title: Adnexal masses: what is the role of ultrasonographic imaging?
abstract: OBJECTIVE
  Adnexal masses represent a common finding among both premenopausal and postmenopausal women. This article will concentrate on the importance of an accurate preoperative diagnosis of adnexal masses that may be encountered in the course of an assessment of the female pelvis. The ultrasonographic modalities including two-dimensional, Doppler, three-dimensional and real-time four-dimensional approach, the accuracy of the technique, and the role of second-level exam will be discussed.
  
  
  METHODS
  In this review, we searched for the most relevant articles on the topic with a special focus on the importance of an accurate preoperative diagnosis of adnexal masses, the different ultrasonographic modalities, and the role of second-level exam.
  
  
  RESULTS
  The primary goal of diagnostic evaluation is to exclude malignancy. Furthermore, differentiation among pelvic masses with non-malignant features is relevant as well since suitable counseling and treatment depend on the suspected histology. Ultrasound represents the first-line modality for assessing adnexal masses and showed a very accurate examination. Ultrasound, performed by experienced operators, is effective in the morphologic evaluation of the adnexal masses and is useful in discriminating between benign and malignant lesions. Second-level exams may include assessment by an experienced ultrasound examiner, magnetic resonance imaging, and computed tomography.
  
  
  CONCLUSIONS
  Ultrasound represents the first-line modality for assessing adnexal masses. Predicting the nature of an adnexal mass is essential regarding counseling, clinical management and surgical planning in such patients. Pattern recognition can accurately diagnose the majority of the benign masses and malignancies.
authors.affiliation: Department of Clinical and Experimental Biomedical Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
authors.forename: Maria Elisabetta
authors.initials: ME
authors.lastname: Coccia
authors.forename: Francesca
authors.initials: F
authors.lastname: Rizzello
authors.forename: Chiara
authors.initials: C
authors.lastname: Romanelli
authors.forename: Tommaso
authors.initials: T
authors.lastname: Capezzuoli
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography