Study objective: To evaluate the risk of malignancy associated with the main macroscopic findings observed on adnexal masses during a laparoscopic approach.
Design: Prospective series of consecutive patients (Canadian Task Force classification II-2).
Setting: Tertiary care university hospital.
Patients: One hundred fifteen patients were included. Ninety-eight had benign and 17 malignant adnexal masses.
Interventions: Diagnostic and operative laparoscopy.
Measurements and main results: Adnexal images were obtained during laparoscopy, recorded, and analyzed according to irregularity on surface, presence of atypical vessels, lobular form, absence of coral-like surface, implants, large-volume ascites, and cloudy or hemorrhagic ascites. A logistic regression was applied, and the independent findings associated with malignant disease were atypical vessels (OR 16.37; 95% CI 2.85-94.13; p <.01) and irregularity on tumor surface (OR 43.41; 95% CI 8.02-234.96; p <.05). In this way, 95% of the cases were correctly diagnosed.
Conclusions: Atypical vessels and irregularity on tumor surface were important criteria of malignancy during laparoscopic treatment of adnexal masses. The recognition of these features can be helpful in choosing the ideal surgical approach mainly when the preoperative evaluation is unsatisfactory.