Imaging Considerations for Adnexal Masses

Adnexal masses are commonly found during routine imaging of the pelvis and can be seen in up to 4-5% of asymptomatic women undergoing pelvic ultrasound (US). These masses encompass a range of pathologies from both gynecologic and non-gynecologic origins and can either be benign or malignant. In Canada the lifetime risk for ovarian cancer is 1.7%. There are approximately 3,100 cases per annum in Canada with 2,000 deaths. Despite its low prevalence, ovarian malignancy is a leading cause of death among gynecological malignancies, with a 5-year survival rate of 47%. Imaging plays an integral role in the detection, characterization, and appropriate triage of adnexal masses. The majority of adnexal masses are benign and can be managed conservatively. For the smaller minority of malignant lesions, accurate characterization with early triage to a gynecological oncology centre has an impact on oncological outcomes, and reduces the risk of re-operation and the time to initiation of adjuvant chemotherapy. Conversely, inappropriate surgical triage of benign masses can have an adverse impact on patient morbidity, compromise fertility, and increase cause-specific death for a variety of conditions, including a range of malignancies and cardiovascular diseases.