Initial evaluation by transabdominal and transvaginal US can often definitively characterize ovarian lesions, specifically those that demonstrate classically benign US features (eg, follicles, functional cysts, hemorrhagic cysts, dermoids, and endometriomas). Lesions that demonstrate solid components such as irregular thick septations, papillary projections, or mural nodules have variable risk of malignancy. Various US and combined US/clinical based criteria have been proposed for standardized interpretation and characterization of adnexal masses to improve risk-stratified management of these lesions [23,24,32-37]. These includes the IOTA simple rules, O-RADS, Society of Radiologists in Ultrasound (SRU) consensus statement for incidental adnexal masses, and Assessment of Different NEoplasias in the adneXa (ADNEX) model. These are beyond the scope of discussion for this document, and the readers are directed to the respective literature for details [23,24,34,37-41]. These systems use some combination of classically benign imaging features, lesion size, locularity, size and number of solid components, and degree of vascularity for categorization and determining overall risk of malignancy. The SRU consensus statement [42] has been shown to decrease unnecessary follow-up care of benign adnexal lesions, correlate with the risk of malignancy in symptomatic women, and demonstrate high sensitivity and specificity for detecting ovarian malignancy [43-45]. O-RADS [23,38] has demonstrated significantly higher sensitivity for malignancy than the IOTA simple rules (96.8% versus 92.1%) and no significant difference in specificity (92.8% versus 93.2%) [46]. Combined transvaginal and transabdominal technique allows for the identification of pertinent features relevant for characterization and categorization of these lesions.
Clinically Suspected Adnexal Mass No Acute Symptoms. Initial evaluation by transabdominal and transvaginal US can often definitively characterize ovarian lesions, specifically those that demonstrate classically benign US features (eg, follicles, functional cysts, hemorrhagic cysts, dermoids, and endometriomas). Lesions that demonstrate solid components such as irregular thick septations, papillary projections, or mural nodules have variable risk of malignancy. Various US and combined US/clinical based criteria have been proposed for standardized interpretation and characterization of adnexal masses to improve risk-stratified management of these lesions [23,24,32-37]. These includes the IOTA simple rules, O-RADS, Society of Radiologists in Ultrasound (SRU) consensus statement for incidental adnexal masses, and Assessment of Different NEoplasias in the adneXa (ADNEX) model. These are beyond the scope of discussion for this document, and the readers are directed to the respective literature for details [23,24,34,37-41]. These systems use some combination of classically benign imaging features, lesion size, locularity, size and number of solid components, and degree of vascularity for categorization and determining overall risk of malignancy. The SRU consensus statement [42] has been shown to decrease unnecessary follow-up care of benign adnexal lesions, correlate with the risk of malignancy in symptomatic women, and demonstrate high sensitivity and specificity for detecting ovarian malignancy [43-45]. O-RADS [23,38] has demonstrated significantly higher sensitivity for malignancy than the IOTA simple rules (96.8% versus 92.1%) and no significant difference in specificity (92.8% versus 93.2%) [46]. Combined transvaginal and transabdominal technique allows for the identification of pertinent features relevant for characterization and categorization of these lesions.