Endoscopic Management of the Large Benign Adnexal Mass

Most large adnexal masses greater than 10 cm are benign.5 Nevertheless, identifying a potential malignancy and determining referral to a gynecologic oncologist is the first important step in management of any adnexal mass. Assessing the likelihood of malignancy is based on a thor­ ough investigation that includes age and reproductive status, risk factors such as personal and family history, physical examination, characteristics on imaging, and biomarkers. In 2008, the International Ovarian Tumor Analysis group developed the Simple Rules, which lists a set of 5 ultra­ sound features indicative of a benign tumor and 5 ultra­ sound features of a malignant tumor (Table 1).6 The tumor is classified as benign if it only has benign features and malignant if it only has malignant features. Incorporating these rules in diagnostic evaluation allows up to 89% of all masses to be classified with a sensitivity of 95% and speci­ ficity of 95%.7,8 The updated American College of Obstetricians and Gynecologists/Society of Gynecologic Oncology Committee Opinion from March 2011 recommends consid­ eration of referral to a gynecologic oncologist when a woman has a pelvic mass suspicious for a neoplasm with the presence of at least one of the following9: