title: Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery.
abstract: OBJECTIVE
  To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate-level laparoscopic surgery for benign adnexal masses.
  
  
  METHODS
  Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy.
  
  
  RESULTS
  One hundred and forty-three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94-99%), specificity of 79% (95% CI, 60-90%), positive predictive value of 95% (95% CI, 89-98%), positive likelihood ratio of 4.58 (95% CI, 2.25-9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01-0.09).
  
  
  CONCLUSIONS
  A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate-level laparoscopic surgery in women with benign adnexal lesions.
authors.affiliation: Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK. joseph.yazbek@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Yazbek
authors.forename: S
authors.initials: S
authors.lastname: Helmy
authors.forename: J
authors.initials: J
authors.lastname: Ben-Nagi
authors.forename: T
authors.initials: T
authors.lastname: Holland
authors.forename: E
authors.initials: E
authors.lastname: Sawyer
authors.forename: D
authors.initials: D
authors.lastname: Jurkovic
mesh_terms: D000290:Adnexa Uteri / Q000000981:diagnostic imaging*; D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography