Performance of laparoscopy in identifying malignant ovarian cysts.
BACKGROUND
Peroperative identification of malignancy is crucial to management planning for ovarian cysts. The aim of this study was to evaluate the performance of laparoscopy in identifying malignant ovarian cysts.


METHODS
Patients undergoing laparoscopy for ovarian cysts from 1998 to 2001 were enrolled prospectively. Physical findings, Doppler ultrasonography, and serum CA 125 served to compute two risk-of-malignancy indexes (RMI-1 and RMI-2), and laparoscopy findings served to categorize lesions as benign, possibly malignant, or malignant. Frozen sections were examined as needed. Final histology was the reference.


RESULTS
Of 313 patients, 294 had benign cysts, six borderline lesions, and 13 malignancies. Sensitivity and specificity were respectively 84 and 93% for RMI-1, 92 and 80% for RMI-2, 100 and 99% for laparoscopy, 91 and 100% for frozen sections, and 100 and 100% for laparoscopy plus frozen sections, which had 100% negative predictive value. Six (1.8%) adverse events occurred.


CONCLUSIONS
Laparoscopy reliably identifies ovarian cancer and borderline disease. Morbidity is low compared to oncologic surgery.
Bensaid
C
C
Gynecological and Oncological Surgery Department, European Georges Pompidou Teaching Hospital, and René Descartes School of Medicine, AP-HP, Paris V, 75015, Paris, France.
Le Frère Belda
M A
MA
Metzger
U
U
Larousserie
F
F
Clément
D
D
Chatellier
G
G
Lécuru
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003560:Cysts / Q000473:pathology* / Q000601:surgery; D003884:Dermoid Cyst / Q000473:pathology; D004715:Endometriosis / Q000473:pathology; D005260:Female; D005629:Frozen Sections; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity