Approach to Adnexal Masses

Adnexal mass is a common gynecologic problem. Most of them are benign and arise from ovary. But, determination of adnexal mass if it has high risk of malignancy preoperatively defining operative procedure and information of patient appropriately is essential for preventing unnecessary procedures. In evaluation of adnexal mass preoperatively it is necessary to use detailed history of patient, physical examination, imaging methods and suitable tumor markers. Recently, in order to discriminate the adnexal mass benign or malign, some malignancy risk indexes based on ultrasound and doppler findings, tumor markers and menopausal status of patient. International Ovarian Tumor Analysis (IOTA) models based on ultrasound findings (septation, papillary projections, presence of acoustic shadows, ascites), doppler imaging of adnexal mass, menopausal status, age, family history, current hormonal therapy, presence of pain; risk of malignancy index (RMI) including multilocularity of adnexal mass, presence of solid component, bilaterality, presence of ascites and evidence of metastasis, menopausal status of patient, serum CA 125 level; and De Priest Morphological Index (MI) based on tumor volume, wall structure of cyst and septa structure are some of these malignancy indexes. As a result of studies that comparing scoring systems it was seen that adnexal masses could be diagnosed with higher sensitivity and specificity by using IOTA scoring system. Thanks to this, with more accurate evaluation of patients preoperatively, optimal surgical method could be planned