title: Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system.
abstract: OBJECTIVE
  To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.
  
  
  METHODS
  Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology.
  
  
  RESULTS
  One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant.
  
  
  CONCLUSIONS
  Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain. jlalcazar@unav.es
authors.forename: J L
authors.initials: JL
authors.lastname: Alcázar
authors.forename: P
authors.initials: P
authors.lastname: Royo
authors.forename: M
authors.initials: M
authors.lastname: Jurado
authors.forename: J A
authors.initials: JA
authors.lastname: Mínguez
authors.forename: M
authors.initials: M
authors.lastname: García-Manero
authors.forename: C
authors.initials: C
authors.lastname: Laparte
authors.forename: R
authors.initials: R
authors.lastname: Galván
authors.forename: G
authors.initials: G
authors.lastname: López-García
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D055815:Young Adult