Diagnosis of presumed benign ovarian tumors

Symptoms of presumed benign ovarian tumors (PBOT) are not specific (LE4). Personal or family history of gynecological cancers can guide the diagnostic strategy. Clinical examination is ineffective for positive, topographic and etiologic diagnosis of PBOT (LE4). Signs of hormonal impregnation may refer to certain types of tumors (LE4). For any patient presenting with a pelvic mass, pelvic ultrasound is in the first-line exam (grade A); it can classify most ovarian tumors. In case of pure liquid unilocular mass smaller than 7 cm, ultrasound is sufficient to characterize the mass (grade A). In case of indeterminate or complex ovarian mass on ultrasound, MRI is useful to characterize the mass (LE2). Beyond 7 cm, the diagnostic performance of ultrasound decreases (LE2). When a non-unilocular liquid ovarian formation is characterized using ultrasound as determinate mass, ultrasound scan is the only exam recommended (grade B). MRI is indicated as a second-line scan for indeterminate masses or greater than 7 cm (grade B). Cyst puncture for diagnostic purposes has no place in the diagnostic strategy of ovarian cysts (grade C). In case of PBOT in pre-pubertal period, dosing biomarkers is useful but should not delay care. In adult women with PBOT, the measurement of CA125 is not recommended for first-line diagnosis (grade C). Current literature data are not sufficient to specify the diagnostic strategy for an ovarian tumor discovered incidentally during laparoscopy. In case of discovery of a high CA125 value, pelvic ultrasound is the first-line examination. The literature data are still limited to define a CA125 threshold value requiring further exploration or special monitoring, in case of normal pelvic ultrasound.