Approach to Adnexal Masses

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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