Clinical Edge

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Diagnosis and Management of Adnexal Masses

Obstet Gynecol; 2016 Nov; Eskander, et al

The American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins has issued guidelines for the evaluation and management of adnexal masses in adolescents, pregnant women, and nonpregnant women. The bulletin also outlines criteria for the identification of adnexal masses that are likely to be malignant and may warrant referral to or consultation with a gynecologic oncologist. Among the (Level A) recommendations:

  • Transvaginal ultrasonography is the recommended imaging modality for a suspected or an incidentally identified pelvic mass. No alternative imaging modality has demonstrated sufficient superiority to transvaginal ultrasonography to justify its routine use.
  • Ultrasound findings that should raise the clinician’s level of concern regarding malignancy include cyst size >10 cm, papillary or solid components, irregularity, presence of ascites, and high color Doppler flow.

Level B recommendations include:

  • The combination of an elevated CA 125 level and a pelvic mass in a postmenopausal woman is highly suspicious for malignancy, and patients with these findings should be referred to or treated in consultation with a gynecologic oncologist.
  • Simple cysts up to 10 cm in diameter on transvaginal ultrasonography performed by experienced ultrasonographers are likely benign and may be safely monitored using repeat imaging without surgical intervention, even in postmenopausal patients.
  • Minimally invasive procedures are the preferred route of surgery for presumed benign adnexal masses.


Evaluation and management of adnexal masses. Practice Bulletin No. 174. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;128:e210–26.