OP17.06: Triage for surgical management of ovarian tumors in symptomatic women: Assessment of an ultrasound-based scoring system

To evaluate prospectively an ultrasound-based scoring system as a method for triaging symptomatic women presenting with an adnexal mass for surgical treatment. 151 symptomatic women scheduled for surgical treatment at our institution between June 2003 and December 2007 were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound prior to surgery. Patients were classified as low-risk or high-risk for malignancy according an ultrasound-based scoring system. Patients with low risk for malignancy were scheduled for laparoscopy and patients for high risk for malignancy were scheduled for laparotomy. Some patients with high risk were scheduled for advanced oncologic laparoscopic surgery. Patients with low risk but tumor size > 10 cm were scheduled for laparotomy. 82 women presented with pelvic pain, 8 had uterine bleeding and 61 referred symptoms suggestive for ovarian malignancy, such as abdominal swelling, bloating and abdominal discomfort. 75 (49.7%) masses were considered as “low risk” and treated by laparoscopy in 58 cases and by laparotomy in 7 cases, because emergency or associated pathology (All tumors were benign). 76 (50.3%) masses were considered as “high risk” and all treated by laparotomy (56 malignant and 4 benign tumors) or by advanced laparoscopy (16 malignant tumors). Ten (6.7%) tumors were considered as “low risk” but scheduled for primary laparotomy because of size > 10 cm (9 benign and 1 malignant). Sensitivity, specificity, PPV and NPV for this scoring system were 98.6%, 94.9%, 94.7% and 98.7%, respectively. The scoring system were more sensitive than patient's complaints (98.6% vs 79.5%, P < 0.0001) and more specific than physical examination (94.9% vs 85.9%, P < 0.0001) Conclusions: Ultrasound based triage of symptomatic women diagnosed, as having an adnexal mass is effective for selecting surgical approach.