Vascular atypia and irregularity on surface as signs of malignant adnexal mass: a complementary method of laparoscopic assessment.
OBJECTIVE
To evaluate the risk of malignancy associated with the main macroscopic findings observed on adnexal masses during a laparoscopic approach.


METHODS
Prospective series of consecutive patients (Canadian Task Force classification II-2).


METHODS
Tertiary care university hospital.


METHODS
One hundred fifteen patients were included. Ninety-eight had benign and 17 malignant adnexal masses.


METHODS
Diagnostic and operative laparoscopy.


RESULTS
Adnexal images were obtained during laparoscopy, recorded, and analyzed according to irregularity on surface, presence of atypical vessels, lobular form, absence of coral-like surface, implants, large-volume ascites, and cloudy or hemorrhagic ascites. A logistic regression was applied, and the independent findings associated with malignant disease were atypical vessels (OR 16.37; 95% CI 2.85-94.13; p <.01) and irregularity on tumor surface (OR 43.41; 95% CI 8.02-234.96; p <.05). In this way, 95% of the cases were correctly diagnosed.


CONCLUSIONS
Atypical vessels and irregularity on tumor surface were important criteria of malignancy during laparoscopic treatment of adnexal masses. The recognition of these features can be helpful in choosing the ideal surgical approach mainly when the preoperative evaluation is unsatisfactory.
Neto Poli
Omero Benedicto
OB
Department of Surgery and Anatomy, College of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. omeropoli@yahoo.com.br
Candido dos Reis
Francisco José
FJ
Rosa e Silva
Júlio Cesar
JC
de Andrade
Jurandyr Moreira
JM
Nogueira
Antonio Alberto
AA
D000291:Adnexal Diseases / Q000175:diagnosis*; D003537:Cystadenoma / Q000601:surgery*; D003884:Dermoid Cyst / Q000175:diagnosis; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies