American Board of Internal Medicine (ABIM) Certification Practice Exam

How is ovarian cancer typically diagnosed in patients with an adnexal mass without ascites?

1. Blood tests alone

2. Ultrasound imaging

3. Surgical exploration

4. CT scan

The correct answer is: Surgical exploration

The diagnosis of ovarian cancer in patients presenting with an adnexal mass without ascites is most definitively achieved through surgical exploration. This procedure allows direct visualization and sampling of the mass and surrounding tissues, which is crucial for accurate diagnosis. During surgical exploration, various techniques such as laparoscopy or laparotomy can be employed, allowing for both assessment of the mass and the potential collection of tissue for histopathological analysis. Imaging studies like ultrasound or CT scans can provide valuable information regarding the morphology and structure of the adnexal mass, but they cannot definitively diagnose ovarian cancer. Blood tests, specifically tumor markers such as CA-125, may aid in the evaluation of ovarian cancer risk, but they are not conclusive for diagnosis and can be influenced by other benign and malignant conditions. For cases of adnexal masses where the presence of ascites is absent, surgical exploration remains the gold standard for establishing a definitive diagnosis, as it eliminates the ambiguity that non-invasive methods might leave. This approach ultimately leads to more precise treatment planning based on the pathological findings obtained directly from the mass.