为了帮助初级保健医生,急诊医生,和妇科医生在附件肿块的初步调查中,定义为子宫附近或卵巢内或周围出现的肿块,输卵管,或周围的结缔组织,并概述了确定将受益于妇科肿瘤科医师进一步治疗的女性的建议。
妇科医生,产科医生,家庭医生,普通外科医生,急诊医学专家,放射科医生,超声波检查者,护士,医学学习者,居民,和研究员。
18岁及以上的成年女性参加附件质量评估。
有附件肿块的妇女应进行个人危险因素评估,历史,和物理发现。初步评估还应包括影像学和实验室测试,以由妇科肿瘤学家或根据SOGC指南编号对妇女进行护理管理。404对良性卵巢肿块的初步调查和处理。
搜索PubMed,CochraneWiley,Cochrane系统评价是在2018年1月对自2000年以来发表的涉及人类受试者的英语材料进行的,使用三组术语:(i)卵巢癌,卵巢癌,附件疾病,卵巢肿瘤,附件肿块,输卵管疾病,输卵管肿瘤,卵巢囊肿,和卵巢肿瘤;(ii)上述术语结合预测肿瘤分期,后续行动,和分期;和(iii)上述两组术语结合超声,肿瘤标志物,CA125,CEA,CA19-9,HE4,多变量指数测定,卵巢恶性肿瘤风险算法,恶性风险指数,诊断成像,CT,MRI,和PET。按照证据质量的降序选择了相关证据,如下所示:荟萃分析,系统评价,指导方针,随机对照试验,前瞻性队列研究,观察性研究,非系统评价,案例系列,和报告。通过交叉引用已确定的评论,确定了其他文章。确定的研究总数为2350,其中59项纳入本综述。
内容和建议由作者起草并达成一致。加拿大妇科肿瘤学会执行和理事会审查了内容并提交了意见供审议。加拿大妇产科医师协会董事会批准了最终草案。使用建议分级评估中描述的标准对证据质量进行评级,发展,和评估(等级)方法框架(在线附录A表A1)。有关强建议和弱建议的解释,请参阅在线附录A的表A2。调查结果摘要可应要求提供。
附件肿块很常见,以及如何对患有附件肿块的患者进行分类和管理护理的指南将继续指导初级保健提供者和妇科医生的实践。当妇科肿瘤学家进行初次手术时,卵巢癌的预后得到改善。可能是完整的手术分期和最佳的细胞减少的结果。鉴于这些优越的结果,辅助附件肿块的分诊以及附件肿块患者的转诊和护理管理的指南至关重要.
建议(父母的等级评定)。
To aid primary care physicians, emergency medicine physicians, and gynaecologists in the initial investigation of adnexal masses, defined as lumps that appear near the uterus or in or around ovaries, fallopian tubes, or surrounding connective tissue, and to outline recommendations for identifying women who would benefit from a referral to a gynaecologic oncologist for further management.
Gynaecologists, obstetricians, family physicians, general surgeons, emergency medicine specialists, radiologists, sonographers, nurses, medical learners, residents, and fellows.
Adult women 18 years of age and older presenting for the evaluation of an adnexal mass.
Women with adnexal masses should be assessed for personal risk factors, history, and physical findings. Initial evaluation should also include imaging and laboratory testing to triage women for management of their care either by a gynaecologic oncologist or as per SOGC
guideline no. 404 on the initial investigation and management of benign ovarian masses.
A search of PubMed, Cochrane Wiley, and the Cochrane systematic reviews was conducted in January 2018 for English-language materials involving human subjects published since 2000 using three sets of terms: (i) ovarian cancer, ovarian carcinoma, adnexal disease, ovarian neoplasm, adnexal mass, fallopian tube disease, fallopian tube neoplasm, ovarian cyst, and ovarian tumour; (ii) the above terms in combination with predict neoplasm staging, follow-up, and staging; and (iii) the above two sets of terms in combination with ultrasound, tumour marker, CA 125, CEA, CA19-9, HE4, multivariable-index-assay, risk-of-ovarian-malignancy-algorithm, risk-of-malignancy-index, diagnostic imaging, CT, MRI, and PET. Relevant evidence was selected for inclusion in descending order of quality of evidence as follows: meta-analyses, systematic reviews,
guidelines, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional articles were identified through cross-referencing the identified reviews. The total number of studies identified was 2350, with 59 being included in this review.
The content and recommendations were drafted and agreed upon by the authors. The Executive and Board of the Society of Gynecologic Oncology of Canada reviewed the content and submitted comments for consideration. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework (Table A1 of Online Appendix A). See Table A2 of Online Appendix A for the interpretation of strong and weak recommendations. The summary of findings is available upon request.
Adnexal masses are common, and
guidelines on how to triage them and manage the care of patients presenting with adnexal masses will continue to guide the practice of primary care providers and gynaecologists. Ovarian cancer outcomes are improved when initial surgery is performed by a gynaecologic oncologist, likely as a result of complete surgical staging and optimal cytoreduction. Given these superior outcomes,
guidelines to assist in the triage of adnexal masses and the referral and management of the care of patients with an adnexal mass are critical.
RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).