title: [Inclusion of symptoms in the discrimination between benign and malignant adnexal masses].
abstract: OBJECTIVE
  To assess the association between clinical symptoms and the diagnosis of malignancy in women with adnexal tumors who underwent surgery.
  
  
  METHODS
  Cross-sectional study, in which 105 women with adnexal tumors and indication for laparotomy/laparoscopy were included. All women were treated at a teaching hospital in the state of São Paulo between November 2009 and March 2011. All patients underwent a structured interview about the occurrence of 18 symptoms associated with ovarian cancer. The interview included the severity, frequency, and duration of these symptoms in the 12 months prior to the first medical consultation. The CA125 levels and the ultrasound classification of the tumors were also evaluated. We calculated for each symptom the prevalence ratio with 95% confidence intervals. The golden-standard was the result of the pathological examination of the surgical specimens.
  
  
  RESULTS
  Of the 105 women included, 75 (71.4%) had benign tumors and 30 (28.6%) had malignant ones. In women with malignant tumors, the most frequent symptoms were: abdominal bloating (70%), increased abdominal size (67%), pelvic pain (60%), menstrual irregularity (60%), swelling (53%), abdominal pain (50%), backache (50%), and early repletion (50%). Women with benign tumors showed essentially pelvic pain (61%), menstrual irregularities (61%), and abdominal swelling (47%). Symptoms significantly associated with malignancy were: bloating (PR=2.0; 95%CI 1.01 - 3.94), increased abdominal size (PR=2.16; 95%CI 1.12 - 4.16), backache (RP=1.97; 95%CI 1.09 - 3.55), swelling (PR=2.25; 95%CI 1.25 - 4.07), early repletion (RP=2.06; 95%CI 1.14 - 3.70), abdominal mass (PR=1.83; 95%CI 1.01 - 3.30), eating difficulties (PR=1.98; 95%CI 1.10 - 3.56), and postmenopausal bleeding (PR=2.91; 95%CI 1.55 - 5.44). The presence of pelvic pain, constipation, dyspareunia, fatigue, abdominal pain, nausea or vomiting, menstrual irregularity, weight loss, diarrhea, and bleeding after intercourse was similar in both groups.
  
  
  CONCLUSIONS
  In women with adnexal tumors including indication of surgical treatment, the preoperative evaluation of symptoms may help predicting malignancy.
authors.affiliation: Departamento de Obstetrícia e Ginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Caio Augusto
authors.initials: CA
authors.lastname: Hartman
authors.forename: Cássia Raquel
authors.initials: CR
authors.lastname: Juliato
authors.forename: Luis Otávio
authors.initials: LO
authors.lastname: Sarian
authors.forename: Amilcar
authors.initials: A
authors.lastname: Barreta
authors.forename: Maria Carolina Szymanski
authors.initials: MC
authors.lastname: de Toledo
authors.forename: Denise da Rocha
authors.initials: Dda R
authors.lastname: Pitta
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
mesh_terms: D015746:Abdominal Pain; D000291:Adnexal Diseases / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain; D011446:Prospective Studies