Approach to the patient with an adnexal mass
- Michael G Muto, MD
Michael G Muto, MD
- Associate Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Section Editors
- Howard T Sharp, MD
Howard T Sharp, MD
- Section Editor — Gynecologic Surgery
- Professor and Vice Chair for Clinical Activities
- Department of Obstetrics and Gynecology
- University of Utah Health Sciences Center
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
An adnexal mass (mass of the ovary, fallopian tube, or surrounding connective tissues) is a common gynecologic problem. In the United States, it is estimated that there is a 5 to 10 percent lifetime risk for women undergoing surgery for a suspected ovarian neoplasm . Adnexal masses may be found in females of all ages, fetuses to the elderly, and there is a wide variety of types of masses (table 1). The principal goals of the evaluation are to address acute conditions (eg, ectopic pregnancy) and to determine whether a mass is malignant.
The initial approach to and an overview of the evaluation of patients with an adnexal mass are reviewed here. Management of an adnexal mass and other related topics are discussed separately:
- National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol 1994; 55:S4.
- Borgfeldt C, Andolf E. Transvaginal sonographic ovarian findings in a random sample of women 25-40 years old. Ultrasound Obstet Gynecol 1999; 13:345.
- Castillo G, Alcázar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol 2004; 92:965.
- Pavlik EJ, Ueland FR, Miller RW, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol 2013; 122:210.
- Guerriero S, Alcazar JL, Ajossa S, et al. Comparison of conventional color Doppler imaging and power doppler imaging for the diagnosis of ovarian cancer: results of a European study. Gynecol Oncol 2001; 83:299.
- You W, Dainty LA, Rose GS, et al. Gynecologic malignancies in women aged less than 25 years. Obstet Gynecol 2005; 105:1405.
- Oltmann SC, Garcia N, Barber R, et al. Can we preoperatively risk stratify ovarian masses for malignancy? J Pediatr Surg 2010; 45:130.
- Cass DL, Hawkins E, Brandt ML, et al. Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg 2001; 36:693.
- Brown MF, Hebra A, McGeehin K, Ross AJ 3rd. Ovarian masses in children: a review of 91 cases of malignant and benign masses. J Pediatr Surg 1993; 28:930.
- Hassan E, Creatsas G, Deligeorolgou E, Michalas S. Ovarian tumors during childhood and adolescence. A clinicopathological study. Eur J Gynaecol Oncol 1999; 20:124.
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol 2007; 110:201.
- http://seer.cancer.gov/ (Accessed on September 07, 2012).
- Givens V, Mitchell GE, Harraway-Smith C, et al. Diagnosis and management of adnexal masses. Am Fam Physician 2009; 80:815.
- Myers ER, Bastian LA, Havrilesky LJ, et al. Management of Adnexal Mass. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025). AHRQ Publication No. 06-E004, Agency for Healthcare Research and Quality, Rockville, MD February 2006.
- Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology 2010; 256:677.
- Webb MJ, Decker DG, Mussey E, Williams TJ. Factor influencing survival in Stage I ovarian cancer. Am J Obstet Gynecol 1973; 116:222.
- Sainz de la Cuesta R, Goff BA, Fuller AF Jr, et al. Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 1994; 84:1.
- Buys SS, Partridge E, Greene MH, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 2005; 193:1630.
- van Nagell JR Jr, Miller RW. Evaluation and Management of Ultrasonographically Detected Ovarian Tumors in Asymptomatic Women. Obstet Gynecol 2016; 127:848.
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117:742.
- Kang S, Kim TJ, Nam BH, et al. Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol 2010; 101:13.
- CLINICAL APPROACH
- Excluding urgent conditions or malignancy
- Anatomic location
- Age and reproductive status
- - Children and adolescents
- - Premenopausal women
- Pregnant women
- - Postmenopausal women
- GENERAL EVALUATION
- Medical history
- Physical examination
- Imaging studies
- Laboratory evaluation
- EVALUATION FOR URGENT CONDITIONS
- First trimester bleeding or pain
- - Ectopic pregnancy
- Acute pelvic or abdominal pain
- - Adnexal torsion
- - Ruptured or hemorrhagic ovarian cyst
- - Tuboovarian abscess
- EVALUATION FOR MALIGNANCY
- Initial evaluation
- - Medical history
- - Physical examination
- - Imaging studies
- - Laboratory studies
- Serum markers for epithelial ovarian carcinoma
- Serum markers for other histologic types
- Surgical exploration
- REFERRAL TO A SPECIALIST
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS