Pelvic ultrasound is the first imaging study that should be done to evaluate adnexal mass. The sensitivity and specificity of pelvic ultrasound are 86-91% and 68-83% respectively^[1].Ultrasonography helps approaching if the mass could be benign or if it has certain characteristics that increases the probability of being malignant. The specificity of ultrasound in detecting benign masses is high (almost certainly benign). The specificity of ultrasound in detecting malignant masses is low but the sensitivity is high because some may turn out to be malignant after surgical evaluation(a reasonable chance of being malignant)

Ovarian cancer can be detected incidentally:^[2][1]

• Pelvic ultrasound is the first imaging study that should be done to evaluate adnexal mass (ovary, fallopian tube, surrounding connective tissue)
• The sensitivity and specificity of pelvic ultrasound are 86-91% and 68-83% respectively
• The adnexal mass can present as one of the following
  • Pain and pressure
  • During physical exam
  • Incidentally on pelvic ultrasound
• Ultrasonography helps approaching if the mass could be benign or if it has certain characteristics that increases the probability of being malignant
• The specificity of ultrasound in detecting benign masses is high (almost certainly benign)
• The specificity of ultrasound in detecting malignant masses is low but the sensitivity is high because some may turn out to be malignant after surgical evaluation(a reasonable chance of being malignant)
• Simple roles are used bu IOTA study group to classify adnexal masses finding on ultrasound into:^[3]
  • Benign adnexal mass findings (B-features ):
    • Unilocular cyst
    • No solid components and if present, <7 mm in diameter
    • Detection of acoustic shadowing
    • Multilocular cyst <10 cm in diameter
    • No blood flow
  • Malignant adnexal mass finding (M-features ):
    • Solid irregular component : not hyperechoic, nodular or papillary,
    • Detection of peritoneal fluid (ascites)
    • Detection of four papillary structures at least
    • Irregularly thick septations , >2 to 3 mm.
    • Irregular solid-multilocular tumor, largest diameter over 10 cm
    • Detection of strong flow in the solid component by the color or power doppler
    • Detection of peritoneal masses, lymphadenopathy, or matted bowel