How I Do It—How to Report the “Complex” Ovarian Mass on US

ABSTRACT Background Transvaginal ultrasound (TV‐US) of the pelvis is now a standard component of the diagnostic armamentarium in gynaecology. After undergoing specialised training, healthcare professionals (sonographers, gynaecologists, and radiologists) performing such scans can diagnose pelvic pathology accurately. TV‐US is fast to perform and cheaper than cross‐sectional imaging. Many gynaecology services now offer ultrasound as a well‐established part of one‐stop clinics, where a diagnosis can be made at the first visit and the patient pathway expedited. Purpose Predicting the risk of malignancy in adnexal masses is so important. This review describes my systematic approach to reporting a “complex ovarian mass” on TV‐US, as a subspecialist gynaecologist‐sonologist. Conclusion Using International Ovarian Tumour Analysis (IOTA) language and IOTA risk of malignancy algorithms allows us to describe and categorise adnexal masses on ultrasound and to predict the risk and stage of malignancy. With experience, experts can also predict the histopathological subtype. This level of diagnostic performance allows us to streamline the patient journey and to reach a diagnosis and management plan faster. You will never call an ovarian mass ‘complex’ again!