2/16/2024 0 Comments Incidental finding on ultrasoundįor most of the twentieth century, the traditional management of a postmenopausal woman with a cystic adnexal lesion was surgical removal. The number of incidentally discovered ovarian masses has significantly increased with technical improvements in and increased utilization of cross-sectional imaging. Some 5–10% of women in the United States will undergo surgery for a suspected adnexal tumor during their lifetime leading to 160,000 to 289,000 hospitalizations annually. Ultimately the following three questions need to be answered in patients with pelvic incidentalomas: (1) does the incidentaloma put the patient at risk for an adverse outcome? (2) can primary or metastatic malignancy be accurately and confidently differentiated from a benign incidentaloma? and (3) if a lesion is benign, might it still require surgical intervention? In this review, guidelines concerning the approach to some of the more common pelvic incidentalomas are presented. This unwillingness is in part driven by a paucity of data on the topic, the lack of clear-cut algorithms with regard to diagnostic and treatment strategies, fear of potential malpractice liability, and/or the anxiety of the patient. The exhaustive evaluation performed in some patients reflects the unwillingness of many physicians to accept uncertainty even in the case of a very rare diagnosis. Subjecting the patient to unnecessary testing and treatment carries its own set of risks that can result in an injurious and expensive cascade of imaging and intervention. Strategies for optimizing patient management of these lesions are only beginning to emerge in terms of deciding which of these incidentalomas can be ignored, which can simply be monitored over time, and which lesions require more aggressive workup. Incidental pelvic lesions have created a management dilemma for both clinicians and radiologists, particularly in the oncology patient in whom any mass, clinical or subclinical, warrants further evaluation. These incidentalomas are unexpected, asymptomatic abnormalities that are discovered serendipitously while searching for other pathology. Recent advances in computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound have led to the detection of incidental ovarian, uterine, vascular and pelvic nodal lesions in both the oncology and non-oncology patient populations that in the past remained undiscovered.
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