Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update
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REVIEW
Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update Erica B. Stein1 · Molly E. Roseland1 · Kimberly L. Shampain1 · Ashish P. Wasnik1 · Katherine E. Maturen1,2 Received: 2 August 2020 / Revised: 29 September 2020 / Accepted: 7 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Incidental adnexal masses are commonly encountered at ultrasound, computed tomography, and magnetic resonance imaging. Since many of these lesions are surgically resected and ultimately found to be benign, patients may be exposed to personal and economic costs related to unnecessary oophorectomy. Thus, accurate non-invasive risk stratification of adnexal masses is essential for optimal management and outcomes. Multiple consensus guidelines in radiology have been published to assist in characterization of these masses as benign, indeterminate, or likely malignant. In the last two years, several new and updated stratification systems for assessment of incidental adnexal masses have been published. The purpose of this article is to offer a concise review of four recent publications: ACR 2020 update on the management of incidental adnexal findings on CT and MRI, SRU 2019 consensus update on simple adnexal cysts, O-RADS ultrasound risk stratification system (2020), and O-RADS MRI risk stratification system (2020). Keywords Adnexal · Ovarian · O-RADS · Magnetic resonance imaging · Simple cyst · Ultrasound
Introduction Incidental adnexal masses are commonly discovered at ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Many women undergo surgical evaluation for these lesions, frequently leading to oophorectomy to establish a definitive, pathologic diagnosis. However, the vast majority of incidentally detected adnexal masses are benign, resulting in many unnecessary oophorectomies. In premenopausal women undergoing surgical resection of an adnexal mass, the frequency of malignancy is below 10% [1–3]. In postmenopausal women undergoing surgical resection of an adnexal mass, the frequency is slightly increased, but still less than 15% [3, 4]. Radiologists therefore play an essential role in preoperative risk stratification, both by accurately characterizing adnexal lesions non-invasively and by providing guidance for appropriate imaging follow-up if intervention is not immediately pursued. * Erica B. Stein [email protected] 1
Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
Department of Obstetrics & Gynecology, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
2
Though imaging often cannot characterize a lesion on a histologic level, it is important for radiologists to understand common pathologic origins of adnexal masses. Ovarian neoplasms are broadly categorized into epithelial, germ cell, and sex cord-stromal tumors based on their histologic origin. Epithelial ovarian tumors (including serous and mucinous subtypes) are the most common tumors and can be furthe
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