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Women older than 50 with small (1–6 cm) complex ovarian masses on ultrasound pose diagnostic dilemmas, especially if CA125 levels are normal. Should surgery be performed to rule out malignancy? If not, when should ultrasound be repeated? To address these questions, investigators in California evaluated the clinical outcomes of 1363 women with small complex masses seen over a 4-year period.
A total of 18 ovarian cancers or borderline tumors occurred, all of which were diagnosed at surgery. Overall, 404 of the 422 women who ultimately underwent surgical removal had benign masses. Six malignancies were identified among the 204 women who underwent surgery immediately after a complex mass was identified. Twelve additional malignancies were identi…