Laparoscopic diagnosis of adnexal cystic masses: a 12-year experience with long-term follow-up

Abstract

Objective: To study the value and the immediate and long-term consequences of the laparoscopic diagnosis of adnexal cystic masses.

Methods: We studied all patients who underwent laparoscopy for an adnexal cystic mass at the Department of Obstetrics, Gynecology, and Reproductive Medicine of the Clermont-Ferrand University Hospital between January 1980 and December 1991. The preoperative workup included routine clinical and ultrasonographic examinations. At laparoscopy, the technique involved peritoneal cytology, ovarian and peritoneal inspection, cyst puncture, and endocystic examination. If a malignant mass was encountered or suspected, the patients were treated by immediate laparotomy with a vertical midline incision. The laparoscopic and pathologic diagnoses were compared. Long-term follow-up was studied using data obtained either clinically or by mail using a standardized questionnaire.

Results: A total of 757 patients with 819 masses were managed by laparoscopy. The mean age was 35.8 +/- 12.6 years and the mean diameter of the cysts was 6.0 +/- 2.7 cm (range 1-20). During this study, 12 tumors of low malignant potential and seven ovarian cancers were encountered (2.5%). The sensitivity of the laparoscopic diagnosis of malignancy was 100%, the specificity 96.6%, and the negative predictive value 100% (773 cases). The positive predictive value was only 41.3%, as 27 tumors were falsely diagnosed as suspicious or malignant. Among eight complications attributed to the diagnostic procedure, three involved spillage of cyst contents.

Conclusion: Using cautious management and strict guidelines, laparoscopic diagnosis of adnexal masses appears reliable and safe, allowing immediate and adequate surgical treatment.