Abstract
Objectives
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.
Design
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).
Results
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'.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 24, 2021
Accepted:
August 22,
2021
Received in revised form:
July 18,
2021
Received:
December 22,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
