Background: Adnexal mass is a common gynecologic problem. The role of imaging isrndifferentiating malignant and benign adnexal masses with intention of guiding patientrnmanagement. Ultrasonography is the initial imaging modality used in the evaluation of adnexalrnmasses and histopathology is the gold standard in confirming the diagnosis. rnObjective: Correlation of ultrasound findings with histopathologic diagnosis of adnexal massesrnat Tikur Anbessa Specialized Hospital. rnMethods: A cross-sectional retrospective study was analyzed from a period of July 1rn2016 tornJune 30 2020 G.C (4-year period) at Tikur Anbessa Specialized Hospital. Medical records of allrnpatients operated for adnexal pathologies were retrieved. Ultrasonographic findings andrnexaminerâ€™s final diagnosis of the mass as to benign or malignant was recorded and itsrnhistopathologic correlation was done using kappa statistical method. rnResult: In this study, of 75 patients with adnexal masses, 41 were malignant and 36 wererncorrectly predicted with ultrasonography. The sensitivity, specificity and accuracy of ult rasoundrnin diagnosing adnexal masses were 87.5%, 70.6% and 80% respectively. We found a positivernpredictive value (PPV) of 78.3% and a negative predictive value (NPV) of 82.8%. Moderaternlevel of agreement was found between ultrasonography and histopathologic diagnosis with kapparnvalue 0.59. rnConclusion and recommendation: USG showed excellent sensitivity with reduced specificityrnin diagnosing malignant adnexal masses. The lower specificity of USG in predicting benign orrnmalignant adnexal pathologies could lead to unnecessary surgical intervention. However, itsrninherent advantage of wide availability, inexpensive, lack of radiation and acceptable sensitivityrnin diagnosing benign and malignant adnexal masses make an USG an important tool in guidingrnfurther patient management. Establishing standardized reporting protocol using ovarian-adnexalrnreporting lexicon for USG and further multicenter prospective studies with strict application ofrnIOTA simple rules for benign and malignant adnexal masses with different level of operatorrnexperience are recommended to make good use of USG in optimizing patient treatment in ourrnsetting rnst