Follow-Up Care of Patients With Complex Adnexal Masses in an Academic Health System: A Cohort Study [ID 1098]

INTRODUCTION: International guidelines recommend follow-up imaging and gynecologic oncology referral for patients with Ovarian-Adnexal Reporting and Data System (O-RADS) 4/5 lesions. We examined factors associated with guideline-concordant follow-up of these lesions in our health system. METHODS: The university IRB exempted this retrospective cohort study of patients with O-RADS 4/5 lesions on ultrasound (US) or magnetic resonance imaging (MRI) from July 1, 2020, to December 31, 2023. Patients with adnexal surgery within 120 days of detection were excluded (n=253). We performed descriptive statistics of our final cohort (n=172). RESULTS: 59.9% were not referred to gynecologic oncology (103/172, 59.9%). 65.7% had a documented pelvic examination after initial detection (113/172, 65.7%), 48.8% had generalist follow-up (84/172, 48.8%), and 15.7% had both generalist and gynecologic oncology follow-ups (27/172, 15.7%). 13.4% had ongoing lesion surveillance at data collection (23/172). 55.0% of the remaining (82/149, 55.0%) had benign follow-up imaging. 9.4% received surgery for persistent abnormalities (14/149, 9.4%) with three cancers diagnosed (3/149, 2.0%). Black compared to White patients had higher rates of incomplete or no follow-up imaging (14/40, 35.0% versus 18/91, 19.8%), follow-up pelvic examinations (30/40, 75.0% versus 62/91, 68.1%), and generalist visits (23/40, 57.5% versus 47/91, 51.6%), with lower rates of gynecologic oncology follow-up (13/40, 32.5% versus 43/91, 47.3%). Insured patients had higher rates of completed follow-up imaging (80/156, 51.3% versus 2/6, 33.3%). CONCLUSIONS/IMPLICATIONS: 22.7% (39/172) of patients with O-RADS 4/5 lesions had no or incomplete follow-up imaging. Higher rates of guideline discordant care among Black and uninsured patients suggest opportunities for care optimization.