Evaluation

• Excluding malignancy is a principal goal of the evaluation of an adnexal mass. The most important factor used to determine the clinical suspicion of malignancy of an adnexal mass is the sonographic appearance of the mass.
• Based upon the ultrasound morphology, in our practice, we categorize masses as high (features of malignancy, ie, solid, nodular, thick septations, intermediate (not anechoic and/or unilocular, but no features of malignancy, eg, a mass with thin septations or low-level echoes), or low risk (anechoic unilocular fluid filled cysts with thin walls).

Oophorectomy

If malignancy has not been excluded, we manage patients according to these risk categories.

• Oophorectomy rather than ovarian cystectomy is required for women with an ovarian mass that is suspicious for malignancy. For premenopausal women, ovarian cystectomy is reasonable if the preoperative suspicion of malignancy is low, the mass appears benign intraoperatively, and there is no evidence of metastatic disease.
• Surgical treatment of some types of adnexal masses (eg, endometrioma, hydrosalpinx) may be therapeutic in women with infertility