Criteria for selection of laparoscopy for women with adnexal mass.
OBJECTIVE
We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience.


METHODS
This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy.


RESULTS
ACOG-negative and tumors≤10 cm and IRM with a cutoff at 300 points and tumors≤10 cm resulted in the same best performance (78% success=38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant.


CONCLUSIONS
The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt.
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Amilcar
A
Barreta
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Luis Felipe
LF
Sallum
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Luis Otávio
LO
Sarian
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Joana Fróes Bragança
JF
Bastos
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil.
Sophie
S
Derchain
D000291:Adnexal Diseases / Q000601:surgery*; D003560:Cysts / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies
Adnexal diseases; Conversion to open surgery; Laparoscopy; Patient selection