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Prediction models play an important role in adnexal mass assessment since they allow clinicians to reliably differentiate adnexal mass as malignant or benign. The models use clinical and ultrasound features to generate a numerical score or probability of malignancy. The use of prediction models in adnexal mass assessment can have several benefits. For example, they can help clinicians identify patients at higher risk for malignancy and thus candidates for surgical treatment. They can also help to guide decision-making regarding the need for additional imaging and the extent of surgical procedures. One commonly used prediction model in adnexal mass assessment is the Risk of Malignancy Index (RMI), which incorporates menopausal status, ultrasound features of an adnexal mass, and serum levels of cancer antigen 125 to classify a lesion. The Simple Rules model is an easy and reproducible prediction model that uses selected (benign and malignant) ultrasound features to determine the likelihood of malignancy. Assessment of Different NEoplasias in the adneXa (ADNEX) model uses clinical and ultrasound features to calculate the probability of different types of malignancy. The malignancies are divided into border-line tumors, invasive ovarian cancer stage I, invasive ovarian cancer stage II - IV and secondary ovarian malignancies. This feature of the ADNEX model offers clinicians a more individualized approach to patients with an adnexal mass. In general, the use of predictive models in the evaluation of adnexal masses can be useful in daily clinical practice, but the decision on further diagnostic or therapeutic procedures should be made following the clinical context, respecting the wishes of the patient.

The study aimed to assess the oncologic and reproductive outcome of fertility-sparing treatment of stage I borderline ovarian tumors (BOTs). A retrospective study of patients aged 18-40 years with stage I BOTs surgically treated during a 10-year period was conducted. In total, 52 patients (average age 32.7+/-5.9) were followed for 16 to 137 months after BOT diagnosis (mean 73.4 months). The overall survival rate was 100%. Recurrence was registered in 4 patients (7.7%). All patients underwent a unilateral salpingo-oophorectomy and all histologic findings corresponded with primary BOTs (3 serous; 1 endometrioid). Higher parity increased while the histological type and stage did not impact recurrence. Average recurrence-free survival was 36.2+/-23.6 months regardless of histological type and stage. Recurrence occurred during the first 3 postoperative years in 75% of cases. Out of 45 women treated with fertility-sparing surgery, 64.4% attempted pregnancy and the pregnancy success rate was 44.8%. Only one pregnancy was conceived by assisted reproduction, while all others were spontaneous. The fertility-sparing treatment in stage I borderline ovarian tumors can be a safe and successful option both in terms of oncologic and reproductive outcomes, regardless of patient and treatment characteristics. Pregnancies after BOT surgery can be achieved with satisfactory rates and adequate outcomes.

Introduction. Transvaginal sonography and human chorionic gonadotropin (hCG) testing are cornerstones of modern clinical practice in cases with the suspected ectopic pregnancy. In unclear cases, if the level of hCG is above the discriminatory zones, the use of uterine curettage is recommended. There is an increasing concern that strict observation of the guidelines would potentially harm otherwise normal early intrauterine pregnancies in certain cases. Case Outline. A 35-year-old woman was admitted to hospital due to a severe lower abdominal pain. Based on the positive pregnancy test and sonographic exams which failed to demonstrate intrauterine pregnancy, the diagnosis of ectopic pregnancy was presumed. Laparoscopy revealed ruptured corpus luteum cyst and the diagnosis was confirmed on histopathological finding. Postoperatively, normal intrauterine gestation was visualized. Conclusion. Since the diagnosis of early pregnancy and its complications can be misleading, in unclear cases, we support the expectative “wait and see” management consisting of serial hCG testing and repeated ultrasound examinations. Avoidance of uterine curettage in such unclear cases would further reduce the possibility of normal early pregnancy interruption.

The study aimed to assess the oncologic and reproductive outcome of fertility-sparing treatment of stage I borderline ovarian tumors (BOTs). A retrospective study of patients aged 18-40 years with stage I BOTs surgically treated during a 10-year period was conducted. In total, 52 patients (average age 32.7+/-5.9) were followed for 16 to 137 months after BOT diagnosis (mean 73.4 months). The overall survival rate was 100%. Recurrence was registered in 4 patients (7.7%). All patients underwent a unilateral salpingo-oophorectomy and all histologic findings corresponded with primary BOTs (3 serous; 1 endometrioid). Higher parity increased while the histological type and stage did not impact recurrence. Average recurrence-free survival was 36.2+/-23.6 months regardless of histological type and stage. Recurrence occurred during the first 3 postoperative years in 75% of cases. Out of 45 women treated with fertility-sparing surgery, 64.4% attempted pregnancy and the pregnancy success rate was 44.8%. Only one pregnancy was conceived by assisted reproduction, while all others were spontaneous. The fertility-sparing treatment in stage I borderline ovarian tumors can be a safe and successful option both in terms of oncologic and reproductive outcomes, regardless of patient and treatment characteristics. Pregnancies after BOT surgery can be achieved with satisfactory rates and adequate outcomes. [ABSTRACT FROM AUTHOR]