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Value of preoperative ultrasound examination in the selection of women with adnexal masses for laparoscopic surgery
Author(s) -
Yazbek J.,
Helmy S.,
BenNagi J.,
Holland T.,
Sawyer E.,
Jurkovic D.
Publication year - 2007
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.5169
Subject(s) - medicine , adnexal mass , laparotomy , ultrasound , laparoscopy , laparoscopic surgery , cyst , likelihood ratios in diagnostic testing , radiology , pelvic examination , surgery , endometriosis , adnexal diseases , gynecology , diagnostic accuracy
Objectives To assess the value of preoperative ultrasound examination in predicting the feasibility of intermediate‐level laparoscopic surgery for benign adnexal masses. Methods Symptomatic women with a clinical or ultrasound diagnosis of adnexal mass were offered a detailed transvaginal ultrasound scan in order to assess the feasibility of laparoscopic cystectomy/oophorectomy. In all cases an attempt was made to establish a likely histological diagnosis using the pattern recognition method. The selection criteria for laparoscopic surgery were: no ultrasound features suggestive of ovarian cancer, predominantly cystic lesion with no solid foci > 5 cm in mean diameter, no evidence of severe pelvic endometriosis or severe pelvic adhesions and dermoid cyst < 10 cm in mean diameter. Laparoscopic surgery was classified as successful if the mass was removed completely without resorting to a laparotomy. Results One hundred and forty‐three women were diagnosed with a total of 162 adnexal cysts. The final dataset consisted of 137 women (with 153 lesions), 113 (82.5%) of whom were selected for laparoscopy and 24 (17.5%) for laparotomy. On histological examination 152 (99.3%) cysts were benign and the remaining one (0.7%) was borderline. The operation was successfully completed laparoscopically in 107/113 (94.7%) cases. The preoperative ultrasound assessment predicted the successful outcome of laparoscopic surgery with a sensitivity of 98% (95% CI, 94–99%), specificity of 79% (95% CI, 60–90%), positive predictive value of 95% (95% CI, 89–98%), positive likelihood ratio of 4.58 (95% CI, 2.25–9.32) and negative likelihood ratio of 0.02 (95% CI, 0.01–0.09). Conclusions A detailed preoperative transvaginal ultrasound examination is a helpful tool for assessing the feasibility of intermediate‐level laparoscopic surgery in women with benign adnexal lesions. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.