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Management of the Adnexal Mass

Liu, James H., MD; Zanotti, Kristine M., MD

doi: 10.1097/AOG.0b013e31821c62b6
Clinical Expert Series
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Adnexal masses are commonly encountered in gynecologic practice and often present both diagnostic and management challenges. This is partly because of the fact that the majority of adnexal masses that are identified represent benign entities that do not necessarily require active intervention, yet a small subset will represent malignant processes that require both timely and appropriate surgical intervention for optimal outcome. To determine the best diagnostic and management strategies in this setting, physicians must effectively triage risk for malignancy by having a thorough understanding of the entities on the differential diagnosis and carefully considering the clinical context for each individual patient. Optimal selection and interpretation of diagnostic tests are enhanced by both an accurate clinical risk assessment and an understanding of the inherent accuracy of diagnostic tests considered in this setting. The purpose of this document is to provide clinicians with a practical strategy for distinguishing benign and malignant masses in the nonpregnant woman. Our approach addresses the critical elements of accurate risk stratification, reviews the performance of diagnostic tests for identifying malignancy, and offers evidence-based management algorithms to optimize outcomes for women with adnexal masses.

The majority of adnexal masses are benign, and the decision for surgery should take into account the accuracy of diagnostic testing and the inherent biology of ovarian cancers.

From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, UH MacDonald Womens' Hospital, Case Medical Center, Cleveland, Ohio.

Continuing medical education for this article is available at

Corresponding author: Kristine M. Zanotti, MD, Department of Obstetrics and Gynecology, UH MacDonald Womens Hospital, 11100 Euclid Ave, Cleveland, OH 44106-5034; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.