ACR Appropriateness Criteria® clinically suspected adnexal mass.
Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI.Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. rdh@hitchcock.org
Robert D
RD
Harris
Marcia C
MC
Javitt
Phyllis
P
Glanc
Douglas L
DL
Brown
Theodore
T
Dubinsky
Mukesh G
MG
Harisinghani
Nadia J
NJ
Khati
Young Bae
YB
Kim
Donald G
DG
Mitchell
Pari V
PV
Pandharipande
Harpreet K
HK
Pannu
Ann E
AE
Podrasky
Henry D
HD
Royal
Thomas D
TD
Shipp
Cary Lynn
CL
Siegel
Lynn
L
Simpson
Darci J
DJ
Wall
Jade J
JJ
Wong-You-Cheong
Carolyn M
CM
Zelop
D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000592:standards*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014463:Ultrasonography / Q000592:standards*