What tests and labs are indicated for a 71-year-old female with left groin pain near the ovary?

From the Guidelines

For a 71-year-old female with left groin pain near the ovary, I strongly recommend starting with a pelvic ultrasound (transvaginal and transabdominal) as the first-line imaging test, followed by a CT scan of the abdomen and pelvis with contrast if needed, to promptly evaluate for potential ovarian cancer or other gynecological conditions. This approach is supported by the most recent evidence from the Journal of the American College of Radiology 1, which suggests that CT abdomen and pelvis with IV contrast may be considered if a life-threatening diagnosis is suspected or if US and MRI are inconclusive.

Initial Evaluation

The initial evaluation should include:

• A complete blood count
• Comprehensive metabolic panel
• Urinalysis
• CA-125 tumor marker 1
• Physical examination by a gynecologist or primary care physician, focusing on the abdomen, pelvis, and inguinal regions to check for hernias, masses, or tenderness

Imaging Studies

Imaging studies should include:

• Pelvic ultrasound (transvaginal and transabdominal) as the first-line test
• CT scan of the abdomen and pelvis with contrast if needed
• MRI may provide better soft tissue detail if initial tests are inconclusive

Potential Causes of Pain

In older women, ovarian pain may indicate various conditions, including:

• Ovarian cysts
• Tumors (benign or malignant)
• Torsion
• Referred pain from other sources like hernias, urinary tract infections, or musculoskeletal issues Given the patient's age, it's particularly important to rule out malignancy, as ovarian cancer risk increases with age and often presents with vague symptoms like groin or pelvic pain 1.

From the Research

Diagnostic Tests for Ovarian Pain

For a 71-year-old female experiencing pain in the left groin near the ovary, several diagnostic tests can be considered:

• Ultrasound (US) imaging is commonly used to assess ovarian torsion and other adnexal pathologies 2, 3
• Computed Tomography (CT) scans can also be used, especially in emergency settings, and have been shown to have high sensitivity and specificity for diagnosing ovarian torsion 3, 4
• Magnetic Resonance Imaging (MRI) may be helpful in cases where the diagnosis remains unclear, particularly in younger patients or those with equivocal sonographic findings 2
• Color Doppler Ultrasound (CDU) may be used to assess ovarian torsion, but its utility is limited if a contrast-enhanced CT scan is negative 4
• Positron Emission Tomography/CT (PET/CT) has been shown to be superior to other imaging modalities for diagnosing malignant ovarian tumors and can also be used to evaluate the dissemination of ovarian cancer 5, 6

Imaging Findings

Imaging findings that may indicate ovarian torsion or other adnexal pathologies include:

• Ovarian enlargement
• Adnexal mass
• Twisting of the vascular pedicle
• Edematous and heterogeneous appearance of the ovary
• Peripheral ovarian follicles
• Free fluid
• Uterine deviation towards the side of torsion
• Adnexal fat stranding
• Tubal dilatation
• Decreased adnexal enhancement 2, 3

Test Sensitivity and Specificity

The sensitivity and specificity of different imaging modalities for diagnosing ovarian torsion vary:

• Pelvic US: 80.0% sensitive and 95.0% specific 3
• Abdominopelvic CT: 100.0% sensitive and 85.0% specific 3
• PET/CT: superior to other imaging modalities for diagnosing malignant ovarian tumors, with an accuracy of 0.921 5