Episode # 3 • 17 Jan 2025
Managing Adnexal Masses in GYN Practice
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.
Timestamps
00:00 - Introduction
02:57 - Incidental Ultrasound Report on a Friday Afternoon
05:57 - Ultrasound Features, ACOG Bulletins and O-RADS
08:44 - Red Flag Findings and Urgent Evaluation
10:58 - Tumor Marker Selection and the Limits of CA 125
14:31 - Markers by Age, Tumor Type and New Assays in Development
19:38 - When MRI Adds Value
23:15 - Surveillance Versus Surgery
27:05 - Cystectomy, Oophorectomy and the Consent Conversation
31:10 - Preventing Rupture and Containing the Specimen
35:42 - Closing Remarks
Resources
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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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