Adnexal masses suspected to be benign treated with laparoscopy.
OBJECTIVE
Guidelines for referring women with pelvic masses suspicious for ovarian cancer to gynecologic oncologists have been developed by the American College of Obstetrician Gynecologists (ACOG). We set out to evaluate the negative predictive value of these guidelines and  to assess a modified algorithm involving minimally invasive surgery in the treatment of women with masses suspected to be benign.


METHODS
257 consecutive patients with adnexal masses of 8cm to 13cm on preoperative ultrasound examination meeting Triage Criteria set forth in ACOG  Committee Opinion 280. Patients meeting the selection criteria were scheduled for operative laparoscopy, washings, adnexectomy, bagging, and colpotomy. A total of 240 patients successfully completed intended treatment (93.38%), and 234 of these did not require admission (97.5%). There was  a low incidence of significant complications: 97.50% of women were successfully treated as outpatients, 97.92% of surgeries lasted <136 minutes, and <97.08% had blood loss <200mL. The negative predictive value of ACOG Committee Opinion 280 Triage Criteria as a deselector for having invasive  ovarian malignancy in our population was 95.57% for premenopausal and 90.91% for postmenopausal women.


CONCLUSIONS
Laparoscopic adnexectomy, bagging, and colpotomy is a desirable goal for patients with ovarian masses in the 8cm to 13cm range meeting selection criteria affording  a minimally invasive approach with attendant benefits including outpatient treatment (97.5%), few complications, low likelihood of iatrogenic rupture of the ovarian capsule (1.25%), and low necessity for reoperation after final pathology is evaluated (6.03%). Negative predictive value of ACOG  Committee Opinion 280 is confirmed in a community gynecology practice and is recommended to form the basis of a new treatment algorithm for women with adnexal masses.
Arizona Regional Medical Center, Mesa, AZ, USA. RHD@DesertWomensCare.com
Richard H
RH
Demir
Greg J
GJ
Marchand
D000291:Adnexal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D020884:Colpotomy; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000592:standards; D014218:Triage / Q000592:standards; D014463:Ultrasonography; D055815:Young Adult