Sahin et al [19] proposed a noncontrast MRI score based on ADNEX and O-RADS models using morphologic assessment and DWI with an 84.9% sensitivity, 95.9% specificity, and 94% accuracy with the caveat of a population with a lower malignancy rate (15.1%) than the original ADNEX and O- RADS models population (18.8% and 18.4%). Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. US Duplex Doppler Pelvis Color or power Doppler should be included in the US examination of the pelvis. Color Duplex is used to evaluate vascularity of any developing solid component. US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated or is contraindicated (eg, no prior history of sexual activity). The bladder should be full to provide the best acoustic window for evaluation. Clinically Suspected Adnexal Mass US Pelvis Transabdominal and US Pelvis Transvaginal Indeterminate lesions are typically benign. 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]. If an indeterminate mass is identified on initial US, then follow-up may be performed either by serial US or by MRI. In a study of 1,363 postmenopausal women, complex adnexal masses ranging in size from 1 to 6 cm had an overall low risk of malignancy of 1.3%, with all epithelial cancer and borderline tumors demonstrating growth by 7 months of sonographic observation [89]. Similarly, in women diagnosed with early-stage high-grade serous cancers, these were rarely <5 cm or without solid components other than septations, further supporting potential observation in small masses [90].
Clinically Suspected Adnexal Mass No Acute Symptoms. Sahin et al [19] proposed a noncontrast MRI score based on ADNEX and O-RADS models using morphologic assessment and DWI with an 84.9% sensitivity, 95.9% specificity, and 94% accuracy with the caveat of a population with a lower malignancy rate (15.1%) than the original ADNEX and O- RADS models population (18.8% and 18.4%). Noncontrast MRI may be used in adnexal mass characterization when the use of IV contrast is precluded. US Duplex Doppler Pelvis Color or power Doppler should be included in the US examination of the pelvis. Color Duplex is used to evaluate vascularity of any developing solid component. US Pelvis Transabdominal Transabdominal US may be performed without transvaginal imaging when the transvaginal examination cannot be tolerated or is contraindicated (eg, no prior history of sexual activity). The bladder should be full to provide the best acoustic window for evaluation. Clinically Suspected Adnexal Mass US Pelvis Transabdominal and US Pelvis Transvaginal Indeterminate lesions are typically benign. 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]. If an indeterminate mass is identified on initial US, then follow-up may be performed either by serial US or by MRI. In a study of 1,363 postmenopausal women, complex adnexal masses ranging in size from 1 to 6 cm had an overall low risk of malignancy of 1.3%, with all epithelial cancer and borderline tumors demonstrating growth by 7 months of sonographic observation [89]. Similarly, in women diagnosed with early-stage high-grade serous cancers, these were rarely <5 cm or without solid components other than septations, further supporting potential observation in small masses [90].