Objective: The aim of our work was to assess the diagnostic accuracy of a scoring system versus subjective assessment of the risk of malignancy of pelvic masses achieved by gynecologist/sonologists in the preoperative triage of a busy gynecology depart­ment. Methods: One hundred and eighty-two consecutive patients who underwent surgical removal of ovarian neoplasms were exam­ined. In 39 patients pelvic masses were bilateral. The total number of neoplasms analyzed in this series was 221. Lesions were exam­ined and scored according to the sonographic characteristics. Gynecologist/sonologists also recorded a subjective evaluation of the adnexal masses defining them as “probably benign”, and “suspicious/probably malignant”. Preoperative ultrasound risk assessment was compared to the final pathologic report and diagnostic accuracy was calculated. CA125 was obtained in all patients and its inde­pendent and combined accuracy was calculated. Results: The sensitivity of the scoring system and subjective evaluation was 86% and 95% respectively, specificity was 79% and 91 % with a positive predictive value of 41 % and 53%. The frequency of positive diagnoses for CA125 was 44% due to the high prevalence of endometrosis in this series (48%). In premenopausal patients (75%) the specificity was 93% and 89% for scoring and subjective evaluation, respectively. The combined use of morphological scoring and CA 125 achieved higher specificity and positive predictive values both for the whole series and in premenopausal patients. Conclusions: These results confirmed that the experience of gynecological surgeons with ultrasound skills, outperforms the mor­phological indexing assessment of ovarian masses. Nonetheless an easy sonographic descriptive scoring system is not significantly lower in accuracy than the expertise achieved by gynecologists with sonographic skills.