-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Adnexal Mass (Reproductive group) From: Zach Newton (zbnewton@atl.mindspring.com) Mon Jul 14 21:37:02 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Claudio Hermosilla Barrios: "Peritoneal Closure" Previous message: R. Daniel Braun M.D.: "IUFD/Hydocephalus" Maybe in reply to: Geffrey H. Klein, MD: "Adnexal Mass (Reproductive group)" Next in thread: Robert Brenner: "Re: Adnexal Mass (Reproductive group)" Geffrey H. Klein, MD wrote: > > This post is a summary of my attempt to outline a protocol for management > of adnexal masses in reproductive age patients. I think we will agree that > these are all patients under 45 years of age. > > Starting with ACOG's criteria for cystectomy for asymptomatic benign cyst > in nonpregnant women of reproductive age > a.Pelvic examination or ultrasound demonstrating a cystic mass that is 8 > cm or larger > b.Persistence of a cystic mass of 6 cm or larger for two cycles > c.Presence of cystic mass that is multilocular or has solid components, > as confirmed by ultrasound examination > > The above findings are an indication for operation rather than observation. > Although it is stated in the criteria set that this is an indication for > cystectomy, there should be some room for ovariectomy in some cases for the > same indication. Due to many of these patient's desire to maintain > reproductive capacity cystectomy is preferable, especially if there are > bilateral masses. Cyst aspiration probably has no role and should be > avoided. The ACOG protocol is for screening cases appropriate for surgical intervention. The actual surgery is not in the domain of the protocol. Since your cited ACOG Criteria Set is in place, simply incorporate that specific protocol into your schema for all adnexal masses in the reproductive age group. Your task then remains to build around the existing ACOG Criteria Set for what remains that is not currently addressed by ACOG Criteria Sets. > Preoperative CA125 is not indicated to determine need for surgery due >to the high false positive rate in the reproductive age group. (2) That is the standard today. >It is unclear to me if it is cost effective to get CA125 preop after > determination of the need for surgery on another basis. Solid masses >in this group should get tumor markers specific for germ cell tumors >(AFP and HCG) (3) Not necessary pre-op. > Preoperative doppler studies are still considered investigational due to > variation in equipment and training. That is current standard (i.e., no Doppler outside of investigational study). > Historical factors like family or personal history of breast, colon, > uterine, or ovarian cancers should be noted. Risk factors for the patient > such as nulliparity, infertility, and delayed childbearing should be noted. Agreed. Format into line items. > Factors requiring conversion to laparotomy from laparoscopy include the > usual complications of laparoscopy that require laparotomy and signs of > malignancy. > > Signs of malignancy include excrescences on the surface of the ovary, > ascites, dense ovarian adhesions, or diaphragm nodules. (4) This is QI issue, not protocol for selection for surgery. > In the absence of the above criteria, observation for 2 cycles is in order. > The addition of oral contraceptives for patients without contraindications > to their use should be strongly encouraged. I know of no supportive evidence to justify this. David Grimes would stomp you flat. >I propose this group be called > Reproductive, observation. -- Zach Newton Z. B. Newton, III, M.D. Atlanta/Gyn Next message: Claudio Hermosilla Barrios: "Peritoneal Closure" Previous message: R. Daniel Braun M.D.: "IUFD/Hydocephalus" Maybe in reply to: Geffrey H. Klein, MD: "Adnexal Mass (Reproductive group)" Next in thread: Robert Brenner: "Re: Adnexal Mass (Reproductive group)"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:20:20 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.