Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.
OBJECTIVE
This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery.


METHODS
The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically.


RESULTS
Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four.


CONCLUSIONS
Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.
Nezhat
F
F
Department of Obstetrics and Gynecology, Mercer University School of Medicine, Macon, GA.
Nezhat
C
C
Welander
C E
CE
Benigno
B
B
D000291:Adnexal Diseases / Q000601:surgery*; D000328:Adult; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D016609:Neoplasms, Second Primary; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D010537:Peritoneum / Q000473:pathology; D007507:Therapeutic Irrigation; D014594:Uterine Neoplasms / Q000601:surgery*
D015295:Antigens, Tumor-Associated, Carbohydrate