Risk analysis of torsion and malignancy for adnexal masses during pregnancy.
OBJECTIVE
To find the risk factors of torsion and malignancy for adnexal tumors during pregnancy.


METHODS
Retrospective, historical cohort study.


METHODS
University hospital.


METHODS
Patients from 1990 to 2004 with adnexal tumors >or=4 cm during pregnancy.


METHODS
Surgery undertaken antepartum, concurrently with cesarean delivery, or postpartum.


METHODS
Tumor size, progression, pathology, incidence of malignancy, and torsion.


RESULTS
Almost all 213 managements analyzed had good surgical and obstetric outcomes. In 174 patients who were followed through pregnancy with known tumor existence, 14.84% +/- 3.05% encountered tumor torsion. Adnexal masses with sizes between 6 and 8 cm had a significantly higher risk of torsion compared with other sizes (22.41% vs. 9.48%; odds ratio 2.8, 95% confidence interval [CI], [1.1, 6.6]). Sixty percent of the torsion happened between the 10th and 17th weeks of gestation, and only 5.9% happened after 20 weeks. The incidence of malignancy was 3.4%, while that of ovarian cancer was 2.3%. Tumor diameters >or=10 cm at initial diagnosis had a higher risk of malignancy versus smaller sizes (8.77% vs. 0.85%; odds ratio 11.2, 95% CI, [1.3, 97.9]), and tumor growth rates >or=3.5 cm/week also had a significantly higher risk of malignancy versus lower rates (8.33% vs. 0.88%; odds ratio 10.2, 95% CI, [1.0, 101.2]).


CONCLUSIONS
Adnexal tumors bearing higher risks for torsion and malignancy should be strongly considered for an aggressive strategy of management during pregnancy.
Yen
Chih-Feng
CF
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and University, Tao-Yuan, Taiwan.
Lin
Shu-Ling
SL
Murk
William
W
Wang
Chin-Jung
CJ
Lee
Chyi-Long
CL
Soong
Yung-Kuei
YK
Arici
Aydin
A
D000291:Adnexal Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D006801:Humans; D018294:Neoplasms, Adnexal and Skin Appendage; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D014102:Torsion Abnormality / Q000209:etiology*