Clinically Suspected Adnexal Mass managed conservatively with 2-year follow-up was 0.3% to 0.4% for malignancy and 0.2% to 0.4% for acute complications such as torsion or cyst rupture [51]. Unilocular cysts, as a whole, in the premenopausal population similarly have a very low risk of malignancy. A recent meta-analysis by Parazzini et al [56] demonstrated that in 987 unilocular cysts removed surgically in premenopausal women, the risk of malignancy was 0.6%. Similar findings were found by Valentin et al [57], with a rate of malignancy of 0.5% in 981 surgically resected lesions. Surgical cohorts have a bias of increased risk of malignancy due to persistent cysts, and thus, this can be extrapolated into an even lower theoretical risk of malignancy in the general population. The most common benign solid adnexal mass is the uterine fibroid. Pedunculated lesions or broad ligament fibroids can often be mistaken for solid adnexal mass. Fibroids are present in up to 20% to 30% of reproductive age women, and the presence of bridging vessels can help identify uterine origin along with careful search for the ovaries [25]. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 3: Adult patient assigned female at birth. Adnexal mass, likely benign, no acute symptoms. Postmenopausal. Follow-up imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up.
Clinically Suspected Adnexal Mass No Acute Symptoms. Clinically Suspected Adnexal Mass managed conservatively with 2-year follow-up was 0.3% to 0.4% for malignancy and 0.2% to 0.4% for acute complications such as torsion or cyst rupture [51]. Unilocular cysts, as a whole, in the premenopausal population similarly have a very low risk of malignancy. A recent meta-analysis by Parazzini et al [56] demonstrated that in 987 unilocular cysts removed surgically in premenopausal women, the risk of malignancy was 0.6%. Similar findings were found by Valentin et al [57], with a rate of malignancy of 0.5% in 981 surgically resected lesions. Surgical cohorts have a bias of increased risk of malignancy due to persistent cysts, and thus, this can be extrapolated into an even lower theoretical risk of malignancy in the general population. The most common benign solid adnexal mass is the uterine fibroid. Pedunculated lesions or broad ligament fibroids can often be mistaken for solid adnexal mass. Fibroids are present in up to 20% to 30% of reproductive age women, and the presence of bridging vessels can help identify uterine origin along with careful search for the ovaries [25]. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 3: Adult patient assigned female at birth. Adnexal mass, likely benign, no acute symptoms. Postmenopausal. Follow-up imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful to follow likely or known benign adnexal masses. Because the roles of US and MRI are well established, there is little reason presently to obtain a CT for benign mass follow-up.