Women's Health

Best Practices for Evaluating an Adnexal Mass with Ultrasound

Learn more about how ultrasound aids in assessment of adnexal mass, along with answers to other frequent questions about diagnosing ovarian issues.

Ultrasound is one of the most powerful tools gynecologists have for evaluating pelvic issues. It provides an accurate assessment of numerous medical conditions safely and affordably, often without requiring costly, time-consuming referrals.

Transvaginal ultrasound is the preferred firstline tool to evaluate ovarian masses. Learn more about how ultrasound aids diagnosis for adnexal concerns.

1. How does ultrasound aid in an adnexal mass diagnosis? OB/GYN patients of all ages can experience an adnexal mass. Most pelvic masses are benign, but occasionally they are malignant. This means that early, accurate evaluation is essential. Ultrasound is the best way to evaluate a mass and provide a differential diagnosis. Guidelines from the International Ovarian Tumor Analysis (IOTA), a built-in protocol on some ultrasound machines, provide a framework for distinguishing between benign and malignant tumors.

2. Which factors should be considered when evaluating an ovarian mass with ultrasound? Even though most ovarian masses are not malignant, ovarian cancer is deadly enough that any mass warrants further examination. Transvaginal ultrasound paired with a pelvic exam provides detailed information to determine the risk of the mass. A physician should look for size, shape, vascularity, density and the presence of fluid. 3D ultrasound provides the tools to evaluate each of these factors and plan next steps for treatment.

3. What is the difference between a simple and complex ovarian cyst? Simple ovarian cysts are fluid-filled sacs on the ovaries. They are common and do not increase the risk of cancer. Often, they resolve on their own. Complex ovarian cysts, on the other hand, pose a little more risk. They are rarely cancerous, but are more likely to require treatment than simple cysts. It can be difficult to distinguish on ultrasound—the IOTA model provides guidelines to clarify the difference between benign and malignant tumors.

4. How can ultrasound help clinicians diagnose ovarian torsion? Ovarian torsion can occur in patients of any age. The condition causes sudden abdominal pain, and as a result can mimic other conditions, such as ruptured ovarian cysts or an ectopic pregnancy. Detailed evaluation is required to discover ovarian torsion and the viability of the ovary. 3D ultrasound with color Doppler shows blood flow to the ovary; by moving the probe along the axis of suspected ovarian or adnexal torsion, the clinician can reveal the classic whirlpool sign that indicates torsion.

From common cysts to cancerous tumors and beyond, transvaginal ultrasound gives clinicians the tools to make a differential diagnosis. With appropriate evaluation, gynecologists can provide an early diagnosis or intervention and get their patients on the right treatment path.