Approach to Adnexal Masses

Yıl 2019, Cilt: 9 Sayı: 1, 25 - 30, 31.01.2019

Huri Güvey

https://doi.org/10.33631/duzcesbed.450500

Öz

Adnexal mass is
a common gynecologic problem. Most of them are benign and arise from ovary.
But, determination of adnexal mass if it has high risk of malignancy
preoperatively defining operative procedure and information of patient
appropriately is essential for preventing unnecessary procedures. In evaluation
of adnexal mass preoperatively it is necessary to use detailed history of
patient, physical examination, imaging methods and suitable tumor markers.
Recently, in order to discriminate the adnexal mass benign or malign, some
malignancy risk indexes based on ultrasound and doppler findings, tumor markers
and menopausal status of patient. International Ovarian Tumor Analysis (IOTA)
models based on ultrasound findings (septation, papillary projections, presence
of acoustic shadows, ascites), doppler imaging of adnexal mass, menopausal
status, age, family history, current hormonal therapy, presence of pain; risk
of malignancy index (RMI) including multilocularity of adnexal mass, presence
of solid component, bilaterality, presence of ascites and evidence of
metastasis, menopausal status of patient, serum CA 125 level; and De Priest
Morphological Index (MI) based on tumor volume, wall structure of cyst and
septa structure are some of these malignancy indexes. As a result of studies
that comparing scoring systems it was seen that adnexal masses could be
diagnosed with higher sensitivity and specificity by using IOTA scoring system.
Thanks to this, with more accurate evaluation of patients preoperatively, optimal
surgical method could be planned.

Anahtar Kelimeler

Adnexal mass, scoring systems, malignancy, ultrasonography

Adneksiyal Kitlelere Yaklaşım

Öz

Adneksiyal
kitle sık karşılaşılan jinekolojik bir problemdir. Çoğunluğu over orijinlidir
ve benigndir. Ancak adneksiyal kitlelerin preoperatif olarak ovarian bir
malignansi açısından yüksek riskli olup olmadığının tespiti, uygulanacak
operatif prosedürün belirlenmesi, hastanın uygun şekilde bilgilendirilmesi
gereksiz işlem yapılmasını önlemek için çok önemlidir. Adneksiyal kitlelerin
preoperatif değerlendirilmesinde ayrıntılı anamnez, fizik muayene, görüntüleme
yöntemleri ve uygun tümör belirteçlerinin kullanımı gerekmektedir. Adneksiyal
kitlelerin malign-benign ayrımında kullanılmak üzere son yıllarda ultrasonografi
ve doppler bulguları, tümör markırları ve hastanın menopozal durumuna dayanan
çeşitli malignite risk indeksleri geliştirilmiştir. Ultrasonografi bulguları,
adneksiyal kitlenin doppler incelemesi, menopozal durum, yaş, aile öyküsü,
hormonal terapi alınıp alınmadığı ve ağrı durumunun birlikte değerlendirildiği
Uluslararası Over Tümörü Analizi (International Ovarin Tumour Analysis-IOTA)
kriterleri, kitlede multilokülasyon olup olmadığı, solid komponentlerin olup
olmadığı, bilateralite, asit ve metastaz bulgularının olup olmadığı, hastanın
menopozal durumu, serum CA-125 düzeyinin baz alındığı malignite risk indeksi,
tümör hacmi, kist duvar yapısı ve septa yapısının değerlendirildiği morfolojik
indeks bunlardan bazılarıdır. Skorlama sistemleri arasında yapılan
karşılaştırılmalı çalışmalar sonucunda IOTA skorlaması ile daha yüksek
sensitivite ve spesifite ile adneksiyal kitleye tanı koyulabileceği
görülmüştür. Bu sayede hastaların preoperatif olarak daha doğru bir şekilde
değerlendirilmesiyle optimal cerrahi yöntem planlanabilecektir.

Anahtar Kelimeler

Adneksiyal kitle, skorlama sistemleri, malignite, ultrasonografi

Kaynakça

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