Full length article| Volume 265, P80-89, October 2021

Management of adnexal mass: A comparison of five national guidelines

  • Lior Friedrich
    Corresponding author at: The Joyce & Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel.
    The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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  • Author Footnotes
    1 Equal contribution.
    Raanan Meyer
    1 Equal contribution.
    The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel

    The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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  • Author Footnotes
    1 Equal contribution.
    Gabriel Levin
    1 Equal contribution.
    The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    The Faculty of Medicine, Hebrew University, Jerusalem, Israel
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  • Author Footnotes
    1 Equal contribution.



      General gynecologists are often the first to face a newly diagnosed adnexal mass. Bothering mass symptoms, fertility issues, and the effect of a possible surgical intervention on fertility in term of mechanical factor and ovarian follicular reserve are all considerations that should be accounted for. This study summarizes and compares five different adnexal mass management guidelines, enabling clinicians to peruse consensus and controversy issues, thus choosing the optimal management method.


      We retrieved, reviewed and compared the most recent national guidelines of adnexal mass management from the national societies of the United States (American College of Obstetricians and Gynecologists), England (the Royal College of Obstetricians and Gynecologists), Canada (the Society of Obstetricians and Gynaecologists of Canada), Australia (the Royal Australian College of General Practitioners), and France (French College of Gynaecologists and Obstetricians).


      There is a broad consensus regarding the role of transvaginal ultrasound as part of the initial evaluation of an adnexal mass and the radiological characteristics suggesting it being malignant. The role of transabdominal ultrasound or doppler mode is controversial. The use of MRI in cases of indeterminate adnexal masses is widely accepted. Ultrasound-guided aspiration is generally not recommended. There is a broad consensus that CA-125 should not be used as an ovarian cancer disease screening tool, though its role in the initial evaluation of adnexal masses is controversial. Risk prediction models are generally accepted, particularly the 'International Ovarian Tumor Analysis simple rules' and the 'Risk of Malignancy Index'.


      Adnexal mass management national guidelines, though similar, had noticeable variations in the content, references cited, and recommendations made. While this variation might raise a concern as to the reproducibility of synthesizing literature, it can help practitioners present all spectra of recommendations and available data.


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