Imaging Considerations for Adnexal Masses

Authors

  • Tanya Chawla, MD Joint Department of Medical Imaging, University of Toronto, Toronto, ON

DOI:

https://doi.org/10.58931/cwht.2024.1315

Abstract

Adnexal masses are commonly found during routine imaging of the pelvis and can be seen in up to 4-5% of asymptomatic women undergoing pelvic ultrasound (US). These masses encompass a range of pathologies from both gynecologic and non-gynecologic origins and can either be benign or malignant.

In Canada the lifetime risk for ovarian cancer is 1.7%. There are approximately 3,100 cases per annum in Canada with 2,000 deaths. Despite its low prevalence, ovarian malignancy is a leading cause of death among gynecological malignancies, with a 5-year survival rate of 47%. Imaging plays an integral role in the detection, characterization, and appropriate triage of adnexal masses.

The majority of adnexal masses are benign and can be managed conservatively. For the smaller minority of malignant lesions, accurate characterization with early triage to a gynecological oncology centre has an impact on oncological outcomes, and reduces the risk of re-operation and the time to initiation of adjuvant chemotherapy. Conversely, inappropriate surgical triage of benign masses can have an adverse impact on patient morbidity, compromise fertility, and increase cause-specific death for a variety of conditions, including a range of malignancies and cardiovascular diseases.

Author Biography

Tanya Chawla, MD, Joint Department of Medical Imaging, University of Toronto, Toronto, ON

Dr. Tanya Chawla is an associate professor in the Joint Department of Medical Imaging (JDMI) at the University of Toronto. She graduated in medicine from the Imperial college (University of London UK) and undertook her diagnostic radiology training at Southampton University Hospital NHS trust in the UK. She undertook fellowship training in abdominal Imaging at the Joint department of medical imaging in Toronto. She returned briefly to the UK to take a position as a consultant radiologist in abdominal and oncological imaging at the Portsmouth Hospital NHS trust prior to returning to JDMI. Her clinical and research interests are in all aspects of abdominal imaging, but her focus has been on GI and gynecological imaging. Her research projects and presentations have been presented at multiple major national and international society meetings and recognized with awards by societies such as ESGAR and RSNA. She is currently university divisional head for abdomen at the University of Toronto. Her passion for education is reflected by her leadership role at the advanced imaging education center (AIEC) and she is chair of the ASM scientific planning committee for the Canadian Association of Radiologists (CAR). She was recently awarded the fellowship for the CAR (2023). She is the president of the Canadian Society of Abdominal Radiology (CSAR) and represents radiology at the Gynecological cancer advisory committee at Ontario Health (formerly Cancer Care Ontario)​.

References

Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, et al. ACR Appropriateness Criteria® clinically suspected adnexal mass, no acute symptoms: 2023 update. J Am Coll Radiol. 2024;21(6s):S79-s99. doi:10.1016/j.jacr.2024.02.017

Valentin L, Hagen B, Tingulstad S, Eik-Nes S. Comparison of ‘pattern recognition’ and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol. 2001;18(4):357-365. doi:10.1046/j.0960-7692.2001.00500.x

Lai HW, Lyu GR, Kang Z, Li LY, Zhang Y, Huang YJ. Comparison of O-RADS, GI-RADS, and ADNEX for diagnosis of adnexal masses: an external validation study conducted by junior sonologists. J Ultrasound Med. 2022;41(6):1497-1507. doi:10.1002/jum.15834

Jha P, Gupta A, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, et al. Diagnostic Performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk score in women in the United States. JAMA Netw Open. 2022;5(6):e2216370. doi:10.1001/jamanetworkopen.2022.16370

Van Calster B, Van Hoorde K, Valentin L, Testa AC, Fischerova D, Van Holsbeke C, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 2014;349:g5920. doi:10.1136/bmj.g5920

Hack K, Gandhi N, Bouchard-Fortier G, Chawla TP, Ferguson SE, Li S, et al. External validation of O-RADS US Risk Stratification and Management System. Radiology. 2022;304(1):114-120. doi:10.1148/radiol.211868

Salvador S, Scott S, Glanc P, Eiriksson L, Jang JH, Sebastianelli A, et al. Guideline No. 403: initial investigation and management of adnexal masses. J Obstet Gynaecol Can. 2020;42(8):1021-1029.e1023. doi:10.1016/j.jogc.2019.08.044

Canadian Cancer Society. Ovarian cancer statistics 2024 [updated May 2024]. Available from: https://cancer.ca/en/cancer-information/cancer-types/ovarian/statistics.

Bouchard-Fortier G, Gien LT, Sutradhar R, Chan WC, Krzyzanowska MK, Liu SL, et al. Impact of care by gynecologic oncologists on primary ovarian cancer survival: a population-based study. Gynecol Oncol. 2022;164(3):522-528. doi:10.1016/j.ygyno.2022.01.003

Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-185. doi:10.1148/radiol.2019191150

Strachowski LM, Jha P, Phillips CH, Blanchette Porter MM, Froyman W, Glanc P, et al. O-RADS US v2022: an update from the American College of Radiology’s Ovarian-Adnexal Reporting and Data System US Committee. Radiology. 2023;308(3):e230685. doi:10.1148/radiol.230685

Buys SS, Partridge E, Greene MH, Prorok PC, Reding D, Riley TL, et al. Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol. 2005;193(5):1630-1639. doi:10.1016/j.ajog.2005.05.005

Hiett AK, Sonek JD, Guy M, Reid TJ. Performance of IOTA Simple Rules, Simple Rules risk assessment, ADNEX model and O-RADS in differentiating between benign and malignant adnexal lesions in North American women. Ultrasound Obstet Gynecol. 2022;59(5):668-676. doi:10.1002/uog.24777

Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016;214(4):424-437. doi:10.1016/j.ajog.2016.01.007

Valentin L. Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses. Ultrasound Obstet Gynecol. 1999;14(4):273-283. doi:10.1046/j.1469-0705.1999.14040273.x

Mytton J, Evison F, Chilton PJ, Lilford RJ. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage. BMJ. 2017;356:j372. doi:10.1136/bmj.j372

Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008;31(6):681-690. doi:10.1002/uog.5365

Timmerman D, Schwärzler P, Collins WP, Claerhout F, Coenen M, Amant F, et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. Ultrasound Obstet Gynecol. 1999;13(1):11-16. doi:10.1046/j.1469-0705.1999.13010011.x

Cao L, Wei M, Liu Y, Fu J, Zhang H, Huang J, et al. Validation of American College of Radiology Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US): Analysis on 1054 adnexal masses. Gynecol Oncol. 2021 Jul;162(1):107–12.

Downloads

Published

2024-11-11

How to Cite

Chawla, T. (2024). Imaging Considerations for Adnexal Masses. Canadian Women’s Health Today, 1(3), 5–10. https://doi.org/10.58931/cwht.2024.1315

Issue

Volume 1, Issue 3, Fall 2024

Section

Articles