THE DIAGNOSTIC ACCURACY OF TRANSVAGINAL ULTRASOUND(TVS) IN DIFFERENTIATING BETWEEN BENIGN AND MALIGNANT ADNEXAL MASSES: A SYSTEMATIC REVIEW

Abstract

Background: Adnexal masses represent a frequent diagnostic challenge in gynecological practice due to their wide spectrum of benign and malignant etiologies. Early and accurate characterization is essential for optimizing patient management, preventing unnecessary surgical procedures, and ensuring timely referral for suspected malignancy. Transvaginal ultrasound (TVUS) remains the primary imaging modality used for this purpose because of its accessibility, affordability, and superior visualization of pelvic anatomy. However, variability in diagnostic accuracy across studies, influenced by differences in operator expertise, imaging protocols, and assessment systems, necessitates a consolidated evaluation of its performance.

Objective: To systematically assess the diagnostic accuracy of transvaginal ultrasound in differentiating benign from malignant adnexal masses and to examine the impact of ultrasound features, structured scoring systems, and operator experience on diagnostic outcomes.

Methods: A systematic search was conducted for studies published between 2020 and 2025 using electronic databases including Google Scholar, ResearchGate, and SagePub. Only primary research evaluating TVUS as a diagnostic tool for adnexal masses was included. Studies were eligible if they reported sensitivity, specificity, positive predictive value, negative predictive value, and true-positive or true-negative rates using histopathology or structured follow-up as reference standards. Review articles, previously published analyses, abstracts, case reports, and incomplete manuscripts were excluded. A total of 6,560 records were initially identified; after removing 3,700 duplicates and screening 2,860 titles and abstracts, 960 full texts were evaluated. Ultimately, 10 studies met the inclusion criteria.

Results: Across the included studies (n=10), sensitivity of TVUS ranged widely but frequently exceeded 90%, with specificity similarly high in most cohorts. True-positive values varied from 4 to 70, while true-negative values ranged from 15 to 79. Several studies utilizing structured systems such as IOTA Simple Rules or ADNEX demonstrated superior diagnostic performance, with some reporting accuracy approaching 100%.

Conclusion: Transvaginal ultrasound remains a highly effective first-line modality for distinguishing benign from malignant adnexal masses, particularly when enhanced by standardized scoring systems and Doppler assessment. Despite variations in methodology and examiner experience, the collective evidence supports its continued role in early detection and clinical decision-making. Future work should emphasize multicenter validation, standardized reporting frameworks, and the development of machine-learning–assisted ultrasound interpretation.