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Sonographic differentiation of benign versus malignant adnexal masses

Deborah Levine, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Sonography is a clinically important imaging modality for assessing whether an adnexal mass is likely benign or possibly malignant. This is important for assessing the need for surgery and for planning preoperative evaluation/preparation, the type of surgical procedure, and the surgical expertise required.

Optimal gray-scale sonographic criteria, the usefulness of Doppler sonography, and the value of combined gray-scale and Doppler sonography for assessing the probability of benign versus malignant ovarian disease will be reviewed here. A general overview of evaluation of the adnexal mass and the general principles of gynecologic ultrasonography are discussed separately. (See "Approach to the patient with an adnexal mass" and "Differential diagnosis of the adnexal mass" and "Ultrasound examination in obstetrics and gynecology".)


Ultrasound versus other diagnostic methods — Morphologic assessment by pelvic ultrasound is the first line study for evaluation of malignancy in an adnexal mass [1]. Ultrasound is relatively less expensive than other imaging modalities, its diagnostic performance is comparable or better, and it does not involve exposure to ionizing radiation. Use of other imaging studies is reasonable in the minority of patients in whom adequate characterization of the mass is not possible with ultrasound. Magnetic resonance imaging (MRI) is generally the next best imaging modality after ultrasound to characterize an adnexal mass [2].

The diagnostic performance of pelvic ultrasound compared with other methods of evaluation of an adnexal mass was best illustrated in a meta-analysis of 204 studies by the United States Agency for Healthcare Research and Quality [3]. The sensitivity and specificity for the diagnosis of ovarian cancer for the diagnostic tools evaluated were:

Bimanual pelvic examination: 45 and 90 percent


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Literature review current through: May 2016. | This topic last updated: Jan 13, 2014.
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