Four Ovarian Cancers Diagnosed During Laparoscopic Management of 1011 Women with Adnexal Masses

Farr Nezhat, MD, Camran Nezhat, MD, Charles E. Welander, MD, & Benedict Benigno, MD; Am J Obstet Gynecol, 1992;167:790-6

The study was conducted to assess the value of laparoscopic management of adnexa masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. All operations were performed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA-125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA-125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.