title: Vascular atypia and irregularity on surface as signs of malignant adnexal mass: a complementary method of laparoscopic assessment.
abstract: 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.
authors.affiliation: Department of Surgery and Anatomy, College of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. omeropoli@yahoo.com.br
authors.forename: Omero Benedicto
authors.initials: OB
authors.lastname: Neto Poli
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Candido dos Reis
authors.forename: Júlio Cesar
authors.initials: JC
authors.lastname: Rosa e Silva
authors.forename: Jurandyr Moreira
authors.initials: JM
authors.lastname: de Andrade
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Nogueira
mesh_terms: 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