In a second multicenter prospective study of 697 women, the prevalence of malignancy in indeterminate lesions ranged from 4.8% to 10.7% using SRU guidelines and IOTA simple rules, respectively [45]. If an indeterminate mass is identified on initial US, then follow-up may be performed either by serial US or by MRI. For example, the former may be helpful to assess a suspected atypical appearing hemorrhagic cyst that is either resolving or undergoing evolution. A reasonable time frame for US follow-up in this setting would be 8 to 12 weeks (as is performed in typical hemorrhagic cysts of larger size in premenopausal women) to permit time for resolution or confirm persistence of a nonphysiologic cyst [23]. If the lesion persists and is stable in size and appearance, further evaluation with MRI may be appropriate, depending on the clinical context and features present. Clinically Suspected Adnexal Mass MRI may be able to assign a specific benign diagnosis or stratify for risk of malignancy, thus requiring no further US follow-up in the majority of cases [17,73]. If not requiring surgical management, indeterminate lesions that are well seen on US may be followed sonographically. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 6: Adult patient assigned female at birth. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Postmenopausal. Follow-up imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful for follow-up of an indeterminate adnexal mass. Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful for follow-up of an indeterminate adnexal mass.
Clinically Suspected Adnexal Mass No Acute Symptoms. In a second multicenter prospective study of 697 women, the prevalence of malignancy in indeterminate lesions ranged from 4.8% to 10.7% using SRU guidelines and IOTA simple rules, respectively [45]. If an indeterminate mass is identified on initial US, then follow-up may be performed either by serial US or by MRI. For example, the former may be helpful to assess a suspected atypical appearing hemorrhagic cyst that is either resolving or undergoing evolution. A reasonable time frame for US follow-up in this setting would be 8 to 12 weeks (as is performed in typical hemorrhagic cysts of larger size in premenopausal women) to permit time for resolution or confirm persistence of a nonphysiologic cyst [23]. If the lesion persists and is stable in size and appearance, further evaluation with MRI may be appropriate, depending on the clinical context and features present. Clinically Suspected Adnexal Mass MRI may be able to assign a specific benign diagnosis or stratify for risk of malignancy, thus requiring no further US follow-up in the majority of cases [17,73]. If not requiring surgical management, indeterminate lesions that are well seen on US may be followed sonographically. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 6: Adult patient assigned female at birth. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Postmenopausal. Follow-up imaging. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful for follow-up of an indeterminate adnexal mass. Because the role of US and MRI is well established, there is little reason presently to obtain a CT for follow-up of an indeterminate lesion. CT Pelvis Without and With IV Contrast CT pelvis without and with IV contrast is usually not useful for follow-up of an indeterminate adnexal mass.