding Cancer Antigen 125 Screening to Gray Scale Sonography for Predicting Specific Diagnosis of Benign Adnexal Masses in Premenopausal Women

The purpose of this study was to assess whether a single determination of the serum cancer antigen 125 (CA-125) level provides additional information to sonography for specific diagnosis of benign adnexal masses in premenopausal women. We conducted a retrospective study comprising 1058 premenopausal women (mean age, 34.8 years) with histologically proven benign adnexal masses. All women had undergone transvaginal sonography and serum CA-125 determination within 1 week before surgery and tumor removal. According to "pattern recognition" analysis, a presumptive diagnosis was provided on gray scale transvaginal sonography for all masses. Positive and negative likelihood ratios were calculated for gray scale sonography and gray scale sonography plus CA-125. Eighty-five women had bilateral masses (1143 masses analyzed). In 7 women with bilateral masses, the histologic diagnoses of the masses were discordant and were excluded. Histologic diagnoses were as follows: endometrioma, n = 452; dermoid cyst, n = 180; serous cyst, n = 158; hemorrhagic cyst, n = 119; mucinous cyst, n = 54; hydrosalpinx, n = 37; and other, n = 109. The median CA-125 level was significantly higher in endometrioma (71.9 IU/mL; range: 5-2620 IU/mL) and hydrosalpinx (59.2 IU/mL; range, 5-601 IU/mL) compared to all other tumor types (P < .001). The CA-125 level was 35 IU/mL or higher in 74% of endometriomas, 58% of hydrosalpinges, 34% of hemorrhagic cysts, 18% of mucinous cysts, 14% of dermoid cysts, and 8% of serous cysts. The positive and negative likelihood ratios for sonography and sonography plus CA-125 (335 IU/mL) for each kind of tumor were not statistically different except for endometrioma, for which the positive likelihood ratio for sonography plus CA-125 (55.0; 95% confidence interval, 27.5-109.9) was significantly higher than for sonography alone (19.2; 95% confidence interval, 13.6-27.1). Cancer antigen 125 screening does not add useful information for specific diagnosis of benign adnexal tumors, except for endometrioma. An elevated CA-125 level significantly increases the probability of such a lesion.

Management of adnexal masses by operative laparoscopy

To assess the efficacy of operative laparoscopy to confirm the diagnosis of benign adnexal masses, and treat the lesions. Consecutive patients evaluated for this indication between January 1989 and December 1993, who met the inclusion criteria. The Jan Palfijn General Hospital, Antwerp, Belgium, and the Department of Obstetrics and Gynecology, University of Varese, Varese, Italy. One hundred twenty-one women with a clinical, biochemical, and ultrasound diagnosis of benign adnexal mass. Operative videolaparoscopy was carried out in all patients using the carbon dioxide or argon laser, electrical, or mechanical means. Depending on the patient's age and the appearance of the adnexal mass aspirate, biopsy, cystectomy, or adnexectomy was performed. The conversion rate to laparotomy was 2.4%. A pathologic diagnosis was made in all cases. In this series no malignancy was encountered. Operative laparoscopy is safe and effective for treating adnexal masses provided that the preoperative diagnosis indicates that the lesions are benign.