Brito Marta Espanhol, Borges André, Rodrigues Sofia, Ambrósio Paula, Condeço Raquel, Lacerda Abílio, Bernardo Maria José, Pinto Patrícia, Djokovic Dusan
Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), 2890-495 Lisbon, Portugal.
Department of Obstetrics and Gynecology, Hospital de S. Francisco Xavier, Centro Hospitalar Lisboa Ocidental (CHLO), 1449-005 Lisbon, Portugal.
Diagnostics (Basel). 2021 Oct 27;11(11):1992. doi: 10.3390/diagnostics11111992.
This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group ( < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.
这项前瞻性多中心研究在葡萄牙的两家三级转诊医院开展，旨在确定附件包块保守治疗期间并发症（恶变、扭转或破裂）的发生率。研究纳入了2016年1月至2020年12月期间经超声诊断为无症状附件包块（国际卵巢肿瘤分析（IOTA）附件恶性风险<10%）的18岁及以上非妊娠患者。患者的保守治疗包括进行长达60个月的系列临床和超声评估、肿物自行消退或手术切除（中位随访时间：17.8个月；范围9 - 48个月）。在监测的573个包块中（328个绝经前附件包块和245个绝经后附件包块），99.5%未观察到并发症。绝经前和绝经后患者的年肿物生长率及形态复杂性增加情况相似。16.4%的患者出现自行消退，在绝经前组更为常见（<0.05）。18.4%的病例进行了手术干预；诊断出1例交界性和1例FIGO IA期浸润性癌。有1例孤立的卵巢扭转病例（0.17%）。这些数据支持对于绝经前后超声检查显示为良性、稳定且无症状的附件包块，保守治疗是一种安全的选择，并强调了对有症状或形态复杂性增加的病变需加快治疗。
