title: Initial evaluation and referral guidelines for management of pelvic/ovarian masses.
abstract: OBJECTIVE
  To optimize the management of adnexal masses and to assist primary care physicians and gynaecologists determine which patients presenting with an ovarian mass with a significant risk of malignancy should be considered for gynaecologic oncology referral and management.
  
  
  METHODS
  Laparoscopic evaluation, comprehensive surgical staging for early ovarian cancer, or tumour debulking for advanced stage ovarian cancer.
  
  
  RESULTS
  To optimize conservative versus operative management of women with possible ovarian malignancy and to optimize the involvement of gynaecologic oncologists in planning and delivery of treatment.
  
  
  METHODS
  Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and the Cochrane Library, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified by searching the web sites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
  
  
  CONCLUSIONS
  1. Primary care physicians and gynaecologists should always consider the possibility of an underlying ovarian cancer in patients in any age group who present with an adnexal or ovarian mass. (II-2B) 2. Appropriate workup of a perimenopausal or postmenopausal woman presenting with an adnexal mass should include evaluation of symptoms and signs suggestive of malignancy, such as persistent pelvic/abdominal pain, urinary urgency/frequency, increased abdominal size/bloating, and difficulty eating. In addition, CA125 measurement should be considered. (II-2B) 3. Transvaginal or transabdominal ultrasound examination is recommended as part of the initial workup of a complex adnexal/ovarian mass. (II-2B) 4. Ultrasound reports should be standardized to include size and unilateral/bilateral location of the adnexal mass and its possible origin, thickness of septations, presence of excrescences and internal solid components, vascular flow distribution pattern, and presence or absence of ascites. This information is essential for calculating the risk of malignancy index II score to identify pelvic mass with high malignant potential. (IIIC) 5. Patients deemed to have a high risk of an underlying malignancy should be reviewed in consultation with a gynaecologic oncologist for assessment and optimal surgical management. (II-2B).
authors.forename: Tien
authors.initials: T
authors.lastname: Le
authors.forename: Christopher
authors.initials: C
authors.lastname: Giede
authors.forename: Shia
authors.initials: S
authors.lastname: Salem
authors.forename: Guylaine
authors.initials: G
authors.lastname: Lefebvre
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.forename: James
authors.initials: J
authors.lastname: Bentley
authors.forename: Rachel
authors.initials: R
authors.lastname: Kupets
authors.forename: Patti
authors.initials: P
authors.lastname: Power
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Renaud
authors.forename: Peter
authors.initials: P
authors.lastname: Bryson
authors.forename: Donald B
authors.initials: DB
authors.lastname: Davis
authors.forename: Susie
authors.initials: S
authors.lastname: Lau
authors.forename: Robert
authors.initials: R
authors.lastname: Lotocki
authors.forename: Vyta
authors.initials: V
authors.lastname: Senikas
authors.forename: Lucie
authors.initials: L
authors.lastname: Morin
authors.forename: Stephen
authors.initials: S
authors.lastname: Bly
authors.forename: Kimberly
authors.initials: K
authors.lastname: Butt
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Cargill
authors.forename: Nanette
authors.initials: N
authors.lastname: Denis
authors.forename: Robert
authors.initials: R
authors.lastname: Gagnon
authors.forename: Marja Anne
authors.initials: MA
authors.lastname: Hietala-Coyle
authors.forename: Kenneth Ian
authors.initials: KI
authors.lastname: Lim
authors.forename: Annie
authors.initials: A
authors.lastname: Ouellet
authors.forename: Maria-Hélène
authors.initials: MH
authors.lastname: Raciot
mesh_terms: D002170:Canada; D005260:Female; D006176:Gynecology; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D010053:Ovary / Q000000981:diagnostic imaging; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards*; D018570:Risk Assessment; D012955:Societies, Medical; D014463:Ultrasonography