Role of Diagnostic Laparoscopy in the Evaluation of Pelvic Adnexal Masses

PURPOSE- To evaluate the causative etiology of pelvic adnexal masses by laparoscopy and to study correlation of findings on clinical examination with that of ultrasound and compare it with findings of diagnostic laparoscopy in patients with pelvic adnexal masses.

METHODOLOGY- The present study was conducted in department of Obstetrics and Gynaecology in Kasturba Hospital, Delhi over a period of 2 years (2012-2014). 50 patients with any gynaecological complaint and with suspected pelvic adnexal mass (group 1) and 50 asymptomatic patients with normal pelvic examination (Group 2) coming for laparoscopic sterilization were taken up for the study. Pelvic examination, ultrasonography and laparoscopy were done in all patients.

RESULTS: On diagnostic laparoscopy, 48(96%) patients had abnormal findings. In group 1, majority of adnexal masses 14 cases (28%) were found to be ovarian cyst. Polycystic ovaries were found in 10 (20%) cases. Endometriotic cyst was detected in 7 cases. Chronic pelvic inflammatory disease (6 cases of tuboovarian mass and 5 cases of hydrosalpinx) was found in 11 cases (22%). No abnormality was found in 2 (4%) cases. 23(46%) cases had adnexal mass on clinical examination and 36 (72%) had positive USG findings in group1. All the cases which had normal laparoscopic findings were also found to have normal clinical and ultrasound findings. In group 2 all 50 patients had normal clinical and ultrasound examination, but only 5(10%) cases had abnormal findings on laparoscopy). The sensitivity of pelvic examination, diagnose the pelvic adnexal mass was 43.34% and that of ultrasonography was 67.9%.

CONCLUSION: Laparoscopy triumphs in detecting many pelvic adnexal masses which clinical methods and USG sometimes fail to identify. This enforces position of laparoscopy as a gold standard for the evaluation of patients with pelvic adnexal masses.