SURGERY FOR OVARIAN MASS

In the United States, nine surgeries are performed for each ovarian cancer diagnosed. This number is substantially higher than in Europe. In addition, many US surgeries in which ovarian cancer is encountered are performed by physicians other than gynecologic oncologists.^[1]

A panel, including North American and European gynecologists, radiologists, gynecologic oncologists, and a pathologist, convened to generate recommendations regarding the use of imaging to assess ovarian masses detected through ultrasound.^[1] The group noted that pattern recognition performed by expert physicians using vaginal ultrasound along with color Doppler assessment represents the most accurate way to evaluate adnexal masses. This approach allows such masses to be triaged into three categories:

• Almost certainly benign includes simple and unilocular cysts, hemorrhagic cysts in premenopausal women, endometriomas, and dermoids or mature cystic teratomas. For asymptomatic low-risk masses, the panel recommends initial 3-month follow-up imaging, which can then be performed annually if the mass is stable or diminishing in size.
• Suspicious for malignancy includes masses with solitary mural nodules > 3 mm, multiple nodules involving more than 50% of the cyst wall or at least four in number, numerous or irregularly thickened and vascular septations, or cystic masses with large solid components. For these high-risk masses, the panel recommends prompt referral to a gynecologic oncologist.
• For indeterminate masses, the panel recommends that women be referred to physicians with particular expertise in gynecologic imaging and that MRI and sonographic follow-up be considered. Even though many women with indeterminate masses will not need surgery, the panel recommends that these women consult with a gynecologic oncologist as these subspecialists have particular expertise in evaluating ovarian masses.

The panel's recommendations can enhance the care of women with ovarian masses by minimizing surgery for asymptomatic women with benign masses, while facilitating identification and prompt referral of women with high-risk masses to gynecologic oncologists.