In a surgical cohort of 3,511 masses, 217 of which were unilocular cysts in postmenopausal women, the rate of malignancy was 3%, with hemorrhagic contents more common in malignant unilocular lesions [57]. In a second study of 15,106 women with 3,259 unilocular cystic lesions, there were 10 cancers detected over a 6.3-year period, none of which developed from the isolated cystic lesion [59]. A more recent meta-analysis demonstrated that of 372 unilocular cysts removed surgically in postmenopausal women, the risk of malignancy was 3.2% [56]. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 4: Adult patient assigned female at birth. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Premenopausal or postmenopausal. Next imaging study for characterization. Up to 22% to 24% of adnexal masses remain indeterminate after US evaluation [61,62]. No single definition exists for these indeterminate lesions. Some examples include multilocular cysts, or lesions with avascular or low level vascular internal solid components. In a multicenter prospective study of 303 indeterminate adnexal cysts, the incidence of malignancy was 3.6% [61]. 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]. Lesions that are not classically benign appearing have a risk of malignancy ranging from 8% to 50% [55]. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion.
Clinically Suspected Adnexal Mass No Acute Symptoms. In a surgical cohort of 3,511 masses, 217 of which were unilocular cysts in postmenopausal women, the rate of malignancy was 3%, with hemorrhagic contents more common in malignant unilocular lesions [57]. In a second study of 15,106 women with 3,259 unilocular cystic lesions, there were 10 cancers detected over a 6.3-year period, none of which developed from the isolated cystic lesion [59]. A more recent meta-analysis demonstrated that of 372 unilocular cysts removed surgically in postmenopausal women, the risk of malignancy was 3.2% [56]. US Pelvis Transvaginal The most useful modality for evaluation of adnexal masses includes transvaginal US combined with transabdominal US approach. Variant 4: Adult patient assigned female at birth. Adnexal mass, indeterminate on initial pelvic US, no acute symptoms. Premenopausal or postmenopausal. Next imaging study for characterization. Up to 22% to 24% of adnexal masses remain indeterminate after US evaluation [61,62]. No single definition exists for these indeterminate lesions. Some examples include multilocular cysts, or lesions with avascular or low level vascular internal solid components. In a multicenter prospective study of 303 indeterminate adnexal cysts, the incidence of malignancy was 3.6% [61]. 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]. Lesions that are not classically benign appearing have a risk of malignancy ranging from 8% to 50% [55]. CT Pelvis With IV Contrast CT pelvis with IV contrast is usually not useful in further characterization of indeterminate adnexal masses. Because the role of MRI is well established, there is little reason presently to obtain a CT for further characterization of an indeterminate lesion.