Montréal, QC.
Halifax, NS.
J Obstet Gynaecol Can. 2020 Aug;42(8):1021-1029.e3. doi: 10.1016/j.jogc.2019.08.044.
To aid primary care physicians, emergency medicine physicians, and gynaecologists in the initial investigation of adnexal masses, defined as lumps that appear near the uterus or in or around ovaries, fallopian tubes, or surrounding connective tissue, and to outline recommendations for identifying women who would benefit from a referral to a gynaecologic oncologist for further management.
Gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists, radiologists, sonographers, nurses, medical learners, residents, and fellows.
Adult women 18 years of age and older presenting for the evaluation of an adnexal mass.
Women with adnexal masses should be assessed for personal risk factors, history, and physical findings. Initial evaluation should also include imaging and laboratory testing to triage women for management of their care either by a gynaecologic oncologist or as per SOGC guideline no. 404 on the initial investigation and management of benign ovarian masses.
A search of PubMed, Cochrane Wiley, and the Cochrane systematic reviews was conducted in January 2018 for English-language materials involving human subjects published since 2000 using three sets of terms: (i) ovarian cancer, ovarian carcinoma, adnexal disease, ovarian neoplasm, adnexal mass, fallopian tube disease, fallopian tube neoplasm, ovarian cyst, and ovarian tumour; (ii) the above terms in combination with predict neoplasm staging, follow-up, and staging; and (iii) the above two sets of terms in combination with ultrasound, tumour marker, CA 125, CEA, CA19-9, HE4, multivariable-index-assay, risk-of-ovarian-malignancy-algorithm, risk-of-malignancy-index, diagnostic imaging, CT, MRI, and PET. Relevant evidence was selected for inclusion in descending order of quality of evidence as follows: meta-analyses, systematic reviews, guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional articles were identified through cross-referencing the identified reviews. The total number of studies identified was 2350, with 59 being included in this review.
The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework (Table A1 of Online Appendix A). See Table A2 of Online Appendix A for the interpretation of strong and weak recommendations. The summary of findings is available upon request.
BENEFITS, HARMS, COSTS: Adnexal masses are common, and guidelines on how to triage them and manage the care of patients presenting with adnexal masses will continue to guide the practice of primary care providers and gynaecologists. Ovarian cancer outcomes are improved when initial surgery is performed by a gynaecologic oncologist, likely as a result of complete surgical staging and optimal cytoreduction. Given these superior outcomes, guidelines to assist in the triage of adnexal masses and the referral and management of the care of patients with an adnexal mass are critical.
SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES): RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
为初级保健医生、急诊医学医生和妇科医生提供指导，帮助他们初步诊断附件肿块，附件肿块是指靠近子宫或在卵巢、输卵管或周围结缔组织附近出现的肿块；并概述了将哪些女性转介给妇科肿瘤医生进行进一步管理的建议。
妇科医生、产科医生、家庭医生、普通外科医生、急诊医学专家、放射科医生、超声科医生、护士、医学生、住院医师和研究员。
年龄在 18 岁及以上、因附件肿块就诊的成年女性。
应评估患有附件肿块的女性的个人风险因素、病史和体格检查结果。初始评估还应包括影像学和实验室检查，以便根据妇科肿瘤医生或 SOGC 指南 404 对良性卵巢肿块的初始评估和管理，对女性进行管理。
2018 年 1 月，我们使用三套术语对 2000 年以来发表的涉及人类受试者的英文文献进行了 PubMed、Cochrane Wiley 和 Cochrane 系统评价的检索：（i）卵巢癌、卵巢癌、附件疾病、卵巢肿瘤、附件肿块、输卵管疾病、输卵管肿瘤、卵巢囊肿和卵巢肿瘤；（ii）上述术语与预测肿瘤分期、随访和分期相结合；（iii）上述两组术语与超声、肿瘤标志物、CA125、CEA、CA19-9、HE4、多变量指数分析、卵巢恶性肿瘤风险算法、恶性肿瘤风险指数、诊断影像学、CT、MRI 和 PET 相结合。根据证据质量依次选择相关证据，证据质量等级如下：荟萃分析、系统评价、指南、随机对照试验、前瞻性队列研究、观察性研究、非系统评价、病例系列和报告。通过交叉引用已确定的综述，还确定了其他文章。总共确定了 2350 项研究，其中 59 项被纳入本综述。
作者起草并同意了内容和建议。加拿大妇科肿瘤学会的执行委员会和董事会审查了内容并提交了供考虑的意见。加拿大妇产科医生学会的董事会批准了最终草案以供发布。证据质量使用 Grading of Recommendations Assessment, Development, and Evaluation（GRADE）方法框架中描述的标准进行评级（在线附录 A 的表 A1）。有关强弱推荐的解释，请参见在线附录 A 的表 A2。有需要时可提供发现摘要。
获益、危害、成本：附件肿块很常见，有关如何对其进行分类以及管理附件肿块患者的护理的指南将继续指导初级保健提供者和妇科医生的实践。当由妇科肿瘤医生进行初始手术时，卵巢癌的结局会得到改善，这可能是由于进行了完整的手术分期和最佳的肿瘤减灭术。鉴于这些更好的结果，协助对附件肿块进行分类以及对附件肿块患者的转介和护理管理的指南至关重要。
总结声明（括号中的 GRADE 评级）：建议（括号中的 GRADE 评级）。
