PB 174 Level A:
- Transvaginal ultrasonography is the recommended imaging modality for a suspected or an incidentally identified pelvic mass. No alternative imaging modal- ity has demonstrated sufficient superiority to trans- vaginal ultrasonography to justify its routine use.
- Ultrasound findings that should raise the clinician’s level of concern regarding malignancy include cyst size greater than 10 cm, papillary or solid compo- nents, irregularity, presence of ascites, and high color Doppler flow.
Consider refer to Gyn Onc when:
- Postmenopausal with elevated CA 125 level, ultrasound findings suggestive of malignancy, ascites, a nodular or fixed pelvic mass, or evidence of abdominal or distant metastasis
- Premenopausal with very elevated CA 125 level, ultrasound findings suggestive of malignancy, ascites, a nodular or fixed pelvic mass, or evidence of abdominal or distant metastasis
- Premenopausal or postmenopausal with an elevated score on a formal risk assessment test such as the multivariate index assay, risk of malignancy index, or the Risk of Ovarian Malignancy Algorithm or one of the ultrasound-based scoring systems from the International Ovarian Tumor Analysis group
Adnexal masses: (mostly from Brader and Daudi):
- Never get CA125 on a pre-menopausal woman with ovarian cyst and known/highly suspected endometriosis (CA125 can be in 100s with benign disease)
- Never uses OVA1, usually only CA125.
- Large complex cysts in younger women are often muscinous cystadenomas.
- Serous cystadenomas are less likely to look complex, but are most common large cysts.
- Solid and cystic masses are more worrisome than cystic or solid alone. *Cystic or solid alone are usually benign (esp. in younger women).