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Evaluation and Management of Ultrasonographically Detected Ovarian Tumors in Asymptomatic Women

van Nagell, John Rensselaer Jr MD; Miller, Rachel Ware MD

doi: 10.1097/AOG.0000000000001384
Contents: The Ovary: Clinical Expert Series
Expert Discussion
Spanish Translation

Data from screening trials indicate that a significant percent of asymptomatic women older than 50 years of age will develop ovarian abnormalities that are detectable by ultrasonography. Most of these abnormalities are benign, and many will resolve spontaneously. However, the risk of ovarian cancer, particularly in postmenopausal women, is of concern. The goal is to use a diagnostic and treatment algorithm that will reliably detect ovarian cancer at the earliest possible stage while limiting the number of women undergoing surgery for benign disease. The combination of morphology indexing and serum biomarker analysis can accurately predict the risk of malignancy in most ovarian tumors. Ovarian tumors with cystic or septate morphology are at minimal risk of malignancy and can be followed with serial ultrasonography evaluations, thereby avoiding the morbidity and cost of surgery. Complex or solid ovarian tumors with a high morphology index score, or those with increasing biomarker production, are at a high risk of malignancy, and patients with these tumors should be referred to a gynecologic oncologist for further evaluation and treatment.

The combination of high-resolution ultrasonography, tumor morphology indexing, and serum biomarker analysis provides accurate assessment of risk of malignancy in ovarian tumors.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky Chandler Medical Center, and the Markey Cancer Center, Lexington, Kentucky.

Corresponding author: John Rensselaer van Nagell Jr, MD, Division of Gynecologic Oncology, University of Kentucky-Markey Cancer Center, 800 Rose Street, Lexington, KY 40536-0293; e-mail:

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

Continuing medical education for this article is available at

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.