Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients
Document · Dec 2023 · 2 min read
In brief
In brief
Multi-center study demonstrates that a consensus-based preoperative risk stratification algorithm reduced unnecessary oophorectomies for benign ovarian masses in pediatric patients from 16.1% to 8.4%. The intervention helps preserve ovarian tissue in children and adolescents, avoiding lifelong health consequences of unnecessary removal.
- A preoperative risk stratification algorithm reduced unnecessary oophorectomies for benign ovarian masses from 16.1% to 8.4% (p=0.03)
- The algorithm showed 91.6% sensitivity and 99.3% PPV for identifying benign lesions, with only 0.7% misclassification of malignant disease
- Most ovarian masses in pediatric patients (94-97%) are benign, yet many undergo oophorectomy with lifelong health consequences
- Algorithm adherence was 95% with 81.8% fidelity across 11 US children's hospitals, demonstrating feasibility of implementation
- Ovary-sparing surgery is appropriate for most pediatric ovarian masses when guided by systematic preoperative risk assessment
Written by the GCMD Library team from the document.
New infographic by Dr. Jose Campos and the Chilean society of pediatric surgeons
"Reducing Unnecessary Oophorectomies for Benign Ovarian Neoplasms in Pediatric Patients"
Authors: Peter C Minneci, Katherine C Bergus, Carley Lutz, Jennifer Aldrink, Christina Bence, Lesley Breech, Patrick A Dillon, Cynthia Downard, Peter F Ehrlich, Mary Fallat, Jason D Fraser, Julia Grabowski, Michael Helmrath, Paige Hertweck, Geri Hewitt, Ronald B Hirschl, Rashmi Kabre, Dave R Lal, Matthew Landman, Charles Leys, Grace Mak, Troy Markel, Joseph Pressey, Manish Raiji, Beth Rymeski, Jacqueline Saito, Thomas T Sato, Shawn D St Peter, Jennifer Cooper, Katherine Deans; Midwest Pediatric Surgery Consortium
Full article: https://pubmed.ncbi.nlm.nih.gov/37787794/
Importance: Although most ovarian masses in children and adolescents are benign, many are managed with oophorectomy, which may be unnecessary and can have lifelong negative effects on health.
Objective: To evaluate the ability of a consensus-based preoperative risk stratification algorithm to discriminate between benign and malignant ovarian pathology and decrease unnecessary oophorectomies.
Design, setting, and participants: Pre/post interventional study of a risk stratification algorithm in patients aged 6 to 21 years undergoing surgery for an ovarian mass in an inpatient setting in 11 children's hospitals in the United States between August 2018 and January 2021, with 1-year follow-up.
Intervention: Implementation of a consensus-based, preoperative risk stratification algorithm with 6 months of preintervention assessment, 6 months of intervention adoption, and 18 months of intervention. The intervention adoption cohort was excluded from statistical comparisons.
Main outcomes and measures: Unnecessary oophorectomies, defined as oophorectomy for a benign ovarian neoplasm based on final pathology or mass resolution.
Results: A total of 519 patients with a median age of 15.1 (IQR, 13.0-16.8) years were included in 3 phases: 96 in the preintervention phase (median age, 15.4 [IQR, 13.4-17.2] years; 11.5% non-Hispanic Black; 68.8% non-Hispanic White); 105 in the adoption phase; and 318 in the intervention phase (median age, 15.0 [IQR, 12.9-16.6)] years; 13.8% non-Hispanic Black; 53.5% non-Hispanic White). Benign disease was present in 93 (96.9%) in the preintervention cohort and 298 (93.7%) in the intervention cohort. The percentage of unnecessary oophorectomies decreased from 16.1% (15/93) preintervention to 8.4% (25/298) during the intervention (absolute reduction, 7.7% [95% CI, 0.4%-15.9%]; P = .03). Algorithm test performance for identifying benign lesions in the intervention cohort resulted in a sensitivity of 91.6% (95% CI, 88.5%-94.8%), a specificity of 90.0% (95% CI, 76.9%-100%), a positive predictive value of 99.3% (95% CI, 98.3%-100%), and a negative predictive value of 41.9% (95% CI, 27.1%-56.6%). The proportion of misclassification in the intervention phase (malignant disease treated with ovary-sparing surgery) was 0.7%. Algorithm adherence during the intervention phase was 95.0%, with fidelity of 81.8%.
Conclusions and relevance: Unnecessary oophorectomies decreased with use of a preoperative risk stratification algorithm to identify lesions with a high likelihood of benign pathology that are appropriate for ovary-sparing surgery. Adoption of this algorithm might prevent unnecessary oophorectomy during adolescence and its lifelong consequences. Further studies are needed to determine barriers to algorithm adherence.