Evaluation of Adnexal Masses: Diagnosis of Adnexal Masses by Histopathology Versus Diagnosis by Other Imaging Tools

Abstract

Background: Adnexal masses are frequently encountered in gynecological practice, presenting with diverse clinical features ranging from benign cysts to malignant tumors. An accurate preoperative diagnosis is essential for differentiating benign and malignant lesions facilitating an effective treatment strategy. The definitive diagnosis could only be achieved through post-operative histopathology. Ultrasonography (USG), especially transvaginal ultrasound (TVUS), has emerged as a preferred imaging technique due to its easy availability, non-invasive nature, and real-time imaging. The objective of this study was to assess the diagnostic precision of USG in identifying adnexal masses, utilizing histopathology as the definitive standard.
Methodology: An observational study was conducted at the Department of Obstetrics and Gynecology, Rawal General and Dental Hospital, Islamabad, Pakistan from [start date] to [end date]. A total of 132 female patients with USG-confirmed adnexal masses were recruited using consecutive non-probability sampling techniques. The study excluded pregnant women, patients with metastatic malignancies, and those with non-operable adnexal masses. Detailed demographic data, clinical presentations, and ultrasound findings were collected. Each patient underwent surgical resection of the adnexal mass, and the specimens obtained were sent for histopathological examination. Data analysis was performed using SPSS version 26, with results expressed as frequencies, percentages, means, and standard deviations. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of USG were calculated for different types of adnexal masses.
Results: The mean age of the participants was 39.5 ± 10.4 years, with 61.3% being married. The predominant clinical symptom reported was abdominal or pelvic pain, observed in 76.5% of the cases, followed by post-menopausal bleeding at 33.3% and the sensation of a lump at 42.4%. Ultrasound findings indicated that a significant majority of adnexal masses exhibited a cystic morphology (68.1%), were found to be unilateral (92.4%), and were primarily derived from the ovary (87.1%). Histopathological analysis identified endometrioma as the predominant diagnosis, accounting for 21.2% of cases, with dermoid cysts following at 18.9%. Ultrasound imaging exhibited the highest sensitivity for follicular cysts at 90% and dermoid cysts at 88%. Regarding specificity, hydrosalpinx and tubo-ovarian abscesses demonstrated the highest rates, at 97% and 95%, respectively. Overall, ultrasound imaging proved to be a reliable diagnostic tool, achieving a sensitivity of 81.4% and a specificity of 89% for malignancy.
Conclusion: The findings of this study emphasize the role of USG as a reliable diagnostic tool for evaluating adnexal masses, demonstrating significant sensitivity and specificity for both benign and malignant conditions. Despite its operator-dependent nature, USG remains a crucial and cost-effective tool for preoperative assessment, particularly in resource-limited healthcare settings.