This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9-48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.

1st Faculty of Medicine Charles University CZ 121 08 Prague Czech Republic

Department of Obstetrics and Gynecology Hospital CUF Descobertas 1998 018 Lisbon Portugal

Department of Obstetrics and Gynecology Hospital de S Francisco Xavier Centro Hospitalar Lisboa Ocidental 1449 005 Lisbon Portugal

Department of Obstetrics and Gynecology NOVA Medical School Faculdade de Ciências Médicas NOVA University of Lisbon 1169 056 Lisbon Portugal

Faculdade de Ciências da Saúde Universidade da Beira Interior 6200 506 Covilhã Portugal

Maternidade Dr Alfredo da Costa Centro Hospitalar Universitário Lisboa Central 2890 495 Lisbon Portugal

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