Ultrasonographic clues to malignancy: a decade of adnexal mass evaluation in pregnant women

The discovery of adnexal masses during pregnancy is being reported more often due to the greater use of prenatal ultrasonography, which leads to important clinical choices that can affect both the mother and the fetus. Although most of these masses are benign, a small proportion are malignant. Accurate diagnosis and management are therefore critical for maternal and fetal prognosis. This retrospective study included 152 pregnant patients diagnosed with an ovarian mass between January 2015 and December 2024 at a tertiary care center. We divided the patients into two groups: observation (n = 92) and surgery (n = 60). The surgical group was further classified as benign, borderline, or malignant based on histopathological findings. We examined the ultrasound characteristics, including the size of the mass, solid parts, finger-like growths, cyst shape, and personal evaluations. We performed the statistical analysis using SPSS version 22.0, considering a p-value of less than 0.05 as statistically significant. Among the 60 patients who underwent surgery, 45% had benign tumors, 33.3% had borderline tumors, and 21.7% had malignant tumors. The median tumor diameter in malignant cases was 115 mm, which was significantly larger than in other groups (p = 0.0001). Malignant masses were more frequently multilocular or solid in nature (p < 0.001). The size of the solid component and the presence of papillary projections were also significantly associated with malignancy (p = 0.0007 and p = 0.002, respectively). Subjective ultrasound assessment showed a high concordance in predicting malignancy. Morphological feature characteristics such as tumor diameter, the presence of papillary projections, and solid components observed on ultrasonography are strong predictors of malignancy. Therefore, it is important to consider these factors. It’s important to carefully examine adnexal masses with ultrasound and involve different specialists when managing these issues during pregnancy.