Introduction

Ovarian masses include ovarian cysts and tumors, which may be either benign or malignant. The prevalence of ovarian cysts presumed to be benign in asymptomatic women of childbearing age is approximately 7 % (1). All the ovarian masses need evaluation to distinguish malignant tumors from the benign ones, as the management protocols for these two entities are entirely different. It has been estimated that up to 10% of women will undergo surgery for an ovarian mass in their lifetime (2). The overall incidence of a symptomatic ovarian cyst being malignant in a premenopausal woman is approximately 1:1000 (2).

Experiment Work

Aims and Objectives

To evaluate the efficacy of clinical examination and ultrasonography for deciding mode of surgery in ovarian masses.

Material and Methods

This prospective cohort study was conducted in the department of Obstetrics & Gynaecology at King George Medical University over a period of 2 years. All women presenting to the gynaecology OPD with an abdominal or pelvic mass were evaluated for the study. Detailed history was taken followed by complete general physical, systemic and gynaecological examination. Women with clinical features suggestive of malignant ovarian tumour i.e. ascites; ovarian mass with solid cystic consistency, irregular surface or margins, immobility; nodularity in pouch of Douglas or recto vaginal septum or pleural effusion were excluded. All recruited women were then subjected to abdominal and pelvic ultrasonography. Women with USG features suggestive of malignancy i.e. solid areas, multiple septations, thick septae (>4mm) and intra- cavitary papillary projections were excluded. Women with sonographic evidence of ascites, peritoneal nodules, hepatic metastasis and retroperitoneal lymphadenopathy were also excluded.

Results

Figure 1 Demographic Profile of the study cohort

Figure 2 Ultrasonography characteristics of the Ovarian masses

Figure 3 Distribution of cases according to CA-125 Levels

Figure 4 Co-relation between CA-125 levels and Histopathological type of ovarian disease

Figure 5 Distribution of cases on the basis of surgical procedure performed

Discussion

75.7% of all the masses removed laparoscopically measured between 5-10 cm and 11.4% measured more than 10 cm in diameter. Yuen PM (6) et al conducted a study in which they included ovarian masses that were clinically not malignant and measured up to 10 cm. These cases were successfully managed with laparoscopic surgery. Ashwini Sidhamalswamy G et al (7) conducted a study to assess the feasibility and outcome of laparoscopic surgery for the management of ovarian cysts above 10 cm in diameter. They observed that cystic masses not associated with ascites or lymphadenopathy and with normal S. CA-125 levels could be managed laparoscopically. Ghezzi et al (8) evaluated the feasibility of laparoscopy in the management of ovarian masses >10 cm in diameter. Evidence of metastasis or gross ascites were taken as exclusion criteria for laparoscopic management. Neither sonographic feature of the mass nor raised S. CA125 levels were included in the exclusion criteria. In their study, 174 out of 186 women presenting with benign ovarian masses were managed laparoscopically with success. Their rate of conversion to laparotomy (6.4%) was similar as ours (6.15%). In both the studies masses that were clinically benign were taken up for laparoscopic management.

Conclusion

It is quite possible to decide the mode of surgery in cases of ovarian masses on the basis of clinical examination and ultrasonography. Size of the mass, bilaterality and raised CA125 should not be limiting factors for laparoscopic management. However, one should not hesitate to convert to laparotomy on presence of any peroperative findings suggestive of ovarian malignancy.

ACKNOWLEDGEMENT

The present study was conceptualised and conducted by Prof. Nisha Singh. Tuhina Singh helped in the data entry and statistical analysis. Draft was prepared by Dr Shailja Srivastava and finalised by Prof Nisha Singh. We acknowledge the support of all patients who participated in the study and all doctors who helped in management of1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11

References

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