Ep. 136 Managing Adnexal Masses in GYN Practice with Dr. Mona Guo and Dr. Marcia Ciccone

It is 4:50 on a Friday, and an ultrasound report lands in your inbox: six centimeter complex right ovarian mass, neoplasm cannot be excluded. What happens next? On this episode of BackTable Women’s Health, Dr. Mona Guo and Dr. Marcia Ciccone team up to discuss how general obstetrician gynecologists should evaluate, follow, and operate on adnexal masses and when to refer to gynecologic oncology. They walk through reading the imaging yourself, understanding what “complex” means on a report, ultrasound features and O-RADS, tumor marker selection, and when an MRI adds value beyond ultrasound.

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Timestamps

00:00 - Introduction02:57 - Incidental Ultrasound Report on a Friday Afternoon05:57 - Ultrasound Features, ACOG Bulletins and O-RADS08:44 - Red Flag Findings and Urgent Evaluation10:58 - Tumor Marker Selection and the Limits of CA 12514:31 - Markers by Age, Tumor Type and New Assays in Development19:38 - When MRI Adds Value23:15 - Surveillance Versus Surgery27:05 - Cystectomy, Oophorectomy and the Consent Conversation31:10 - Preventing Rupture and Containing the Specimen35:42 - Closing Remarks

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More about this episode

The conversation separates true emergencies like torsion, hemorrhage, and abscess from imaging findings that require faster evaluation, then breaks down the tumor marker panel, including the limits of CA 125, the value of hormonal and GI markers, and how thresholds shift by age and presentation. They review evidence supporting surveillance of simple cysts under ten centimeters, surgical choices between cystectomy and oophorectomy, and the consent and extraction plans that prevent upstaging from a cyst rupture. The episode closes with practical pearls for preventing spill, managing tubo-ovarian abscess, and the value of a quick call to a colleague when the next step is unclear.

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Resources

ACOG Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016https://doi.org/10.1097/AOG.0000000000001768 Andreotti RF, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020https://doi.org/10.1148/radiol.2019191150 ACR Ovarian-Adnexal Reporting and Data System (O-RADS)https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Reporting-and-Data-Systems/O-Rads Modesitt SC, et al. Risk of malignancy in unilocular ovarian cystic tumors less