Diagnostic approach to adnexal lesions in young females in their second and third decades

Background To review the imaging options and features of different ovarian lesions in young females. We also aimed to put a simple approach to reach the appropriate diagnosis. Patients and methods A retrospective study of 120 patients were included in their second and third decades. All cases had examined by ultrasound then other preferred imaging modalities were used either CT or MRI to reach the appropriate diagnosis. Further, serological and pathological assessments were done in some cases. Results Ovarian pathologies were 89.1% and extra-ovarian adnexal lesions were 10.8%. Non-tumoral ovarian pathologies were the upper hand in both decades, followed by benign tumors in the first decade; however, the overall malignancy was common in the second decade. The ultrasound provided substantial proof of the diagnosis in 34.1% without further need for advanced imaging with a sensitivity and specificity of 100% besides it helped in the discrimination between benignity and malignancy of the ovarian tumors with calculated overall sensitivity and specificity of 93.7 and 88%, respectively. MRI and DWI have raised the sensitivity and specificity up to 95.4% and 96.3% respectively in the setting of ovarian tumor's nature discrimination. Conclusions The majority of adnexal lesions were benign in this age group. It was not always possible to distinguish between benign and malignant adnexal tumors using ultrasound only, so adding CT and /or MRI for more characterization of some lesions raises the diagnostic performance of the diagnosis to achieve proper management for saving fertility and crucial when ovarian cancer discovered to help adjuvant therapy and enhance patient outcomes.