Background/Objectives: We aimed to determine the reliability of simple ultrasound (US) markers and CA-125 measurements in diagnosing peri- and postmenopausal ovarian masses. Methods: The study was conducted in a retrospective setting. The preoperative imaging properties of peri- (PEM) and postmenopausal (POM) ovarian cysts were examined. Based on ultrasound findings, lesions were categorized as either (1) simple cysts, defined as unilocular, anechoic structures without solid components, or (2) complex cysts, characterized by any deviation from this morphology. Imaging characteristics, mass size, and demographic data were matched with histology and CA125 levels. Results: In total, 379 cystic structures (PEM: N = 195, average age: 45.6 years; range: 40–54 years, POM: N = 184, average age 61.2 years; range: 41–88 years) were analyzed. In the PEM group, there were 75 simple (Ø < 5 cm N = 32, Ø ≥ 5 cm N = 43) and 122 complex cysts (Ø < 5 cm N = 29, Ø ≥ 5 cm, N = 93), while in the POM group, 49 simple (Ø < 5 cm N = 9, Ø ≥ 5 cm N = 40) and 135 complex cysts (Ø < 5 cm N = 15, Ø ≥ 5 cm N = 120) were found. In the PEM group, malignancy was detected in complex cysts larger than 5 cm (N = 16, 17.58%). In the POM group, malignancy was present in 40 cases, and 3 of them proved to be smaller than 5 cm. The majority of cysts were functional (54.36%) in the PEM group. In the POM group, serous cysts were the most frequent (38.04%), followed by malignant (21.74%) and mucinous cysts (13.04%). CA125 was elevated in 66 of 217 cases (30.41%); only 23 were malignant (NPV: 0.95, PPV: 0.35). Conclusions: Functional cysts are frequently found among perimenopausal ovarian cysts, with malignancy occurring exclusively in complex cysts exceeding 5 cm in diameter. However, complex cysts of any size carry a significant risk of malignancy in menopause, thus, surgery is recommended. Simple cysts can be followed by serial scans in both groups. CA-125 does not give added value to the detection of malignancy in perimenopausal patients. However, in postmenopausal complex morphology cysts larger than 5 cm, it may give added value to the suspicion of malignancy.

Background: The management of ovarian cysts in postmenopausal women is still a diagnostic dilemma. Although ultrasound is the diagnostic cornerstone of the initial assessment, it is limited by its interpretation in cases without clear morphological features of malignancy. Objectives: The aim of this study was to assess whether the addition of grayscale ultrasound features with inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can improve diagnostic accuracy in the identification of malignant ovarian lesions as compared to benign cysts in postmenopausal women. Methods: A total of 103 surgically removed adnexal masses were examined retrospectively. Ultrasound morphology was categorized to either simple or complex while NLR and PLR were calculated from preoperative full blood counts. The reference standard was histopathology. Results: Of the 103 cysts taken out, 74 cysts (71.8%) were benign while 29 cysts (28.2%) were malignant. Complex morphology was shown by all malignant lesions. NLR values in malignancy vs. benignancy showed a mean NLR of 4.96 ± 2.3 in the malignant cases, while it was 2.56 ± 1.2 in the benign cases (p < 0.001). In a similar fashion, the PLR was 198.4 ± 45.1 in malignant compared to 134.2 ± 32.7 in benign cases (p < 0.001). In the group of complex cysts (n = 52), NLR and PLR were compared to differentiate between malignant and benign lesions. In logistic regression, complex morphology was an independent predictor of malignancy, while NLR showed a positive, non-significant trend; PLR was not independently associated. Conclusions: Use of NLR and PLR in combination with grayscale ultrasonographic morphology improves the diagnostic characterization of postmenopausal women with adnexal masses. This easy, cost-effective method might aid in better triage and surgery planning.

Background/Objectives: To determine the reliability of simple ultrasound (US) markers and CA-125 measurement in diagnosing peri- and postmenopausal ovarian masses. Methods: The study was conducted in a retrospective setting. Preoperative imaging properties of peri- (PEM) and postmenopausal (POM) ovarian cysts were examined. According to US findings, two groups were made: (1) simple cysts: unilocular, anechoic cysts without any solid part, (2) complex cysts: cystic structures with different parameters from the simple cysts. Imaging characteristics, size of the mass, and demographic data were matched with histology and CA125 levels. Results: 379 cystic structures (PEM: N=195, average age: 45.6yrs; range: 40-54yrs, POM: N=184, average age 61.2yrs; range: 41-88yrs) were analyzed. In the PEM group 75 simple (Ø<5cm N=32, Ø≥5cm N=43) and 122 complex cysts (Ø<5cm N=29, Ø≥5cm, N=93), while in the POM group 49 simple (Ø<5cm N=9, Ø≥5cm N=40) and 135 complex cysts (Ø<5cm N=15, Ø≥5cm N=120) were found. In the PEM group, malignancy was detected in complex cysts larger than 5cm (N=16, 17.58%). In the POM group malignancy was present in 40 cases, three of them proved to be smaller than 5cm. Majority of cysts were functional (54.36 %) in the PEM group. In the POM group, serous cysts were the most frequent (38.04%), followed by malignant (21.74%) and mucinous cysts (13.04%). CA125 was elevated in 66 of 217 cases (30.41%); only 23 were malignant (NPV: 0.95, PPV: 0.35). Conclusions: Functional cysts are frequently found among perimenopausal ovarian cysts, but malignancy was detected only in cysts with complex morphology larger than 5 cm. However, complex cysts of any size carry a significant risk of malignancy in menopause, thus, surgery is recommended. Simple cysts can be followed by serial scans in both groups. CA-125 did not give added value to the detection of malignancy.

Background/Objectives: The COVID-19 pandemic disrupted gynecologic care pathways and required stricter prioritization of surgical treatment. We evaluated whether the pandemic restriction period was associated with changes in the characteristics of women with adnexal masses reaching surgery and explored ADNEX discrimination within the histologically verified surgical cohort. Methods: This retrospective single-center study included all consecutive women evaluated for an adnexal mass in a dedicated gynecologic ultrasound clinic during a pre-pandemic baseline period and a COVID-19 restriction period. Ultrasound examinations were performed by the same expert using International Ovarian Tumor Analysis (IOTA) terminology and the IOTA Assessment of Different NEoplasias in the adneXa (ADNEX) score was calculated prospectively at the time of examination. Histological analyses were restricted to surgically managed patients. Results: Overall, 340 women were evaluated in the non-COVID period and 211 during the COVID period; 149 (43.8%) and 40 (19.0%), respectively, underwent surgery. After exclusion of five adolescents from the pre-pandemic group, 144 and 40 operated patients were analyzed. The COVID-era surgical cohort was older (median 52.0 vs. 39.0 years, p = 0.0053), had higher ADNEX scores (median 13.7% vs. 4.4%, p = 0.0010), and had a higher proportion of borderline or malignant histology (32.5% vs. 13.2%, p = 0.0083). In an exploratory pooled logistic model, ADNEX score and COVID-period status were associated with non-benign histology. The AUCs were 0.789 and 0.905 in the COVID and non-COVID surgical cohorts, respectively, without a statistically significant between-cohort difference (p = 0.169). Conclusions: The COVID-19 restriction period was associated with a lower proportion of evaluated women proceeding to surgery and with enrichment of the operated cohort for older patients and lesions with higher sonographic risk and non-benign histology. Because surgical selection itself depended partly on ultrasound findings and outcomes were unavailable for non-operated women, these data should not be interpreted as independent validation of ADNEX or proof that deferred management was safe.