From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, UH MacDonald Womens' Hospital, Case Medical Center, Cleveland, Ohio.
Obstet Gynecol. 2011 Jun;117(6):1413-1428. doi: 10.1097/AOG.0b013e31821c62b6.
Adnexal masses are commonly encountered in gynecologic practice and often present both diagnostic and management challenges. This is partly because of the fact that the majority of adnexal masses that are identified represent benign entities that do not necessarily require active intervention, yet a small subset will represent malignant processes that require both timely and appropriate surgical intervention for optimal outcome. To determine the best diagnostic and management strategies in this setting, physicians must effectively triage risk for malignancy by having a thorough understanding of the entities on the differential diagnosis and carefully considering the clinical context for each individual patient. Optimal selection and interpretation of diagnostic tests are enhanced by both an accurate clinical risk assessment and an understanding of the inherent accuracy of diagnostic tests considered in this setting. The purpose of this document is to provide clinicians with a practical strategy for distinguishing benign and malignant masses in the nonpregnant woman. Our approach addresses the critical elements of accurate risk stratification, reviews the performance of diagnostic tests for identifying malignancy, and offers evidence-based management algorithms to optimize outcomes for women with adnexal masses.
附件包块在妇科临床实践中很常见，常常带来诊断和处理方面的挑战。这在一定程度上是因为大多数被识别出的附件包块代表良性实体，它们不一定需要积极干预，但一小部分将代表恶性过程，需要及时和适当的手术干预以获得最佳结果。为了确定在这种情况下的最佳诊断和管理策略，医生必须通过深入了解鉴别诊断中的实体，并仔细考虑每个患者的临床情况，有效地对恶性风险进行分类。通过准确的临床风险评估和对该环境中考虑的诊断测试的固有准确性的理解，可以增强对诊断测试的最佳选择和解释。本文档的目的是为临床医生提供一种实用的策略，用于区分非孕妇的良性和恶性肿块。我们的方法解决了准确风险分层的关键要素，审查了用于识别恶性肿瘤的诊断测试的性能，并提供了基于证据的管理算法，以优化附件包块妇女的结局。
