Evaluation of Adnexal Masses and its Diagnostic Value of Clinical Findings, Ultrasonography and its Correlation with Histopathological Diagnosis

Objective: Adnexal masses is a common clinical presentation in gynaecological practice and can be of gynaecological or non- gynecologic origin. it includes masses arising from ovaries, fallopian tubes, broad ligament and structures within broad ligament that are developed from the embryonic nests. the term adnexal mass is most often used for masses involving the ovary because of high propensity of the ovary for neoplasia. Therefore, gynecologist must evaluate these masses using clinical and radiological information and the balance the risk of surgical intervention for a benign vs malignant process. the objective of this study is to find out the diagnostic value of the clinical findings, ultrasonography and its correlation with histopathological diagnosis in adnexal masses. Methods: This is a prospective study undertaken in the department of obstetrics and gynaecology Mysore medical College and research institute Mysore from 7/12/2020 to 11/12/2021, All patients with clinical diagnosis all of adnexal masses where included. After a detailed history, complete general physical examination and bimanual examination a provisional diagnosis was made. The patient was then subjected to an ultrasound examination consisting of at the trans vaginal or transabdominal routes with colour Doppler in selective cases. Biochemical investigations like CA 125 where done. Risk of malignancy index (RMI) for each tumor was calculated. Following surgery, specimen was sent for histopathological examination and the report were collected with preoperative clinical and imaging findings. Results: The incidence of undergoing surgical intervention was 5.26 %. The incidence of ovarian masses was 93%. 84% were neoplastic and 16% non-neoplastic. The incidence of malignancy was 9.5%. The mean age of presentation of adnexal masses was 38.11 years with majority of tumors occurring in the age group of 41-50 years. There were highly significant differences amount tumor types (benign, malignant) and menstrual status with malignancy being more prevalent in postmenopausal group. Sensitivity and specificity of clinical diagnosis in discriminating benign and malignant ovarian tumor were 87.5% and 93.47% respectively with an accuracy of 93 %. Sensitivity and specificity of ultrasound examination were 87.5% and 95.65% respectively with an accuracy of 95% which was slightly better than clinical diagnosis. When both clinical and sonological diagnosis were combined the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign neoplasm where 87.5%, 96.7%, 70% and 98.8 8% with a false positive rate of 39% and false negative rate of 1.11 %. Their combined accuracy was 96%. CA 125 as a laboratory test showed a sensitivity of 62.5%, specificity of 84.25% and an accuracy of 82.14%. Risk of malignancy index (RMI) more than 200 showed a sensitivity of 62.5%, specificity of 95.65% and an accuracy of 93 %. Surface epithelial tumor- serous type, was the most common histological finding followed by mucinous type among both benign and malignant neoplasms. Conclusion: Ovarian masses contribute to a majority of adnexal masses and are a common site for neoplasia. Clinical findings, sonography with Doppler correlates positively with histopathology in early detection of malignancy and its appropriate management.